How kinematic disturbance in the deformed rheumatoid thumb impacts on hand function: a biomechanical and functional perspective

The effect of rheumatoid arthritis on upper extremity functions: A kinematic perspective

AIM

To examine the global upper extremity kinematics in 3D while performing "jar opening motion" in Rheumatoid Arthritis (RA) and to compare these with healthy individuals.

METHOD

Twenty-four women (12 healthy, 12 RA) were included. Evaluations were made with a JAMAR dynamometer, Health Assessment Questionnaire, and 3D kinematic analysis of global upper extremity during "jar opening motion." The time taken during "jar opening motion" was analyzed in 2 parts (Part 1, Part 2), with total time: part 1 + part 2. In addition, shoulder-to-table distance; elbow flexion angle; wrist extension angle; the area scanned and angular rotation by arm, forearm and hand were used in the analysis.

RESULTS

Between groups, there was a statistical difference in: bilateral hand grip strength; part 1, part 2, total time; shoulder-to-table distance; elbow flexion angle; the area scanned by hand; angular rotation of arm and hand in favor of the healthy group (P < .05). In stepwise multiple regression analysis, the most predictive variable for disability was elbow flexion, explaining 53.9% of disability.

CONCLUSION

Compared to healthy individuals, individuals with RA have slower motion, more elbow flexion, less hand grip strength, circular pattern in hand, rotation in arm and hand. Increased disability may result in greater load on elbow flexion.

Patient-reported outcome measures for patients with hand-specific impairments-A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly used to provide evidence for treatment effects and to guide rehabilitation. To our knowledge, no disease-specific PROM exists for the assessment of patients with flexor tendon lesions of the hand. We believe that PROMs used to assess hand function, regardless of diagnosis, contain relevant items for patients with flexor tendon lesions of the hand.

PURPOSE

The aim of our study was to identify and collect items from pre-existing PROMs used by clinical experts to assess the health status and function in patients with reduced hand function.

STUDY DESIGN

A scoping review searching for PROMs with hand-specific content was conducted to ensure face validity. As these items are assumed to have been through an evaluation process by the clinical specialists, they have the advantage and likelihood of being useful.

METHODS

We searched five bibliographic databases. All PROMs with hand-specific content used to assess hand function were considered for inclusion. Questionnaires written in English, Danish, Swedish, and Norwegian were included. An analysis of content redundancy was conducted, and items were grouped according to The World Health Organization's International Classification of Functioning, Disability and Health.

RESULTS

Seventy-three PROMs were included with a total of 1,582 items. The majority of the items were redundant across measurement instruments, and redundant items were consolidated, resulting in 179 nonredundant items. All nonredundant items were classified according to the International Classification of Functioning, Disability and Health components.

CONCLUSIONS

This review presents a collection of 179 items ensuring face validity for patients with hand-related disease/injury.

Wireless Manipulation Mechanism and Analysis for Actively Assistive Pinch Movements

Pinching motions are important for holding and retaining objects with precision. Therefore, training exercises for the thumb and index finger are extremely important in the field of hand rehabilitation. Considering the need for training convenience, we developed a device and a driving system to assist pinching motions actively via a lightweight, simple, and wireless mechanism driven by the magnetic forces and torques generated by magnets attached to the tip of these two fingers. This device provides accurate pinching motions through the linking structures connecting the two magnets. The fabricated device has minimal mechanical elements with an ultralightweight of 57.2 g. The magnetic field, the intensity of which is based on the time variant, generates a pinching motion between the thumb and index finger, thus rendering it possible to achieve repetitive training. To verify the generation of an active pinching motion, we fabricated a finger model using a 3D printer and a rubber sheet and observed the active motions generated by the newly developed device. We also verified the performance of the proposed mechanism and driving method via various experiments and magnetic simulations. The proposed mechanism represents an important breakthrough for patients requiring hand rehabilitation and wearable assistive motion devices.

Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance

Background

Although drug therapy for rheumatoid arthritis (RA) has recently improved, treating patients with established disease, whose hands have three major deformities (thumb deformity, finger deformities, and ulnar drift), remains a challenge. The underlying complex pathophysiology makes understanding these deformities difficult, and comprehensive assessment methods require accumulated skill with long learning curves. We aimed to establish a simpler composite method to understand the pathophysiology of and alterations in the hand deformities of patients with RA.

Methods

We established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 (100 hands of 52 patients) and 2015 (63 hands of 37 patients) after case exclusion. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantitated and entered as parameters into a two-step cross-sectional cluster analysis for the data in 2004. The parameters in each cluster were plotted at each evaluation point. Two-way analysis of covariance was used to examine whether differences existed between evaluation points and clusters of deformity parameters.

