Do Impairments Predict Hand Dexterity After Distal Radius Fractures? A 6-Month Prospective Cohort Study

Patient-Reported Outcomes Can Serve as a Functional Substitute for Grip Strength

Background  Grip strength has traditionally been seen as an objective measurement of hand function, while the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) has emerged recently as a common patient-reported outcome metric for similar purposes. The primary objective of this study was to determine if a correlation exists between grip strength, PROMIS UE, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores in hand and upper extremity clinic patients. Methods  PROMIS UE, Pain Interference (PI), and Depression (D), as well as QuickDASH were prospectively administered to patients from July 16 to September 3, 2020. A grip strength ratio (GSR), calculated by dividing the grip strength of the injured hand by that of the noninjured hand, was recorded for each individual to control for personal differences in grip strength. Data were analyzed using Spearman's correlation coefficients with the significance level at p  < 0.05. Results  Fifty patients participated in this study. The median GSR was 0.55. QuickDASH demonstrated strong correlations with both PROMIS UE and PI ( r (48) = -0.81, p  < 0.05; r (48) = 0.86, p  < 0.05). GSR correlated moderately with PROMIS UE ( r (48) = 0.63, p  < 0.05). Finally, GSR and QuickDASH also exhibited moderate correlation with each other ( r (48) = -0.62, p  < 0.05). Conclusion  PROMIS UE and QuickDASH are shown to correlate moderately with GSR. This suggests the PROMIS UE forms as an effective measure of hand/wrist function in hand clinic patients and may be substituted for grip strength measurements.

Distal Radius Fracture Rehabilitation

Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.

Managing patient expectations about recovery after a distal radius fracture based on patient reported outcomes

INTRODUCTION

PROMs are increasingly used by clinicians to evaluate recovery after distal radius fractures, but can also be used as benchmark data to help patients managing their expectations about recovery after DRF.

PURPOSE OF THE STUDY

The study aimed to determine the general course of patient-reported functional recovery and complaints during 1 year after a DRF, depending on fracture type and age. The study aimed to determine the general course of patient-reported functional recovery and complaints during one year after a DRF, depending on fracture type and age.

METHODS

Retrospectively analyzed PROMs of 326 patients with DRF from a prospective cohort at baseline and at 6, 12, 26 and 52 weeks included PRWHE questionnaire for measuring functional outcome, VAS for pain during movement, and items of the DASH for measuring complaints (tingling, weakness, stiffness) and limitations in work and daily activities. The effect of age and fracture type on outcomes were assessed using repeated measures analysis.

RESULTS

PRWHE scores after one year were on average 5.4 points higher compared to the patients' pre-fracture scores. Patients with type B DRF had significantly better function and less pain than those with types A or C at every time point. After six months, more than 80% of the patients reported mild or no pain. Tingling, weakness or stiffness were reported by 55-60% of the overall cohort after six weeks, while 10-15% had persisting complaints at one year. Older patients reported worse function and more pain, complaints and limitations.

CONCLUSIONS

Functional recovery after a DRF is predictable in time with functional outcome scores after one-year follow-up that are similar to pre-fracture values. Some outcomes after DRF differ between age and fracture type groups.

Severity of persistent pain and disability can accurately screen for presence of pain catastrophizing and fear of performing wrist movements in individuals with distal radius fracture

BACKGROUND

The evidence indicating presence of psychological factors concerns in individuals who report persistent residual pain and disability over a longer term after distal radius fractures (DRF) is emerging but requires further inquiry.

OBJECTIVES

To examine the associations of persistent wrist pain and disability at 6-months after DRF with the presence of psychological factors.

METHODS

Eighty-five patients with DRF were evaluated for wrist pain and disability with subscales of Patient-rated wrist evaluation (PRWE), 6-months after the fracture. The associations of wrist pain and disability with these psychological factors at 6-months after DRF were examined using multivariable logistic regression models. The ability of PRWE scores at 6-months after DRF to accurately classify individuals with and without these psychological factors was examined using the area under the receiver operating characteristic curve (AUC).

RESULTS

Higher PRWE-P scores were significantly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. In addition, higher PRWE-F scores were also highly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. The PRWE-P or PRWE-F Scores of ≥18/50 showed the best combination of sensitivity and specificity in identifying individuals with pain catastrophizing, emotional distress, and fear of performing wrist movements at 6-months after DRF (AUC values of ≥0.88).

CONCLUSION

The novel finding of this study is that scores of ≥18/50 PRWE-P or PRWEF can be used to screen for the presence of these psychological factors.

