Do current upper limb orthotic classification systems help clinicians choose and design effective orthoses? A scoping review with expert interviews.

BACKGROUND: Orthosis (orthotic) fabrication is an essential part of the treatment plan for many upper extremity conditions. PURPOSE: We aim to comprehensively identify the current body of evidence about the purpose, structure, scope, and application of available orthotic classification systems. Our secondary aim was to know if the current classification systems can be used as a decision guide for clinicians. STUDY DESIGN: A scoping review. METHODS: A scoping review of research studies identified through data-based and gray literature was conducted to determine studies that addressed classification systems of the orthosis (orthotic) in the hand and upper limb. Two investigators screened study titles and abstracts and did the data extraction. To do a comprehensive review, all the hand therapy associations were contacted and asked to share their specific orthosis classification system. To answer our second aim, we discussed our findings with the experts in a panel. RESULTS: Twelve different classification systems were identified, which were developed with different aims. Five classification systems classified orthosis based on their function (n = 5, 50%); one based on therapeutic goals and proposed a decision algorithm. Two of the proposed systems were aimed at helping in decision-making or offering an algorithm for therapists to help them choose the proper orthosis. The expert panel process identified that the current classification systems could not help clinicians select proper orthosis for their patients. CONCLUSIONS: There are different classification systems which were developed with various aims. However, none of those can help clinicians make informed decisions about appropriate orthosis choices for their patients.

Interpretation and content validity of the items of the Hamilton inventory to evaluate outcomes in Persian-speaking patients with complex regional pain syndrome: A cognitive interview approach.

BACKGROUND: The Hamilton Inventory for complex regional pain syndrome (CRPS) is a multidisciplinary assessment tool to evaluate signs and symptoms in patients with CRPS, developed in the English language. PURPOSE: This study aims to translate and cross-culturally adapt this tool for Persian-speaking patients with CRPS. Furthermore, this study aimed to understand how 1) Persian-speaking experts and patients interpret and calibrate responses to items on the Hamilton Inventory and 2) compensatory strategies that might affect responses. STUDY DESIGN: A cross sectional study with cognitive interview method. METHODS: Ten health care providers and 10 patients with CRPS were interviewed using cognitive interviewing techniques (talk-aloud, semi-structured interview probes). All interviews were recorded and transcribed verbatim. A directed content analysis was done to analyze the interviews using a previously established framework. RESULTS: Overall, the items on the Hamilton Inventory were well received by participants. Areas, where questions were unclear to some participants were recorded and categorized into five themes: Clarity and Comprehension (100%) in item 1 from the health professional tool and (65%) from the eleven items of the patient-reported tool. Perspective modifiers of culture influenced the calibrations of items "I feel my condition has negatively affected my relationships." (12%) and "My symptoms affect my comfort level with intimacy." (20%) from the patient-reported tool. CONCLUSION: The findings of this study demonstrate that there is no need for substantive changes to the items of the Hamilton Inventory, as they tend to be understood by Persian-speaking experts and patients with CRPS.

A description of the barriers, facilitators, and experiences of hand therapists in providing remote (tele) rehabilitation: An interpretive description approach.

BACKGROUND: Telerehabilitation is increasingly being used to meet the rehabilitation needs of situations where face-to-face therapy is not possible. Nevertheless, reports on barriers and facilitators of implementing this method from the perspective of therapists still need to be made available. PURPOSE: To investigate the experiences of hand therapists when implementing telerehabilitation, examining the difficulties, barriers, and facilitators encountered during its implementation. STUDY DESIGN: Qualitative study. METHODS: This study used a purposive sampling method to recruit therapists with varying experiences in telerehabilitation and conducted semi-structured interviews. Data collection and analysis continued iteratively until thematic saturation was achieved. A total of 14 therapists were interviewed via Zoom. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The process of interpretive description guided interviews and analysis of the interviews to identify key barriers and facilitators in providing telerehabilitation. RESULTS/DISCUSSION: Six main themes and 10 corresponding sub-themes were constructed concerning facilitators and barriers to telerehabilitation: factors related to the patient, therapy, therapists, injury, technology, and policy. Therapists implemented different coping strategies in their interventions and measurements to facilitate treatment. However, some interventions, such as orthotic fabrication, could not be done online. Educating therapists, providing a standard method, and integrating with in-person rehabilitation can overcome the barriers to telerehabilitation in hand therapy. CONCLUSIONS: Technology was the main facilitator and, on the other hand, a barrier to providing online hand therapy interventions. Therapists generally reported high satisfaction and usability of this method. Despite all barriers, telerehabilitation can be implemented as a part of hand therapy interventions alongside face-to-face therapy as a hybrid method. The barriers and facilitators experienced and raised by therapists can be added to what is already known regarding telerehabilitation in hand therapy. They might be applied to guide therapeutic procedures and upcoming studies.

