Dexter: a tool to facilitate impairment ratings

A test case: does the availability of visual feedback impact grip strength scores when using a digital dynamometer?

A cross-sectional, quantitative study of clinical measurement utility. New technological advances can challenge the efficacy of even the most widely accepted and respected tests. For example, grip strength instruments offer digital or computerized displays, precision scoring, and varied interfaces that differ from traditional Jamar™ dynamometers (Lafayette, IN). This test case explores how the opportunity to view grip strength scores during testing can influence outcomes. One hundred forty-six healthy subjects, aged 18-24 years, were tested for grip strength under visual feedback and no visual feedback conditions, using the JTech Grip Dynamometer (Salt Lake City, UT). Participants achieved a small, yet statistically significant, 1.74 lb stronger grip score with visual feedback (p<0.002). The order of grip testing conditions yielded no statistically significant differences (p=0.559). These findings suggest the need to consider how new features, unavailable with the analog Jamar™ dynamometer and unaccounted for in existing clinical guidelines could potentially influence grip scores.

LEVEL OF EVIDENCE

Not applicable.

Combat casualty hand burns: evaluating impairment and disability during recovery

This study evaluated the use of the American Medical Association (AMA) impairment guides and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in U.S. military casualties recovering from burn injury to the hand. Study sample included patients with burns to at least one hand and complete evaluations of impairment and disability upon discharge from the hospital and at a follow-up visit less than four months later. AMA and DASH scores were calculated for each visit and standardized response means (SRMs) were calculated to indicate responsiveness. Correlation between impairment and disability was assessed at discharge and follow-up and scores were examined for ability to discriminate between casualties returned to duty (RTD) and casualties not returned to duty (N-RTD). Both outcome instruments revealed a statistically significant change in scores between visits (p<0.001) with corresponding SRM indexes greater than 0.8 (large effect). There was a moderate correlation (r=0.50) between impairment and disability at discharge and a moderately high correlation (r=0.74) at follow-up. Both AMA and DASH scores clearly discriminated between casualties RTD (AMA 10+/-10 and DASH 12+/-12) and casualties N-RTD (AMA 39+/-19 and DASH 41+/-17) with improved accuracy at follow-up visit. The AMA and DASH can provide a comprehensive assessment of impairment and disability and may be used to detect changes in patient health status over time while clearly discriminating between RTD and N-RTD in combat casualties recovering from burn injury to the hand(s).

Thermal and electrical injuries

Through progress in wound management, resuscitation, intensive care treatment, and a coordinated rehabilitation process, modern burn care has been able to deliver substantial increases in survival and improvement in functional outcomes for burn victims. The development of regionalized burn centers has contributed greatly to this progress. As the field of burns matures, burn centers are preparing to meet future challenges through collaborative efforts in disaster management and outcomes research.