Influence of psychological factors on grip strength

Understanding individuals' perspectives and experiences of recovery following a proximal humerus fracture: an interpretive description

PURPOSE

Proximal humerus fractures are common in older adults and optimizing their outcomes following this injury can be challenging. This study explored recovery from the perspective of individuals who experience proximal humerus fracture.

MATERIALS AND METHODS

We conducted in-depth semi-structured interviews (n = 14) with participants (aged 45 and over) recruited from a hand clinic in London, Ontario using a purposive sampling technique. The exploratory interviews were audio-recorded, transcribed, and analyzed using interpretive description approach.

RESULTS

Four themes emerged from the narratives of individuals: challenges of day-to-day activities, coping as you go, recapturing valued life roles, and support matters.

CONCLUSIONS

Recovery after PHF seems relative to contexts and manifests within numerous scenarios. Based on individuals' narratives, the context produces a mosaic that contributes to unique recovery perception and experience. Awareness of the context emphasizes the complexity inherent in recovery and may guide healthcare professionals' efforts toward care for their patients.IMPLICATIONS FOR REHABILITATIONIndividuals with proximal humerus fracture experience recovery as a personal and dynamic process occurring in their diverse contexts.Healthcare professionals need to recognize the significant impact of context on individuals' physical, emotional, and social life following proximal humerus fracture (PHF).A multidisciplinary treatment plan might be desirable where people with PHF and health care professionals collaborate as a whole.Building a multidisciplinary health team including healthcare professionals, peer support, and case management may remove some barriers and facilitate the transition to recovery.

Factors Which Predict Adverse Outcomes in Anterior Cervical Discectomy and Fusion Procedures in the Nonelderly Adult Population

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

The largest published cohort of anterior cervical discectomy and fusion (ACDF) patients was queried to better characterize demographic and operative factors that predict 90-day complication and 2-year reoperation risk.

SUMMARY OF BACKGROUND DATA

The MarketScan Database was queried from 2007 to 2016 to identify adult patients until 65 years, who underwent an ACDF procedure using International Classification of Diseases 9th Version (ICD-9) and Current Procedural Terminology (CPT) codes. MarketScan is a national insurance claims database that contains millions of patient records across all 50 states.

METHODS

Multivariate logistic regression was used to identify factors associated with complications until 90 days and reoperations until 2 years.

RESULTS

Of 138,839 ACDF procedures, 8500 patients (6.1%) experienced a complication within 90 days of the ACDF, and 7433 (5.4%) underwent surgical revision by 2 years. While the use of anterior cervical plating did not predict 2-year reoperation, it was associated with dramatically reduced 90-day complication risk (adjusted odds ratio [aOR]: 0.32; 95% confidence interval [CI]: 0.30-0.34; P <0.001). Upon multivariate analysis, female sex (aOR: 0.83; 95% CI: 0.79-0.87; P <0.001) was associated with decreased risk of 2-year reoperation, while depression predicted a 50% increase in reoperation risk (aOR: 1.51; 95% CI: 1.43-1.59; P <0.001). The single largest factor associated with reoperation risk, however, was the presence of a 90-day postoperative complication (aOR: 1.79; 95% CI: 1.66-1.94; P <0.001).

CONCLUSION

Increased patient comorbidities and the use of bone morphogenic protein were found to increase the risk for postoperative complications, while cervical plating was associated with a strong decline in this risk. In addition, poor patient mental health outweighed the adverse of impact of other comorbidities on 2-year revision risk. The presence of a postoperative complication was the key modifiable risk factor associated with reoperation risk. Conclusions from this study may help surgeons better identify high-risk ACDF patients for more careful patient selection, counseling, informed consent, and management.

Association of psychological factors with limb disability in patients with cervical radiculopathy: comparison with carpal tunnel syndrome

Background

Regarding musculoskeletal conditions, patient’s psychological distress, are shown to be associated with higher disability. Cervical radiculopathy (CR) and carpal tunnel syndrome (CTS), are two conditions caused by entrapment of cervical nerve roots and carpal median nerve, respectively. This study aims to investigate the association of psychological factors including depression, anxiety, and pain catastrophizing, with measures of upper limb patient-reported and performance-based disability, in patients with CR, and compare the obtained results with our similar study on CTS.

Methods

In a cross-sectional study, we recruited 92 patients with CR, and investigated their disability level using patient-reported questionnaires (Quick Disabilities of the Arm, Shoulder and Hand (DASH) and pain Likert Scale) and by measuring grip and pinch strength. We also assessed their psychological status with Hospital Anxiety and Depression Scale questionnaire for depression (HADS-D) and anxiety (HADS-A) and also Pain Catastrophizing Scale (PCS) tools. We performed correlational coefficient analysis between disability and psychological scores and regression analysis of dependent variables (Pain, DASH, grip and pinch scores) and independent (psychological) variables. Finally, Z observed value was calculated to compare correlational coefficients between two diseases of CTS and CR.