Occupational Performance 1 Year After a Distal Radius Fracture From the Perspective of the International Classification of Functioning, Disability and Health.

IMPORTANCE: Distal radius fractures (DRFs) frequently compromise independent functioning. OBJECTIVE: To analyze occupational performance post-DRF using the Canadian Occupational Performance Measure (COPM) and related interviews, guided by the International Classification of Functioning, Disability and Health (ICF). COPM score was compared with standard metrics: Patient-Reported Wrist Evaluation (PRWE) and Participation Behavior Questionnaire (PBQ). METHOD: Through a semistructured COPM interview, participants highlighted self-care, productivity, and leisure. They completed the PRWE and PBQ, linking results to ICF sets. DESIGN: Prospective cohort. SETTING: Outpatient hand surgery clinic at a trauma center. PARTICIPANTS: Patients (N = 120), 1 yr post-DRF. OUTCOMES AND MEASURES: Incorporated COPM, PRWE, and PBQ, linked to ICF. RESULTS: Analysis identified 73 codes, aligning with 30 ICF Hand Conditions codes. Main concerns related to self-care (15.21%), leisure (12.16%), and productivity (16.22%). Major challenges pertained to domestic (67.00%) and civic life (64.53%) within ICF. Occupational performance was positively correlated with participation (r = .62) and inversely with disability (r = -.62). CONCLUSIONS AND RELEVANCE: DRFs result in varied occupational challenges that are not always reflected in standard measures. The COPM offers a comprehensive insight into post-DRF patient challenges, emphasizing the value of diverse clinical assessment approaches. What This Article Adds: This study highlights the importance of a holistic approach in occupational therapy for DRF patients, revealing that standard measurements might overlook key challenges that they face. By adopting broader evaluative methods, occupational therapists can better address patient-specific needs and enhance their rehabilitation outcomes.

Does Disability Correlate With Impairment After Hand Injury?

BACKGROUND: Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability. Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments. However, the degree to which this is the case has been incompletely explored. QUESTIONS/PURPOSES: The purpose of this study was to determine if disability (as measured by the Disabilities of the Arm, Shoulder and Hand [DASH] and the Michigan Hand Questionnaire [MHQ]) and pain intensity correlate with impairment (as measured by the American Medical Association [AMA] impairment guide). Secondary study questions addressed the effect of pain intensity and symptom of depression on predicting disability. METHODS: Impairment and disability were evaluated in a sample of 107 hand-injured patients a mean of 11 months after injury. Impairment rating was performed prospectively. From the patients who came for therapy, they were invited to fill out the questionnaire and evaluated for impairment rating. Response variables of DASH, MHQ, and visual analog scale pain intensity values were collected at the same setting. Other explanatory variables included demographic, injury-related, and psychological factors (symptoms of depression measured with the Beck Depression Inventory). Initial bivariate and multivariate analyses were performed to determine correlations of disability and pain to impairment rating and other exploratory variables. RESULTS: Disability as measured by the DASH showed intermediate correlation with AMA impairment (r = 0 .38, beta = 0.36, p = 0.000). Together with gender, it accounted for only 22% of the variability in DASH scores. Similarly, MHQ score correlated with impairment rating (r = -0.24, beta = -0.23, p < 0.05). However, together with age, injured hand accounted for only 19% of the variability in MHQ scores. However, pain intensity did not correlate with impairment (r = -0.46, p > 0.05). Interestingly, pain intensity did correlate with the time passed from surgery but it was correlated with symptom of depression (r(2) = 0.10, beta = 0.33, p = 0.001). CONCLUSIONS: The limited correlation between impairment and disability emphasizes the importance of factors other than pathophysiology in human illness behavior. These may include physical (pain, dominant injured hand) and conditional factors (time since surgery) or psychological factors such as depression and adapting; all mentioned can be considered as personal factors that may be different in each patient. So considering personal difference and any other condition except the impairment alone can help to better plan interventions and also diminish disability level. LEVEL OF EVIDENCE: Level III, therapeutic study.

Orthotic Intervention with Custom-made Thermoplastic Material in Acute and Chronic Mallet Finger Injury: A Comparison of Outcomes.

