Test-retest reliability of tip, key, and palmar pinch force sense in healthy adults

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.

AMBER: A Device for Hand Motor and Cognitive Rehabilitation-Development and Proof of Concept

Stroke survivors usually exhibit concurrent motor and cognitive impairment. Historically, rehabilitation strategies post-stroke occur separately in terms of motor and cognitive functions. However, recent studies show that hand motor interventions can have a positive impact on cognitive recovery. In this work, we introduce AMBER (portAble and Modular device for comprehensive Brain Evaluation and Rehabilitation), a new device developed for the evaluation and rehabilitation of both hand motor function and cognition simultaneously. AMBER is a simple, portable, ergonomic and cheap device based on Force Sensitive Resistors, in which every finger interaction is recorded to provide information about finger strength, processing speed, and memory status. This paper presents the requirements of the device and the design of the system. In addition, a pilot study was conducted with 36 healthy individuals using the evaluation module of the device to assess its psychometric properties, as test-retest reliability and measurement error. Its validity was also evaluated comparing its measurements with three different gold standards for strength, processing speed and memory. The device showed good test-retest reliability for strength (ICC =0.741-0.852), reaction time (ICC =0.715 - 0.900) and memory (ICC =0.556-0.885). These measures were correlated with their corresponding gold standards (r =0.780-890). AMBER shows great potential to impact hand rehabilitation, offering therapists a valid, reliable and versatile tool to comprehensively assess patients. With ongoing advancements and refinements, it has the opportunity to significantly impact rehabilitation practices and improve patient outcomes.

Reference data for the hand grip and palmar pinch force sense errors and the relationship between school-entry-age in young adults

BACKGROUND

Hands execute intricate tasks vital for everyday life and professions such as cooking, tailoring, and craftsmanship.

OBJECTIVE

This study aimed to establish reference data for hand grip and palmar pinch force sense in young adults, accounting for gender differences, and to determine the correlation between these data and school-entry ages.

METHODS

The cross-sectional observational study comprised 284 participants (156 females and 128 males). Demographic details, including age, gender, weight, and height, were recorded. Participant ages ranged from 18 to 29, representing the youth workforce population as defined by the International Labour Organization. Factors like hand dominance and school-entry age were ascertained based on participants' self-reports. Hand grip and palmar pinch force senses were separately assessed in the dominant and non-dominant hands of 130 randomly chosen participants to evaluate test-retest reliability.

RESULTS

Hand grip (dominant: p < 0.001, non-dominant: p = 0.002) and palmar pinch force sense errors were significantly lower in male participants compared to females. Palmar pinch force sense error for the dominant hand was reduced in males (p = 0.002), but no significant disparity existed between genders for the non-dominant hand (p = 0.222). Healthy adults who began school at age five or earlier exhibited a decreased force sense error rate (p < 0.05).

CONCLUSIONS

Force sense error reference values vary based on gender and school-entry age. This reference data will aid rehabilitation specialists working with young adults in physiotherapy and occupational therapy fields in identifying potential impairments.

Pinch force sense test-retest reliability evaluation using contralateral force matching task

A high test-retest reliability in measurement of pinch force sense is required to assess a clinical parameter accurately over a longitudinal study. Ipsilateral reproduction (IR) task and contralateral matching (CM) task have commonly been used for the assessment of force sense. To date, there has been little research on the test-retest reliability of pinch force sense utilizing the contralateral force matching task. This research aimed to explore this phenomenon across a spectrum of reference force levels (10, 30, and 50 percent maximum voluntary isometric contraction (MVIC)) using a contralateral matching task. Every participant in the study was tested twice by the same skilled experts, with each session separated by one week. Although normalized variable error indicated a poor level of reliability (intraclass correlation coefficient (ICC) = - 0.25 to 0.05) for these force sense tests, normalized constant error (ICC = 0.76-0.85) and normalized absolute error (ICC = 0.61-0.81) results indicated a fair to good of reliability. The lower bound of 95% CI of ICC for NAE and NCE indicated fair test-retest reliability (0.41-0.69). These findings suggest that investigators can reasonably obtain a fair to good test-retest reliability when investigating pinch force sense using the contralateral matching task. The Bland-Altman plots, SEM, and MDD95% were lower at these lower reference force level (10% MVIC) compared to the level of higher reference forces (30% and 50% MVIC). Therefore, when the reference force level increases, the participant needs a larger NAE or NCE decrease to show that their pinch force sense has indeed improved.

Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: an assessor-blinded randomised controlled trial

OBJECTIVES

To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS).

DESIGN

An assessor-blind randomised controlled trial.

SETTING

Hospital-based hand therapy clinics.