Results

The results of the correlational coefficient analysis indicate that all three HADS-A, HADS-D and PCS scores correlated with DASH score (r = 0.49, 0.37, 0.38 for HADS-A, HADS-D and PCS, respectively; p < 0.001 for all three). HADS-A also significantly correlated with VAS pain score (r = 0.41, P < 0.001) and grip strength (r = − 0.25, P = 0.016). Linear regression analysis revealed that anxiety has a notable value for DASH and VAS pain scores as well as grip strength. Fisher’s r correlation coefficient to z transformation, revealed that there was no difference between two diseases of CTS and CR in terms of the resulted r coefficients from correlational coefficient analysis between disability and psychological distress.

Conclusion

It is concluded that psychological disorders are associated with disability in CR patients, with anxiety also correlating with objective disability parameter of grip strength. Finally, both CTS and CR patients’ disabilities associate with anxiety, depression, and catastrophysing thinking in a similar manner.

Level of evidence

Level IV (cross-sectional study).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05593-2.

The Association Between Psychological Factors and Outcomes After Distal Radius Fracture

PURPOSE

The aim of this study was to identify psychological factors associated with pain intensity and disability following distal radius fracture.

METHODS

We prospectively followed 216 adult patients with distal radius fracture for 9 months. Demographics, injury and treatment details, and psychological measures (Hospital Anxiety and Depression Score [HADS], Pain Catastrophizing Scale, Posttraumatic Stress Disorder Checklist-Civilian, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire Brief [IPQB], General Self-Efficacy Scale, and Recovery Locus of Control [RLOC]) were collected at enrollment. Multivariable linear regression was used to identify factors associated with Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Likert pain scores.

RESULTS

Higher 10-week DASH scores were associated with increased age, the presence of a nerve pathology, increased HADS Depression subscale scores, increased IPQB scores, and lower RLOC scores. Higher 9-month DASH scores were associated with increased age, increased deprivation scores, increased numbers of medical comorbidities, a greater degree of radial shortening, increased HADS Depression subscale scores, and lower RLOC scores. A higher 10-week pain score was associated with increased deprivation and IPQB scores. A higher pain score at 9 months was associated with an increased number of medical comorbidities.

CONCLUSIONS

Psychosocial factors measured early after fracture are associated with pain and disability up to 9 months after distal radius fracture. Illness perception is a potentially modifiable psychological construct not previously studied in hand conditions. It may provide a suitable target for psychological interventions that could enhance recovery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Normative Static Grip Strength of Saudi Arabia's Population and Influences of Numerous Factors on Grip Strength

Most daily tasks require exerting static grip strength which can be challenging for the elderly as their strength diminishes with age. Moreover, normative static grip strength data are important in ergonomics and clinical settings. The goal of this study is to present the gender, age-specific, hand-specific, and body-mass-index-specific handgrip strength reference of Saudi males and females in order to describe the population's occupational demand and to compare them with the international standards. The secondary objective is to investigate the effects of gender, age group, hand area, and body mass index on the grip strength. A sample of 297 (146 male and 151 female) volunteers aged between 18 and 70 with different occupations participated in the study. Grip strength data were collected using a Jamar dynamometer with standard test position, protocol, and instructions. The mean maximum voluntary grip strength values for males were 38.71 kg and 22.01 kg, respectively. There was a curvilinear relationship of grip strength to age; significant differences between genders, hand area, and some age groups; and a correlation to hand dimensions depending on the gender.

Effects of attentional bias modification on chronic low back pain in older outpatients: A randomized crossover trial (pilot study)

OBJECTIVES

In the present study, the effect of attentional bias modification (ABM) on older outpatients, with chronic low back pain, was examined.

DESIGN

This was a single-center, randomized, single-blinded, crossover trial and patients were randomly divided in a 1:1 allocation ratio into two groups: an ABM Leading group and an ABM Trailing group.

PARTICIPANTS

Forty-three outpatients with chronic low back pain participated.

INTERVENTIONS

Patients were evaluated four times and the treatments were ABM + Normal intervention or Normal intervention only.

OUTCOMES

Outcome measures included pain intensity on the Numerical Rating Scale, the Pain Catastrophizing Scale, Fear-Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Somatic Symptom Scale-8, and EuroQol 5 Dimension-3 levels questionnaire. In addition, we performed the 30-second Chair-Stand test and the Timed Up & Go test for physical function evaluations.

RESULTS

There was no change in pain intensity due to ABM. However, the total Pain Catastrophizing Scale score was significantly decreased, and the EuroQol 5 Dimension-3 levels questionnaire and 30-second chair-stand test were significantly improved (P <.05).

TRIAL REGISTRATION

The Health Science Ethics Committee, Graduate School of Biomedical Sciences, Nagasaki University (permit number: 17060861), and the clinical trial was registered with UMIN (UMIN000029424).