Objectives: To compare the effect of using custom-made orthosis on improving extension lag and reducing disability in acute and chronic mallet fingers. Methods: We recruited 51 patients with acute or chronic Doyle type-1 mallet fingers, who were provided with a custom-made thermoplastic anti-mallet finger orthosis to wear full-time for 6 weeks and an additional 2 weeks at nighttime. The primary outcome, extension lag, was assessed at enrollment as well as six- and twelve-week follow-ups. Secondary outcomes included disability and satisfaction, which were evaluated using the Disability of the Arm, Shoulder, and Hand questionnaire at enrollment and 12 weeks, and a satisfaction scale at 12 weeks follow-up. Data analysis was conducted using univariate analysis of variance (ANOVA), one-way repeated measure mixed model analysis of covariance (ANCOVA), and independent sample t-test. Results: A total of 43 participants, 25 acute and 18 chronic mallet fingers, completed the 12-week evaluation. The study found no significant difference between the two groups in terms of improvement in extension lag at either follow-up time point (P=0.21). Disability improved in both the acute and chronic groups at follow-up (P<0.05). Additionally, both groups expressed satisfaction with the treatment outcome, and no statistically significant difference was observed (t=0.173, P=0.51). We could not identify any clinically significant difference between the two groups in regard to extension lag, disability, or satisfaction at follow-up. Notably, 96% of the patients in the acute group and 88% of the patients in the chronic group demonstrated good to excellent outcomes. Conclusion: Orthotic intervention with custom-made thermoplastic material in acute and chronic mallet fingers improved extension lag and disability, and both groups were satisfied with the treatment outcomes. The findings of our study indicated that patients with chronic mallet fingers benefited from orthotic interventions in the same way that patients with acute mallet fingers did.

Fear of Movement in People With CRPS: A Psychometric Evaluation of the Tampa Scale-11 for Kinesiophobia.

BACKGROUND: People with complex regional pain syndrome (CRPS) commonly report a fear of movement that can worsen symptoms and increase disability. The Tampa Scale of Kinesiophobia (TSK) is used to evaluate fear of movement and (re)injury, but findings have been inconsistent in different populations. OBJECTIVE: To evaluate the psychometric properties of the Persian version of TSK-11 in individuals with upper limb CRPS. Specifically, to determine whether the factor structure aligns with the original 2-factor model, consisting of "activity avoidance" and "somatic focus." MATERIALS AND METHODS: People with CRPS (n=142, mean age=42, 54% female) completed the TSK. The psychometric testing included internal consistency, test-retest reliability (intraclass correlation coefficient), and convergent construct validity. Confirmatory and exploratory factor analyses were performed to evaluate the structural validity. RESULTS: The TSK-11 showed acceptable internal consistency (Cronbach alpha 0.93) and excellent test-retest reliability (intraclass correlation coefficient=0.93, 95% CI: 0.92-0.94). The Standard Error of Measurement and Minimal Detectable Change were 4.3 and 11.7, respectively. The results also demonstrated excellent criterion validity ( r =0.81). Confirmatory factor analysis demonstrated that the original 2-factor model did not fit. Exploratory factor analysis derived a 2-factor solution with different items. The factor structure accounted for 64.91% of the variance, and the internal consistency of the factors was acceptable (>0.90). Expert consensus suggested naming these 2 factors as fear avoidance and magnification and helplessness. DISCUSSION: The TSK-11 demonstrates excellent retest reliability in people with CRPS. The original 2-factor structure was not confirmed, and a new 2-factor structure of the TSK-11 was proposed consisting of subscales for Fear Avoidance Beliefs and Magnification/Helplessness. Given the overlap between these constructs and the construct of pain catastrophizing, further study is needed to clarify both measures' content validity and relative uniqueness.

Sustainable practices in hand therapy: a global perspective.

Given its significant environmental footprint, healthcare sustainability is paramount. This study delves into the contributory role of hand therapy, assessing hand therapists' comprehension, implementation and barriers to sustainable practices, focusing on orthotic fabrication. A global survey distributed via social media and professional networks collected data on sustainability awareness, practices and educational needs from 113 respondents, primarily from North America (34%) and Europe (32%). Although 91% recognized climate change, only 34% practised sustainability. Despite 57% attempting eco-friendly actions in orthotic fabrication, such as reusing components (65%), knowledge of reusable materials was low (17%) and recycling thermoplastics was inadequate (74.3%). The main barriers were lack of awareness (59%), material scarcity (56.6%) and time constraints (54%). The findings underscore the urgent need for enhanced education, better resource availability and policy reforms to close the gap between awareness and action, promoting sustainability in hand therapy.

Factor structure of Participation Behavioural Questionnaire (PBQ) in patients with hand injuries.