Results

Five clusters most appropriately described hand deformity: (i) cluster 1, minimal deformity; (ii) cluster 2, type 1 thumb deformity; (iii) cluster 3, thumb deformity and severe boutonnière deformity; (iv) cluster 4, type 2 or 3 thumb deformity and severe ulnar drift; and (v) cluster 5, thumb deformity and severe swan-neck deformity. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. Clusters 1–4 had similar disease duration but showed different paths of deformity progression from disease onset. Clusters 1 and 2 represented conservative deformity parameters and clusters 3, 4, and 5 represented progressive deformity parameters. Over time, thumb deformity evolved into other types of deformities and swan-neck deformity worsened significantly.

Conclusions

Our comprehensive analysis identified five deformity patterns and a progressive course in the rheumatoid hand. Knowledge of the characteristics of progressive deformity parameters may allow rheumatologists to more easily implement practical interventions and determine functional prognosis.

Cross-cultural adaptation and psychometric properties of the Turkish version of the Manual Ability Measure-36 (MAM-36) in people with multiple sclerosis

OBJECTIVE

The Manual Ability Measure-36 (MAM-36) has been used to assess subjective upper limb function in people with several neurological and non-neurological diseases. Besides, the MAM-36 is one of the most commonly used patient-reported outcome measures (PROMs) in people with multiple sclerosis (pwMS). The aim was to translate and conduct cross-cultural adaptation of the MAM-36 into Turkish and investigate its psychometric properties in pwMS.

METHODS

The MAM-36 was translated and culturally adapted into Turkish. Two hundred pwMS were recruited for the psychometric study. Hand skills, handgrip strength, upper limb spasticity, disability level, and quality of life were evaluated by the validated performance-based tests and questionnaires including the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) which is a validated MS-specific PROM to assess upper limb function.

RESULTS

MAM-36 was significantly correlated with the performance-based tests and questionnaires, EDSS, age, and disease duration (p < 0.05). MAM-36 and AMSQ were strongly correlated (r_s = - 0.90, p < 0.01). PwMS with spasticity had significantly lower MAM-36 scores compared to those without spasticity (p < 0.01). Internal consistency (Cronbach's alpha = 0.97) and test-retest reliability (ICC = 0.97) was high.

CONCLUSION

The Turkish version of MAM-36 has been found as a valid and reliable method for measuring upper limb function in pwMS.

Hand Kinematics Characterization While Performing Activities of Daily Living Through Kinematics Reduction

Improving the understanding of hand kinematics during the performance of activities of daily living may help improve the control of hand prostheses and hand function assessment. This work identifies sparse synergies (each degree of freedom is present mainly in only one synergy), representative of the global population, with emphasis in unveiling the coordination of joints with small range of motion (palmar arching and fingers abduction). The study is the most complete study described in the literature till now, involving 22 healthy subjects and 26 representative day-to-day life activities. Principal component analysis was used to reduce the original 16 angles recorded with an instrumented glove. Five synergies explained 75% of total variance: closeness (coordinated flexion and abduction of metacarpophalangeal finger joints), digit arching (flexion of proximal interphalangeal joints), palmar-thumb coordination (coordination of palmar arching and thumb carpometacarpal flexion), thumb opposition, and thumb arch. The temporal evolution of these synergies is provided during reaching per intended grasp and during manipulation per specific task, which could be used as normative patterns for the global population. Reaching has been observed to require the modulation of closeness, digit arch and thumb opposition synergies, with different control patterns per grasp. All the synergies are very important during manipulation and need to be modulated for all the tasks. Finally, groups of tasks with similar kinematic requirements in terms of synergies have been identified, which could benefit the selection of tasks for rehabilitation and hand function assessments.

Course of Grip Force Impairment in Patients With Early Rheumatoid Arthritis Over the First Five Years After Diagnosis

OBJECTIVE

Objective measures of function are important in rheumatoid arthritis (RA). The objective of this study was to investigate grip strength in patients with early RA.

METHODS

An inception cohort of 225 patients with early RA was followed in accordance with a structured protocol. Average and peak grip force values of the dominant hand (measured using a Grippit device [AB Detektor]) were evaluated and compared to expected age- and sex-specific reference values from the literature. Separate analyses were performed for those with limited self-reported disability (Health Assessment Questionnaire disability index [HAQ DI] score ≤0.5) and clinical remission (Disease Activity Score in 28 joints <2.6).

RESULTS

Baseline average grip force among RA patients was significantly lower than the corresponding expected value (mean 105N versus 266N; P < 0.001). Observed average and peak grip force values were significantly reduced compared to those expected in women as well as in men over time and at all time points. The average grip force improved significantly from inclusion to the 12-month visit (age-corrected mean change 34N [95% confidence interval 26-43]). At 5 years, the average grip force was still lower than that expected overall (mean 139N versus 244N; P < 0.001), and also among those with HAQ DI scores ≤0.5 and those in clinical remission.

CONCLUSION

Grip strength improved in early RA patients, particularly during the first year. However, it was still significantly impaired 5 years after diagnosis, even among those with limited self-reported disability and those in clinical remission. This suggests that further efforts to improve hand function are important in early RA.