The Ability of Upper Extremity Surgeons to Assess Patient's Functional Status

PURPOSE

To compare surgeon and patient assessment of upper extremity functional status at the time of initial consultation. We hypothesized that surgeons and patients demonstrate low levels of agreement with respect to assessing pain scores, functional status, and self-efficacy.

METHODS

One hundred forty-three consecutive new patients were evaluated by 1 of 5 fellowship-trained upper extremity surgeons. Patients completed a Numeric Pain Rating Scale as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Pain Interference (PI), and Self-Efficacy (SE) instruments. Surgeons provided their own estimates of patient function on each questionnaire at the conclusion of the visit and were blinded to the results of the patient-reported outcome measures (PROMs) for the duration of the study. Estimation errors, which represent the absolute value of the difference between the patient's actual score and the surgeon's estimated score on each questionnaire, were calculated for each questionnaire.

RESULTS

As a group, surgeons assumed that the PROMIS UE and SE scores were higher than the patients' actual scores and assumed that patients had lower PROMIS PI scores than were actually reported. Mean estimation errors for all PROMIS instruments were greater than 10 points and larger than the SD for these instruments in the general population.

CONCLUSIONS

Upper extremity surgeons demonstrate difficulty assessing their patient's self-reported functional status, pain interference, and level of self-efficacy during initial consultations.

CLINICAL RELEVANCE

Although formalized PROMs are infrequently administered in orthopedic clinics, increased utilization of these questionnaires would allow for a more accurate baseline functional assessment. When evaluating new patients in the outpatient clinic, surgeons should recognize the potential limitations of their assessments of patient-reported function.

Association of depression with malnutrition, grip strength and impaired cognitive function among senior trauma patients

BACKGROUND

Depression is common among senior adults, yet understudied among trauma patients. The purpose of this study was to assess the prevalence of depressive symptoms among seniors hospitalized in acute trauma care, to compare patients with depressive symptoms vs. those without, and to evaluate whether depression symptoms affects discharge destination.

METHODS

This cross-sectional and prospective analysis was conducted among community-dwelling patients ≥70 years old, hospitalized at the Senior Trauma Center of the University Hospital Zurich, Switzerland. We used the Geriatric Depression Scale (GDS-15) to assess presence of depressive symptoms. Using a cutoff value of 5 points, we compared age- and gender-adjusted characteristics of patients with and without depressive symptoms. Multinomial logistic regression models were used to estimate the odds of returning home vs. not adjusting for age, gender, nutritional status, cognitive function and others.

RESULTS

Of the 273 seniors enrolled, 104 (38.1%) were men and the mean age was 79.4 (SD = 6.5) years. We identified 52 (19.0%) patients with depressive symptoms. These patients were more likely to be older (p = 0.04), at risk for malnutrition (p<0.0001), at least pre-frail (p = 0.005), and have decreased cognitive function (p = 0.001). They were also more than twice as likely to be discharged to acute geriatric care compared to home (OR = 2.28 (CI = 1.12-4.68)).

LIMITATIONS

Depressive symptoms were assessed during acute care without data before hospitalization.

CONCLUSIONS

Senior trauma patients with depressive symptoms during acute care were more likely to be at higher risk of malnutrition, have cognitive decline and are more likely to receive additional geriatric care.

The Effects of Industrial Protective Gloves and Hand Skin Temperatures on Hand Grip Strength and Discomfort Rating

Daily working activities and functions require a high contribution of hand and forearm muscles in executing grip force. To study the effects of wearing different gloves on grip strength, under a variety of hand skin temperatures, an assessment of the maximum grip strength was performed with 32 healthy male workers with a mean age (standard deviation) of 30.44 (5.35) years wearing five industrial gloves at three hand skin temperatures. Their ages and anthropometric characteristics including body mass index (BMI), hand length, hand width, hand depth, hand palm, and wrist circumference were measured. The hand was exposed to different bath temperatures (5 °C, 25 °C, and 45 °C) and hand grip strength was measured using a Jamar hydraulic hand dynamometer with and without wearing the gloves (chemical protection glove, rubber insulating glove, anti-vibration impact glove, cotton yarn knitted glove, and RY-WG002 working glove). The data were analyzed using the Shapiro-Wilk test, Pearson correlation coefficient, Tukey test, and analysis of variance (ANOVA) of the within-subject design analysis. The results showed that wearing gloves significantly affected the maximum grip strength. Wearing the RY-WG002 working glove produced a greater reduction on the maximum grip when compared with the bare hand, while low temperatures (5 °C) had a significant influence on grip when compared to medium (25 °C) and high (45 °C) hand skin temperatures. In addition, participants felt more discomfort in both environmental extreme conditions. Furthermore, they reported more discomfort while wearing neoprene, rubber, and RY-WG002 working gloves.