BACKGROUND: Participation is considered a critical outcome of successful rehabilitation and should be evaluated. OBJECTIVE: We aimed to evaluate the structural validity of the Participation Behaviour Questionnaire (PBQ) in people with hand injuries. METHODOLOGY: The PBQ contains 30 items that measure participation as conceptualized in the ICF. PBQ was developed with Rasch analysis to measure participation in hand injured. A sample of 404 patients with hand injuries and a mean age of 37 (16.0) participated and was randomly split for exploratory and confirmatory factor analysis (EFA/CFA). RESULTS: Both EFA and CFA confirmed a four factor-solution. These factors were named: Social Participation and Interpersonal Relationships, Autonomy and Role, Subjective Satisfaction with Participation, Recreational, Sport, and Leisure Time. The value of Cronbach's alpha was 0.96 for the total scale and >0.85 for each subscale. CONCLUSIONS: The structural validity of the PBQ was confirmed using both EFA and CFA. The PBQ measures four dimensions of participation.

The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis.

OBJECTIVES: To summarize and critically appraise the body of evidence on conservative management of complex regional pain syndrome (CRPS), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: We conducted a literature search from inception to November 2021 in the following databases: Embase, Medline, CINAHL, Google Scholar, PEDRO, and Psychinfo. Two independent reviewers conducted risk of bias and quality assessment. Qualitative synthesis and meta-analysis were the methods for summarizing the findings of the RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the overall quality and certainty of the evidence on each treatment outcome. RESULT: Through a database search, 751 records were found, and 33 RCTs were eligible for inclusion. Studies were published between 1995 and 2021. The overall risk of bias for 2 studies was low, 8 studies were unclear, and 23 studies were high.Low-quality evidence suggests that mirror therapy (as an addition to conventional stroke rehabilitation interventions) and graded motor imagery program (compared with routine rehabilitation interventions) may result in a large improvement in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients. Low-quality evidence suggests that pain exposure therapy and aerobic exercises as an additive treatment to physical therapy interventions may result in a large improvement in pain up to a 6-month follow-up. The evidence is very uncertain about the effect of all other targeted interventions over conventional physical therapy or sham treatments on pain and disability. DISCUSSION: There is an ongoing need for high-quality studies to inform conservative management choices in CRPS.

Rehabilitation Interventions for Complex Regional Pain Syndrome: An Overview of Systematic Reviews.

OBJECTIVES: An increasing number of systematic reviews have been conducted on various conservative management of complex regional pain syndrome (CRPS) targeting different rehabilitation interventions and objectives. The intent of this article was to summarize and critically appraise the body of evidence on conservative management of the CRPS and to provide an overall picture of the current state of the literature. METHODS: This study was an overview of systematic reviews on conservative treatments for CRPS. We conducted a literature search from inception to January 2023 in the following databases: Embase, Medline, CINAHL, Google Scholar, Cochrane Library, and Physiotherapy Evidence Database (PEDro). Two independent reviewers conducted study screening, data extraction, and methodological quality assessment (using AMSTAR-2). Qualitative synthesis was the preferred method for reporting the findings of our review. We calculated the corrected covered area index to account for the proportion of overlapping primary studies that were included in multiple reviews. RESULT: We identified 214 articles, and a total of 9 systematic reviews of randomized controlled trials were eligible for inclusion. Pain and disability were the most common outcomes evaluated in the reviews. There were 6 (6/9; 66%) high-quality, 2 (2/9; 22%) moderate-quality, and 1 critically low-quality systematic review (1/9;11%), with the quality of the included trials ranging from very low to high. There was a large overlap across primary studies that were included in the systematic reviews (corrected covered area=23%). The findings of high-quality reviews support the effectiveness of mirror therapy (MT) and graded motor imagery (GMI) programs on pain and disability improvement in CRPS patients. The large effect size was reported for the effectiveness of MT on pain and disability (SMD:1.88 (95% CI: 0.73-3.02) and 1.30 (95% CI: 0.11-2.49), respectively) and the effectiveness of GMI program (GMIP) on pain and disability improvement (SMD: 1.36 (95% CI: 0.75-1.96) and 1.64 (95% CI: 0.53-2.74), respectively). DISCUSSION: The evidence is in favor of adopting movement representation techniques, such as MT and GMI programs, for the treatment of pain and disability in patients with CRPS. However, this is based on a small body of primary evidence, and more research is required to generate conclusions. Overall, the evidence is not comprehensive or of sufficient quality to make definitive recommendations about the effectiveness of other rehabilitation interventions in improving pain and disability.