PARTICIPANTS

Fifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks.

OUTCOME MEASURES

The standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen's manoeuvre test, Tinel's sign and the Boston CTS Questionnaire.

RESULTS

Both groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen's manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength.

CONCLUSION

Splinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6 months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs.

TRIAL REGISTRATION NUMBER

ISRCTN13189602.

Test-retest Reliability and Precision of the Rotterdam Intrinsic Hand Myometer

PURPOSE

The purpose of this study was to determine the test-retest reliability and precision of Rotterdam Intrinsic Hand Myometer (RIHM) in healthy adults.

METHODS

Twenty-nine participants originally recruited via convenience sampling at a Midwestern state fair returned approximately 8 days later for retest. An average of three trials for each of the five intrinsic hand strength measurements were collected using the same technique that was used during initial testing. Test-retest reliability was assessed using the intraclass correlation coefficient or ICC(2,3) and precision was evaluated using the standard error of measurement (SEM), and the minimal detectable change (MDC90)/MDC%.

RESULTS

Across all measures of intrinsic strength, the RIHM and its standardized procedures had excellent test-retest reliability. Index finger metacarpophalangeal flexion demonstrated the lowest reliability, and right small finger abduction, left thumb carpometacarpal abduction, and index finger metacarpophalangeal abduction tests had the highest reliability. Precision, as evidenced by SEM and MDC values, was excellent for tests of left index and bilateral small finger abduction strength and acceptable for all other measurements.

CONCLUSIONS

Test-retest reliability and precision of RIHM across all measurements was excellent.

CLINICAL RELEVANCE

These findings indicate that RIHM is a reliable and precise tool in measuring intrinsic strength of hands of healthy adults, although further research is needed in clinical populations.

Assessment of grip force sense test-retest reliability in healthy male participants

There has been a lack of research to date regarding the test-retest reliability of grip force sense in healthy adult males. This study was therefore designed to explore this topic across a series of target force levels using an ipsilateral force reproduction task. The same experienced research staff conducted two testing sessions for each study participant, with 1 week between test sessions. Intraclass correlation coefficient values indicated that these force sensing tests exhibited good to fair reliability with respect to both absolute error (0.42-0.63) and constant error (0.49-0.60), although variable error was indicative of poor reliability (-0.85 to 0.14). Together, these results suggest that researchers can achieve a fair level of test-retest reliability when analysing grip force sense in healthy adult males, with results being most reliable at force levels of 20 N and 50 N, as determined based upon measured constant error and absolute error. Practitioner summary: To ensure that grip force sense can be accurately interpreted over time, it is important to assess the test-retest reliability. It is recommended that practitioners measure the absolute error and constant error at force levels of 20 N and 50 N when assessing grip force sense in a clinical setting.

Application of Feedback Type on Performance of Abdominal Drawing-In Maneuver in Healthy Adults: A Quasi-Experimental Study of Motor Control and Motor Learning

OBJECTIVE

The aim of this study was to compare the effects of verbal, tactile-verbal, and visual feedback on muscle activation of the lumbar stabilizers relative to extremity movers during an abdominal drawing-in maneuver when feedback is withheld.

METHODS

This quasi-experimental study equally divided 54 healthy adults into 3 feedback groups (verbal, tactile-verbal, and visual) who trained twice per week over a 4-week period to perform supine abdominal drawing-in maneuvers. The percentage of maximum voluntary isometric contraction of rectus abdominis, multifidus (MF), erector spinae, and hamstrings (HS) as an outcome measure was acquired using surface electromyography. A 2-way factorial analysis of variance with bootstrapping allowed for comparison of post-pre difference scores across the interaction of feedback and muscle groups.

RESULTS

Hamstring activation decreased in those receiving tactile-verbal feedback relative to an increase in participants given visual feedback. Furthermore, when using verbal feedback, HS activity increased relative to a decline in rectus abdominis, and when presenting visual feedback, HS activity increased relative to a decrease in MF. However, no post-pre changes were seen across muscles with tactile-verbal feedback.

CONCLUSION

Although tactile-verbal feedback did not increase MF recruitment, it produced less HS activity than visual feedback. Undesirable HS recruitment may reflect boredom or feedback dependency.

Effect of pinch types on pinch force sense in healthy adults

Pinch force sense plays an important role in the performance of daily finger movements, including tip, key, palmar pinch. The present study investigated the roles of pinch type in the sensation of pinch force among healthy participants in the ipsilateral force reproduction trial. This study instructed forty healthy adult subjects (20 women and 20 men) in producing reference forces at different levels [10, 30, 50% maximal voluntary isometric contraction (MVIC)] by adopting 3 pinch types (tip, key, and palmar pinches) and in reproducing the above force levels with the identical hand. Our study revealed that subjects are significantly more sensitive detecting alterations of pinching forces with tip pinch but not key or palmar pinch under high forces (30 and 50% MVIC) but not at lower force levels (10% MVIC).