The Effect of Priming With Questionnaire Content on Grip Strength in Patients With Hand and Upper Extremity Illness

BACKGROUND

Grip strength is a performance-based measure of upper extremity function that might be influenced by priming (the influence of a response to a stimulus by exposure to another stimulus). This study addressed the influence of questionnaire content on performance measurements such as grip strength between patients who complete the standard Pain Catastrophizing Scale (PCS) compared with patients who complete a positively adjusted PCS.

METHODS

Between June 2015 and August 2015, we enrolled 122 patients who presented to 3 hand surgeons at 3 outpatient offices. They were randomized to 2 groups: the control group, which completed the PCS, and the intervention group, which completed a positively phrased version of the PCS. Before and after completion of the questionnaire, we measured each patient's grip strength 3 times by alternating between hands. Two patients were excluded after participation. We calculated both the preintervention and postintervention mean and maximum grip strengths.

RESULTS

There was no significant difference between groups on mean or maximum grip strength before completion of the questionnaires. There was a greater improvement in mean grip strength of both hands in the intervention group compared with the PCS group. This improvement was statistically significant in the affected hand. The maximum grip strength showed a statistically significant greater improvement in both hands in the positive PCS group compared with the control group.

CONCLUSIONS

Positive priming through a questionnaire leads to an increase in mean and maximum grip strength when compared with the standard questionnaire that uses negative terms rather than positive.

Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors

BACKGROUND

Hand-grip strength (HGS) serves as a proxy measure for muscle function and physical health. Studies have shown that low HGS is associated with common age-related disorders including frailty and sarcopenia. The aim of the present study was to establish the normative values of HGS among older adults in Singapore and to compare it with data from Western and other Asian countries. The study also aimed to explore the sociodemographic and anthropometric correlates of HGS.

METHODS

Data were collected from 2043 men and women aged 60 years and above who took part in the Well-being of the Singapore Elderly study in 2013. HGS was obtained using a Jamar Plus + digital hand dynamometer. Normative data were stratified by; 5-year age groups, sex and ethnicity. Relationships between the HGS with various sociodemographic and anthropometric correlates were examined using multiple linear regression analysis.

RESULTS

The mean HGS demonstrate a decreasing trend with increased age across all ethnic groups and sexes. HGS among Singapore older adults were relatively low compared to Western and other Asian countries. Males in the youngest age group (60-64) and of Chinese ethnicity attained greater HGS values than their counterparts. When the regression analysis was stratified for sex, significant associations were found between height, upper arm circumference with HGS in the males sample, and between height, weight, waist circumference and HGS in the females sample.

CONCLUSIONS

Older adults in Singapore have a relatively weak HGS compared to other countries. Greater height and weight, and smaller waist circumference are independently associated with greater HGS in females but not males. These results facilitate the interpretation of HGS conducting using Jamar digital-type dynamometers among the older adults in Singapore.

Associations of Blood Cadmium Levels With Depression and Lower Handgrip Strength in a Community-Dwelling Elderly Population: A Repeated-Measures Panel Study

BACKGROUND

Although biologically plausible, few studies have linked cadmium exposure to depression or muscle strength. Herein, we hypothesized that blood cadmium concentrations are associated with depression and lower handgrip strength in a community-dwelling elderly population.

METHODS

Data from 983 elderly participants who completed up to 3 surveys between 2012 and 2015 were analyzed. At every survey, we assessed depressive status using the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K) and measured handgrip strength and blood cadmium levels (mean, 1.24 μg/L). We evaluated the associations of cadmium with depression using generalized linear mixed models, and handgrip strength using linear mixed models. All models were adjusted for sociodemographic factors, lifestyle factors including active and passive smoking, weight, height, and comorbidity status.

RESULTS

Interquartile-range increase (0.645 μg/L) in blood cadmium levels was associated with depression defined as SGDS-K score ≥8 (odds ratio = 1.27, 95% confidence interval: 1.06, 1.52) and lower handgrip strength (right hand: β = -0.40, 95% confidence interval: -0.75, -0.09; left hand: β = -0.36, 95% confidence interval: -0.69, -0.04). The association between cadmium levels and handgrip strength was robust after further adjustment for depressive status, although it attenuated in size by 14.7%-18.0%.

CONCLUSIONS

After adjusting for potential confounders, blood cadmium concentrations were associated with depression and lower handgrip strength in an elderly population. The participants' depressive status partially mediated the association between cadmium levels and handgrip strength.

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

BACKGROUND

Patients with hand fractures often have pain, swelling, and stiffness in the joints of the hand, which may lead them to protect their hands, resulting in more stiffness and in delayed recovery. However, the effects of pain-coping strategies and catastrophization (the tendency to expect the worst to occur when pain is present, an approach that can be thought of as the opposite of "coping") on functional recovery after hand fractures have not been investigated in depth.