Evaluation of individual finger forces during activities of daily living in healthy individuals and those with hand arthritis

INTRODUCTION

Measuring finger forces during activities of daily living and how these forces change for individuals with pathologies such as arthritis is valuable to our understanding of hand function.

PURPOSE OF THE STUDY

The purpose of this study was to determine the forces of individual fingers during the performance of daily activities in healthy participants and determine the envelope of these applied forces.

METHODS

This is a cross-sectional study investigating twenty-five healthy participants (12 female: 22-65 years old and 13 male: 20-53 years old) and participants with osteoarthritis (12 female: 52-79 years old and 9 male: 64-79 years old) examined at one time point. The force sensors were calibrated for each individual using a load cell to provide force output in Newtons. Each participant performed 19 activities of daily living two times. Force was plotted over time for each task, and the maximum force in each finger during that task was evaluated.

RESULTS

The range of applied forces was 1.4 ± 0.6 N to 34.8 ± 1.6 N for healthy participants and 2.3 ± 1.0 N to 30.7 ± 3.7 N for those with osteoarthritis.

DISCUSSION

Sensors allowed for real-time monitoring of finger forces during tasks of daily life. This provides the opportunity to isolate hand grips based on finger recruitment and provide information about the magnitude of forces during the activity.

CONCLUSION

Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions.

Ulnar Styloid Fracture Accompanying Distal Radius Fracture Does Not Affect Hand Function, but What About Hand Dexterity?

Introduction  Hand dexterity is not addressed in patients with distal radius fracture (DRF) accompanied with ulnar styloid fracture (USF) in literature. This study aimed to determine whether an associated USF following a DRF has any effect on hand dexterity. Materials and Methods  Patients diagnosed with DRF were included in the study and were divided into two groups according to the USF presence (USF group and non-USF group). Pain, range of motion, Quick-DASH (Quick-Disabilities of the Arm, Shoulder, and Hand), handgrip and pinch strength, Purdue Pegboard test, and Jebsen Taylor Hand Function test were measured in the sixth month. Results  A total of 125 patients, 68 females (54.4%) and 57 males (45.6%) were included in the study. The mean age of the patients was 47.15 ± 13.41 (18-65) years. There were 60 patients (48%) in the USF group and 65 patients (52%) in the non-USF group. No significant difference was found in pain, range of motion, Quick-DASH and handgrip and pinch strength between the groups ( p > 0.05). The hand dexterity tests showed no statistically significant difference between the groups in the sixth month ( p > 0.05). Discussion  Hand function can be determined more accurately by assessing hand dexterity. In this study, it is emphasized that concomitant USF does not lead to poorer hand dexterity.

Joint Protection Programmes for People with Osteoarthritis and Rheumatoid Arthritis of the Hand: An Overview of Systematic Reviews

Purpose: Joint protection has been introduced as a self-management strategy for people with rheumatoid arthritis (RA) and osteoarthritis (OA) of the hand. The purpose of this study was to conduct an overview of systematic reviews (SRs) and critically appraise the evidence to establish the current effectiveness of joint protection for people with hand RA and OA. Method: A comprehensive search was conducted of six databases from January 2008 to May 2018. SRs that evaluated the effectiveness of joint protection for people with hand arthritis were eligible for inclusion. The A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 checklist was used to assess the methodological quality of each SR. Results: Nine SRs were included: two were rated as high quality, and seven were rated as low quality. Seven of the nine did not take into account risk of bias when interpreting or discussing their findings, six did not assess publication bias, and five did not register their protocol. The high-quality reviews found no clinically important benefit of joint protection for pain, hand function, and grip strength levels. The low-quality reviews reported improvements in function, pain, grip strength, fatigue, depression, self-efficacy, joint protection behaviours, and disease symptoms in people with RA. Conclusions: High-quality evidence from high-quality reviews found a lack of any clinically important benefit of joint protection programmes for pain, hand function, and grip strength outcomes, whereas low-quality evidence from low-quality reviews found improvements in these outcomes.

Manual ability in hand surgery patients: Validation of the ABILHAND scale in four diagnostic groups

Background

Patients treated in hand surgery (HS) belong to different demographic groups and have varying impairments related to different pathologies. HS outcomes are measured to assess treatment results, complication risks and intervention reliability. A one-dimensional and linear measure would allow for unbiased comparisons of manual ability between patients and different treatment effects.

Objective

To adapt the ABILHAND questionnaire through Rasch analysis for specific use in HS patients and to examine its validity.