Functional outcome after digit replantation versus amputation

Background

The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies.

Patients and methods

Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient’s range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes–Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively.

Results

Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups.

Conclusion

Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation.

Level of evidence

IV.

What Are the Patient-reported Outcomes of Trapeziectomy and Tendon Suspension at Long-term Follow-up?

BACKGROUND

There are multiple options for the treatment of thumb carpometacarpal joint osteoarthritis (CMC1 OA), with evidence for pain relief and improved function. Although simple trapeziectomy has the lowest complication risk, tendon suspension of the first metacarpal and interposition is still the most commonly used surgical procedure in patients with CMC1 OA. Although there are several reports of good short-term results after trapeziectomy and tendon suspension-interposition arthroplasty, few studies have evaluated long-term outcomes. This study is one of the largest and longest follow-up evaluations of a cohort of patients with CMC1 OA who were treated with trapeziectomy and suspension-interposition arthroplasty, capturing 96% of the original cohort for evaluation.

QUESTIONS/PURPOSES

(1) After trapeziectomy and tendon suspension surgery, what are the long-term, patient-reported outcomes and clinical measurements (strength and ROM); and in unilateral procedures, how do these parameters compare with those of the contralateral hand that was not operated on? (2) What is the mean subsidence (unloaded trapezial space), and does pinch strength correlate with the amount of subsidence?

METHODS

From 1998 to 2005, 130 patients underwent trapeziectomy and abductor pollicis longus (APL) suspension-interposition arthroplasty for CMC1 OA at one orthopaedic department. During this period, 15 patients were treated with CMC1 arthrodesis and four were treated with implant arthroplasty, for a total of 149 patients. The surgeons used APL suspensionplasty for most patients, based on age and expected postoperative function; they also employed this procedure to avoid hardware or implant failure issues. The 100 living patients were asked to participate in this retrospective study, 96% (96) of whom were enrolled. The mean age at surgery was 58 ± 7 years. The patients completed a two-item thumb pain scale (modified from the SF-36 body pain scale), a hand pain VAS (average level of pain experienced over the week preceding measurement), and the 11-item QuickDASH. Patient-reported outcomes data were obtained from all 96 patients, and 83% (80) of patients underwent bilateral hand radiography and a physical examination at a mean follow-up of 17 ± 2.4 years. We calculated outcome data for each patient, and in 39 patients with unilateral surgery and intact contralateral CMC1 joint, we compared the operated side with the contralateral side. We compared our outcome data with that from the Swedish National Quality Registry for Hand Surgery (HAKIR), noting comparable outcomes for pain and QuickDASH scores.

RESULTS

At long-term follow-up after trapeziectomy and APL suspension surgery, the mean thumb pain score was 19 ± 26, hand pain VAS score 23 ± 25, and QuickDASH score 26 ± 21. In the patients with unilateral surgery and intact contralateral CMC1 joint, the thumb pain score for the operated side was lower than the contralateral side, specifically 19 ± 25 compared with 29 ± 30 (mean difference -9.8 [95% CI -19.5 to -0.2]; p = 0.045); hand pain VAS score was 24 ± 23 versus 30 ± 25 (mean difference -6.1 [95% CI -15.2 to 3.1]; p = 0.19), and the QuickDASH score was 27 ± 19. Grip strength showed no differences between the operated and contralateral sides (mean 16.7 ± 7.3 kg versus 16.6 ± 6.9 kg, mean difference 0.1 [95% CI -1.6 to 1.8]; p = 0.90), while pinch was different (4.4 ± 1.4 versus 5.0 ± 1.5 kg, mean difference -0.6 [95% CI -0.9 to -0.3]; p = 0.001). The mean trapezial space was 4.4 ± 2.2 mm, and there was no association between the trapezial space and pinch strength (0.07 kg [95% CI -0.04 to 0.18] per mm of space; p = 0.17).

CONCLUSION

The finding of comparable pain and function between operated and unoperated sides at long-term follow-up suggests that trapeziectomy and tendon suspension-interposition arthroplasty provides predictable outcomes, and surgeons can use these data to counsel patients that surgery can potentially return them to comparable use. However, as patients often have asymptomatic radiographic OA on the contralateral side, future studies are needed to examine the impact of asymptomatic disease on function.

LEVEL OF EVIDENCE

Level IV, therapeutic study.