QUESTIONS/PURPOSES

Are preoperative catastrophization and anxiety in patients with hand fractures associated with (1) decreased grip strength; (2) decreased range of motion; and (3) increased disability at 3 and 6 months after surgical treatment for a hand fracture? Secondarily, we asked if there are other patient and injury factors that are associated with these outcomes at 3 and 6 months.

METHODS

A total of 93 patients with surgically treated hand fractures were enrolled in this prospective study. Preoperative assessments measured coping strategies evaluated by measuring catastrophic thinking with the Pain Catastrophizing Scale and pain anxiety with the Pain Anxiety Symptom Scale. At 3 and 6 months postoperatively, grip strength, total active range of motion, and disability (Quick Disabilities of the Arm, Shoulder, and Hand score) were assessed. Bivariate and multivariate analyses were performed to identify patient demographic, injury, and coping skills factors that accounted for outcomes of strength, motion, and disability.

RESULTS

Decreased grip strength was associated with catastrophic thinking (beta = -1.29 [95% confidence interval, -1.67 to -0.89], partial R(2) = 11%, p < 0.001) and anxiety (beta = -0.83 [-1.16 to -0.50], partial R(2) = 7%, p = 0.007) at 3 months, but by 6 months, only anxiety (beta = -0.74 [-1.04 to -0.44], partial R(2) = 7%, p = 0.010) remained an important factor. Decreased total active range of motion was associated with pain catastrophizing (beta = -0.63 [-0.90 to -0.36], partial R(2) = 6 %, p = 0.024) and anxiety (beta = -0.28 [-0.42 to -0.14], partial R(2) = 3%, p = 0.035) at 3 months but not at 6 months. Similarly, increased disability was associated with pain catastrophizing (beta = 1.09 [1.39-0.79], partial R(2) = 12%, p < 0.001) and anxiety (beta = 0.93 [1.21-0.65], partial R(2) = 11%, p = 0.001) at 3 months; these factors failed to be associated for 6-month outcomes.

CONCLUSIONS

Preoperative poor coping skills as measured by high catastrophization and anxiety were associated with a weaker grip strength, decreased range of motion, and increased disability after surgical treatment for a hand fracture at 3 months. However, poor coping skills did not show persistent effects beyond 6 months. More research may be needed to show interventions to improve coping skills will enhance treatment outcome in patients after acute hand fractures.

LEVEL OF EVIDENCE

Level III, prognostic study.

"Bedside-to-Bench" Behavioral Outcomes in Animal Models of Pain: Beyond the Evaluation of Reflexes

Despite the myriad promising new targets and candidate analgesics recently identified in preclinical pain studies, little translation to novel pain medications has been generated. The pain phenotype in humans involves complex behavioral alterations, including changes in daily living activities and psychological disturbances. These behavioral changes are not reflected by the outcome measures traditionally used in rodents for preclinical pain testing, which are based on reflexes evoked by sensory stimuli of different types (mechanical, thermal or chemical). These measures do not evaluate the impact of the pain experience on the global behavior or disability of the animals, and therefore only consider a limited aspect of the pain phenotype. The development of relevant new outcomes indicative of pain to increase the validity of animal models of pain has been increasingly pursued over the past few years. The aim has been to translate “bedside-to-bench” outcomes from the human pain phenotype to rodents, in order to complement traditional pain outcomes by providing a closer and more realistic measure of clinical pain in rodents. This review summarizes and discusses the most important nonstandard outcomes for pain assessment in preclinical studies. The advantages and drawbacks of these techniques are considered, and their potential impact on the validation of potential analgesics is evaluated.

Cross-sectional and longitudinal associations between radiographic features and measures of pain and physical function in hand osteoarthritis

OBJECTIVE

Previous longitudinal studies have shown no associations between increasing amount of radiographic hand osteoarthritis (OA) and levels of hand pain/disability. In this longitudinal study, we aimed to study whether radiographic hand OA was related to pain/disability in cross-sectional and longitudinal settings focusing on joint-specific analyses.

METHODS

We included 190 patients (173 women, mean (standard deviation, SD) age 61.5 (5.7) years) from the Oslo hand OA cohort, of whom 112 had 7-year follow-up data. Finger joints were scored for radiographic OA according to the Kellgren-Lawrence scale and Osteoarthritis Research Society International (OARSI) atlas. Pain and function were assessed by clinical examination (joint tenderness), grip strength and the Australian/Canadian (AUSCAN) questionnaire. Associations between radiographic hand OA and tenderness in the same joint were examined by logistic regression analyses with Generalized Estimating Equations, whereas associations between overall amount of radiographic OA and hand pain/disability were assessed by linear regression (adjusted for age and sex).

RESULTS

A dose-dependent association was found between the severity of radiographic OA and tenderness in the same joint. Joints that progressed into severe radiographic OA during follow-up had the highest odds of developing tenderness (OR = 11, 95% confidence interval (CI) 4.0-33). Incident erosions seemed to be the most important individual feature associated with incident tenderness (OR = 6.2, 95% CI 3.2-12). Weak associations were found between the amount of radiographic hand OA and overall hand pain/disability.