Methods

A preliminary 90-item questionnaire was presented to 216 patients representing the diagnoses most frequently encountered in HS, including distal radius fracture (n = 74), basal thumb arthritis (n = 66), carpal tunnel syndrome (n = 53), and heavy wrist surgery (n = 23). Patients were assessed during the early recovery and in the late follow-up period (0–3 months, 3–6 months and >6 months), leading to a total of 305 assessments. They rated their perceived difficulty with queried activities as impossible, difficult, or easy. Responses were analyzed using the RUMM2030 software. Items were refined based on item-patient targeting, fit statistics, differential item functioning, local independence and item redundancy. Patients also completed the QuickDASH, 12-item Short Form Survey (SF-12) and a numerical pain scale.

Results

The rating scale Rasch model was used to select 23 mostly bimanual items on a 3-level scale, which constitute a unidimensional, linear measure of manual ability with good reliability across all included diagnostic groups (Person-Separation Index = 0.90). The resulting scale was found to be invariant across demographic and clinical subgroups and over time. ABILHAND-HS patient measures correlated significantly (p<0.001) with the QuickDASH (r = -0.77), SF-12 Physical Component Summary (r = 0.56), SF-12 Mental Component Summary (r = 0.31), and pain scale (r = -0.49).

Conclusion

ABILHAND-HS is a robust person-centered measure of manual ability in HS patients.

Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis

OBJECTIVE

The aim of this study was to critically appraise, compare, and summarize the quality of the measurement properties of grip strength (GS) in patients with musculoskeletal, neurologic, or systemic conditions and healthy participants without these conditions.

DATA SOURCES

We followed the Consensus-based Standards for the Selection of Health Measurement Instruments guideline. To identify studies on measurement properties of GS, we searched the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Physiotherapy Evidence, and Cochrane Library databases from inception until June 2019. Meta-analyses were carried out using a random effects model and 95% CIs were calculated.

STUDY SELECTION

Studies were included if they reported at least 1 measurement property of hand GS in a population with musculoskeletal, neurologic, and systemic conditions or a healthy population without these conditions.

DATA EXTRACTION

The extracted data included the study population, setting, sample size, measurement evaluated, and the test interval.

DATA SYNTHESIS

Twenty-five studies were included with 1879 participants. The pooled results indicated excellent intraclass correlation coefficient (ICC) of 0.92 (95% CI, -0.88-0.94 for healthy participants without any conditions, ICC of 0.95 (95% CI, -0.93-0.97) for upper extremity conditions, and an ICC of 0.96 (95% CI, -0.94-0.97) for patients with neurologic conditions. Minimum clinically important difference (MCID) scores for hand GS were 5.0 kg (dominant side) and 6.2 kg (nondominant side) for patients post stroke, 6.5 kg for the affected side after distal radius fracture, 10.5 lb and 10 kPa for immune-mediated neuropathies, 17 kg for patients with lateral epicondylitis, and 0.84 kg (affected side) and 1.12 kg (unaffected side) in the carpometacarpal osteoarthritis group; MCID GS estimates were 2.69-2.44 kg in the healthy group without conditions.

CONCLUSION

Our synthesized evidence indicated that GS assessment is a reliable and valid procedure among healthy participants as well as across various clinical populations. Furthermore, our MCID summary scores provided useful information for evaluating (clinical importance) new interventions regarding hand GS.

Physical impairments predict hand dexterity function after distal radius fractures: A 2-year prospective cohort study

Introduction

The overall aim of this study was to determine whether physical impairments – loss of range of motion and grip strength – could be used to predict hand dexterity functions in patients at 1 and 2 years after distal radius fracture.

Methods

This was a prospective cohort study. Hand dexterity was assessed at three different levels using the NK hand dexterity test. We used a manual goniometer to measure the active range of motion in the affected hand for wrist flexion and extension movements, and a J-Tech grip strength device to measure patients’ hand grip strength levels. Assessments were performed at 1- and 2-year follow-ups. Separate multivariable regression analyses were performed to determine if range of motion predicts hand dexterity functions at 1 and 2 years after distal radius fracture.

Results

A total of 160 patients with distal radius fracture were included in this study. Range of motion (flexion and extension) and grip strength were both statistically significant (p < 0.05) independent variables in predicting hand dexterity functions at all three levels among patients after distal radius fracture at 1-year follow-up. Range of motion and strength levels accounted for 31%, 33% and 22% of the variance in patients’ large, medium and small hand dexterity functions, respectively. At 2 years, grip strength remained the only statistically significant (p < 0.001) independent variable in predicting hand dexterity functions at all three levels.

Conclusions

Physical impairments (loss of range of motion and grip strength) have higher predictive values for large and medium hand dexterity functions, than small hand dexterity functions, in patients after distal radius fracture, at both 1- and 2-year follow-up periods.