CONCLUSION

Radiographic hand OA is associated with tenderness in the same joint, and erosive development strongly predicts future joint tenderness independent of other radiographic features.

Evaluation of vitamin D level and grip strength recovery in women with a distal radius fracture

PURPOSE

Vitamin D is known to contribute to muscular function. The purpose of this study was to determine whether the level of vitamin D is associated with grip strength recovery in women after a distal radius fracture.

METHODS

We analyzed grip strength recovery after a distal radius fracture in 70 women over age 50 years. We measured vitamin D levels and grip strength recovery, which we analyzed as a function of age, surgical care, baseline vitamin D level, vitamin D supplementation, wrist range of motion, pain level, and radiographic results at 6 months. We performed multivariate analysis to identify factors that independently predicted grip strength recovery at 6 months after injury.

RESULTS

Grip strength of affected hands averaged 65% of the contralateral sides (range, 25% to 100%) at 6 months after injury. We found no significant correlation between baseline vitamin D level and grip strength recovery. However, baseline vitamin D level correlated with the grip strengths of uninjured sides. Multivariate analysis indicated that younger age, vitamin D supplementation, and greater wrist range of motion were independently associated with better grip strength recovery at 6 months after injury.

CONCLUSIONS

This study demonstrated that in women with a distal radius fracture, baseline vitamin D level is not associated with grip strength recovery in the injured hand. However, baseline vitamin D level correlated with grip strength in the uninjured hand. In addition, vitamin D supplementation may help grip strength recovery in the injured hand. Further prospective, comparative studies are warranted to confirm the effect of vitamin D supplementation on grip strength recovery.

Association between individual DASH tasks and restricted wrist flexion and extension after volar plate fixation of a fracture of the distal radius

BACKGROUND

Symptoms and psychosocial factors are suggested to account for more of the variation in disability than physical impairment, but perhaps less so at the level of specific tasks. This study assessed the influence of impaired wrist motion on specific tasks on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

METHODS

Sixty-three patients with an operatively treated fracture of the distal radius completed the Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale, and Center for Epidemiologic Studies Depression Scale (CES-D) just before surgery and the DASH questionnaire 3 months after surgery. Nine questions on the DASH were selected as potentially sensitive to changes in wrist motion and evaluated in bivariate and multivariable analyses.

RESULTS

In multivariable models of factors associated with specific tasks, only "Open a tight or new jar" was affected by wrist flexion and PCS accounting for 33 % of the variation. Motion, pain, and PCS were significant predictors of the DASH score. Among the eight tasks not related to wrist motion, 33 % of the variation in disability with writing was accounted for by PCS and limb dominance; 20 % of disability preparing a meal by pain, CES-D, and PCS; 14 % of disability with making a bed by pain and CES-D; and 23 % of changing a light bulb overhead by age, pain, and fracture type.

CONCLUSIONS

After volar plate fixation of a fracture of the distal radius, upper extremity disability based on select items from the DASH questionnaire correlated minimally with impairment of wrist motion, even at the level of specific tasks.

LEVEL OF EVIDENCE

Prognostic Level II.

Evaluation of factors influencing grip strength in elderly koreans

Objectives

Grip strength has been used as a measure of function in various health-related conditions. Although grip strength is known to be affected by both physical and psychological factors, few studies have looked at those factors comprehensively in a population-based cohort regarding elderly Koreans. The aim of this study was to evaluate potential factors influencing grip strength in elderly Koreans.

Methods

We evaluated dominant hand grip strengths in 143 men and 123 women older than 65 years who participated in a population-based cohort study, the Korean Longitudinal Study on Health and Aging (KLoSHA). Individuals who had a history of surgery for musculoskeletal disease or trauma in the upper extremity were excluded. Factors assessed for potential association with grip strength were; 1) demographics such as age and gender, 2) body constructs such as height, body mass index (BMI), and bone mineral density (BMD), 3) upper extremity functional status using disabilities of the arm, shoulder and hand (DASH) scores, and 4) mental health status using a depression scale and the short form-36 (SF36) mental health score. Multivariate analyses were performed in order to identify factors independently associated with grip strength.

Results

Grip strengths of dominant hands in elderly Koreans were found to generally decrease with aging, and were significantly different between men and women, as expected. Multivariate analyses indicated that grip strength was independently associated with age, height and BMI in men (R² = 21.3%), and age and height (R² = 19.7%) in women. BMD, upper extremity functional status, or mental health status were not found to be associated with grip strength.

Conclusions

This study demonstrates that in elderly Koreans, grip strength is mainly influenced by age and height in both men and women, and additionally by BMI in men. BMD or self-reported physical or mental health status was not found to influence grip strength in elderly Koreans. This information may be helpful in future studies using grip strength as a measure of function in elderly Koreans.

Recovery from depressive symptoms over the course of physical therapy: a prospective cohort study of individuals with work-related orthopaedic injuries and symptoms of depression

STUDY DESIGN

Prospective cohort.

OBJECTIVES

(1) To determine the trajectory of depressive symptoms over the course of physical therapy, (2) to identify variables that best predict the resolution of depressive symptoms, and (3) to explore the relationship between recovery from depressive symptoms and long-term outcomes.

BACKGROUND

Twenty-five percent to 50% of patients referred to physical therapy for orthopaedic injuries suffer from symptoms of depression. Depressive symptoms have been identified as an influential risk factor for problematic response to physical therapy. Despite these findings, there is a dearth of research specifically exploring the trajectory and determinants of patients' depressive symptoms over the course of physical therapy, which has impeded the evidence-based management of patients with depressive symptoms.

METHODS

One hundred six patients with work-related musculoskeletal injuries and symptoms of depression received 7 weeks of physical therapy and were followed 1 year after treatment onset. Pain intensity, depressive symptoms, and other psychosocial factors were evaluated throughout treatment, and data were collected at 1-year follow-up.

RESULTS

Depressive symptoms resolved in 40% of patients, and resolution was linked to pain and disability at 1-year follow-up. Persistence of depressive symptoms at treatment completion was predicted by elevated levels of depressive symptoms and pain catastrophizing at pretreatment, and by lack of improvement in levels of depressive symptoms and pain self-efficacy at midtreatment.

CONCLUSION

For many patients, depressive symptoms resolve over the course of physical therapy, and resolution is associated with long-term improvements in pain and disability. These findings will help identify patients whose depressive symptoms are least likely to respond to physical therapy and may therefore warrant additional treatment.

Determinants of grip strength in healthy subjects compared to that in patients recovering from a distal radius fracture

PURPOSE

Grip strength is influenced primarily by body mass index, sex, and age. It is also partly voluntary and correlates with symptoms of depression. This study examined whether psychological factors influence grip more in the setting of injury than in healthy volunteers.

METHODS

Grip strength was evaluated in one hundred subjects, 50 healthy individuals and 50 patients 6 weeks after a nonsurgically treated fracture of the distal radius. Grip strength was measured as the mean of 3 attempts, and patients completed questionnaires for arm-specific disability (Disabilities of the Arm, Shoulder, and Hand), depression, pain anxiety, catastrophic thinking, and negative thoughts in response to pain.

RESULTS

The mean grip strength in the injured group was 55% of the uninjured side. Pain anxiety accounted for 9% of the variability in grip strength in injured wrists. Among healthy patients, sex was the only correlate of dominant-side grip strength, and body mass index accounted for 8% of the variation in the grip strength of the nondominant side divided by the dominant side.

CONCLUSIONS

The majority of the variation in grip strength remains unaccounted for, but physical factors correlate best with grip strength and percent grip strength of the nondominant side divided by the dominant side in healthy patients, and psychological factors correlate best with absolute grip in patients recovering from distal radius fractures.

CLINICAL RELEVANCE

The influences on grip strength are complex, but the differences among recovering and healthy patients demonstrate a role for nonphysical factors in grip strength during recovery.

Objective physical functioning in patients with depressive and/or anxiety disorders

BACKGROUND

Poorer physical function in patients with depressive or anxiety disorders has been reported, but is often measured by self-reports which may be biased by mood. This study examined the association between depression and anxiety and physical function using objective measures in a large cohort, and investigated which psychiatric characteristics are associated with physical function.

METHODS

Baseline data from the Netherlands Study of Depression and Anxiety were used, including persons with current depressive and/or anxiety disorders (n = 1629) and healthy controls without lifetime diagnoses (n = 629). Psychiatric characteristics studied included type of disorder, duration, severity, age of onset, and antidepressant use. Hand grip strength and lung function were used as general objective measurements of physical function.

RESULTS

Women with depressive or anxiety disorders had significantly poorer physical function - both lower grip strength and lung function - compared to healthy controls, especially those with a late age of onset (≥ 40 years). Poorer lung function was present among the women using antidepressants, those with higher symptom severity, and those with depression compared to anxiety disorder. In men, depressive or anxiety disorder was associated with better lung function but not with hand grip strength.

LIMITATIONS

Due to the cross-sectional design no causal relationships could be established.

CONCLUSIONS

In women, depressive or anxiety disorders were associated with objective indicators of poorer physical function. Since this association was most pronounced for later onset disorders, it suggests a larger role of physical function in depressive and anxiety disorders at later age.

Five-position grip strength measures in individuals with clinical depression

STUDY DESIGN

Case-control study.

OBJECTIVES

To compare the results of 5-position grip strength testing between a group of individuals newly diagnosed with clinical depression and a group of age-matched and sex-matched individuals without depression.

BACKGROUND

Clinicians often employ 5-position (or 5-rung) grip strength dynamometry as a measure of sincerity of effort. However, patients with clinical depression are known to show altered performance on motor skill tests. Therefore, the results of 5-position grip strength dynamometry in the clinically depressed may be subject to misinterpretation.

METHODS

Consecutive patients newly diagnosed with clinical depression (n = 45) and age- and sex-matched individuals without clinical depression (n = 45) were recruited over a 3-month period. Each group underwent identical 5-position grip strength testing of both hands. Measures were analyzed using a statistical analysis method based on an 8.5-lb (3.83-kg) SD cutoff and visual analysis of force curve plots by clinicians naïve to the participants' diagnosis.

RESULTS

Participants with clinical depression had an SD equal to or less than 8.5 lb in 60 of 90 hands tested, while the participants in the control group had an SD equal to or less than 8.5 lb in 1 of 90 hands. Clinicians who analyzed force plots considered participants with depression to have exerted "limited effort" in 70% of cases and those who were not depressed to have exerted limited effort in 18% of cases.

CONCLUSION

A high percentage of individuals diagnosed with clinical depression produced statistical and graphical representations of 5-position grip strength measures that suggested poor volitional effort, which is often interpreted as lack of sincerity of effort. Clinicians unaware of the presence of clinical depression in patients could misinterpret the results of 5-position grip strength testing in this population.

The implications of chronic pain models for rehabilitation of distal radius fracture

Distal radius fracture (DRF) is the most common fracture and usually occurs as a result of a fall. Most patients recover following DRF with minimal residual pain or disability; however, a small subset of patients continue to experience pain and disability even one year after the injury. Currently, there are no practice guidelines for early identification and treatment of patients who are potentially at greater risk of developing these adverse outcomes. As a result, hand therapy management of patients following DRF does not incorporate screening of these at-risk patients. The objective of this paper is to apply constructs from learned helplessness and cognitive-behavioural models of chronic pain in assessing the psychosocial risk profile of patients following DRF. We have also integrated key findings derived from studies addressing personal and life-style factors in assessing this risk profile. This framework is proposed as a basis to categorize patients as higher or lower psychosocial risk for developing chronic pain and disability following DRF. We outline a model depicting the RACE approach (Reducing pain, Activating, Cognitive reshaping, Empowering) towards the management of patients following DRF. The model suggests that patients with minimal psychosocial risk factors are managed based on their injury profile and those with higher psychosocial risk are treated with the risk-based RACE approach. Using a biopsychosocial RACE approach to prognosis and treatment, hand therapy intervention can be customized for patients recovering from DRF. In future, researchers can conduct clinical trials to compare the RACE-based treatment approach to routine hand therapy in mitigating the risk of chronic pain and disability in patients with elevated risk profile for adverse outcomes following DRF.

Prediction of grip and key pinch strength in 978 healthy subjects

BACKGROUND

Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the predictive power of cofactors and to predict population-based normative grip and pinch strength.

METHODS

A representative population survey was used as the basis for prediction analyses (n = 978). Bivariate relationships between grip/pinch strengths of the dominate hand were explored by means of all relevant mathematical functions to maximize prediction. The resulting best functions were combined into a multivariate regression.

RESULTS

Polynoms (up to the third degree) were the best predictive functions. On the bivariate level, height was best correlated to grip (46.2% explained variance) and pinch strength (37.7% explained variance) in a linear relationship, followed by sex, age, weight, and occupational demand on the hand. Multivariate regression provided predicted values close to the empirical ones explaining 76.6% of the variance for grip strength and 67.7% for pinch strength.

CONCLUSION

The five easy-to-measure cofactors sex, age, body height, categorized occupational demand on the hand, and body weight provide a highly accurate prediction of normative grip and pinch strength.

Predicting pain and disability in patients with hand fractures: comparing pain anxiety, anxiety sensitivity and pain catastrophizing

There is a range of anxiety-related constructs associated with pain and pain-related disability. Those most often examined are pain catastrophizing, pain anxiety and anxiety sensitivity. All three are conceptualized to be important in the development and maintenance of chronic pain, and are included within fear avoidance models. Surprisingly these constructs are not routinely examined together, and when they are, have been investigated in healthy individuals using experimental techniques or patients with chronic conditions. Although these constructs are also thought to be important in acute clinical pain, they tend not to been examined together in the same study. The focus of the current research was therefore to examine these three anxiety-related constructs in an acute pain setting, and examine their relative influence on both pain and pain-related functional disability. Participants were 82 patients with a hand fracture, recruited from a fracture clinic at a general hospital. They completed a battery of measures related to anxiety, pain and disability. Once controlling for injury-related variables, catastrophizing was found to predict current pain, pain-related anxiety predicted task-related pain, whereas anxiety sensitivity was (negatively) associated with disability. These findings are discussed in light of the relative role that these anxiety-related constructs have in pain and disability, as well as implications for future research.