Characterization of functioning in breast cancer survivors: an interpretive descriptive analysis study based on the International Classification of Functioning, Disability, and Health (ICF) and the Item-Perspective Classification Framework.

PURPOSE: Breast cancer survivors may experience a variety of disabilities that could potentially compromise their independent functioning. This study aimed to examine their perspectives and experts on their functioning and interpret concepts with the International Classification of Functioning, Disability, and Health (ICF) and the Item-Perspective Classification Framework (IPF). METHODS: Interpretive descriptive methods were used with in-depth interviewing with 16 breast cancer survivors and 22 experts using a semi-structured interview guide. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The extracted data were linked to the ICF Core Set for Breast cancer and were interpreted by the IPF. RESULTS: Four main themes emerged to define the functioning of breast cancer survivors: body functioning, physical functioning, social functioning, and mental functioning. Three other factors were also categorized as modifiers of functioning personal, emotional, and environmental. The 592 extracted meaningful concepts were linked to 38 (47%) categories from the ICF: 16 Body Functions, 14 Activities and Participation, and 8 Environmental Factors. The IPF classified all the extracted concepts, and most rational appraisals fell in the biological (B) domain. The concepts that required emotional appraisal were classified in Psychology (P). CONCLUSION: Psychological and emotional factors were pivotal in defining functioning in patients with BC.

Rehabilitation specialists need to consider a holistic approach to breast cancer survivor care that addresses physical functioning and social, emotional, and environmental factors that may affect their overall well-being.The findings suggest that rehabilitation interventions that aim to improve the functioning of breast cancer survivors should target a range of areas, including body functioning, physical functioning, social functioning, and mental functioning.It is important for rehabilitation professionals to consider personal, emotional, and environmental factors that influence the functioning of breast cancer survivors when designing interventions.Using the ICF Core Set for Breast Cancer and the IPF can help rehabilitation specialists better understand the functioning of breast cancer survivors and develop more effective interventions.

Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version of the Satisfaction and Recovery Index (SRI): Structural Validity, Construct Validity, Internal Consistency, and Test-retest Reliability.

Background: The Satisfaction and Recovery Index (SRI) is a generic importance-weighted health satisfaction tool to measure the process and state of recovery following musculoskeletal injuries. The objectives of this study are (1) to translate and cross-culturally adapt the SRI to Persian and (2) evaluate its psychometric properties. Methods: The forward-backward translation technique was used for translation, and two rounds of cognitive interviews were conducted to assess cultural appropriateness. Participants (n=100, mean age=32.5, 82%male) had acute (i.e., <30 days) musculoskeletal injuries of any etiology. Structural validity, construct validity, internal consistency, and test-retest reliability were evaluated. Results: Participants identified issues in 3/6 areas of a coding system during the cognitive interviews: comprehension/clarity, relevance, and inadequate response definition. These issues informed subsequent changes to arrive at the final version of the SRI-P. The SRI-P had adequate construct validity (P<0.001), the confirmatory factor analysis demonstrated a two-factor structure, the internal consistency was acceptable (Cronbach's α=0.83), and it was deemed reliable (ICC2, 1=0.72). Conclusion: The psychometric evaluation revealed that the SRI-P has adequate construct validity, internal consistency, and test-retest reliability. Unlike the original English version, the SRI-P has a two-factor structure, which appears to be related to cultural differences in interpreting some of the items. The clinical importance of this study is that the SRI (which captures the state of recovery and how important the various items of the tool are to each patient and how satisfied they are with their recovery) can now be available to surgeons and therapists in the orthopedic and rehabilitation realms in Persian populations.

Design of a biological method for rapid detection of presence of PCR inhibitors in aged bone DNA.

BACKGROUND: Molecular human identification is one of the most important tests performed in forensic laboratories. Some of these tests are applied for identification of human remains from natural disasters, wars, etc., but problems may occur as a result of DNA degradation and external DNA contamination. We investigated effects of bacterial DNA on identifying the presence or absence of PCR inhibitors in aged bone DNA. METHODS: DNA samples were extracted from blood, bone remains and Escherichia coli. These DNA were amplified using human and bacterial specific primers. RESULTS: Using different blood, aged bone, and bacterial DNA dilutions along with PCR based methods; we checked their positive, negative effects, or detecting presence of inhibitors in aged bone DNA by PCR method. CONCLUSIONS: Our observation indicated that the addition of bacterial DNA could be a valid biological method for testing the quality of bone DNA to enable us to obtain a usable profile for the identification of human remains. This method will help to test the presence of inhibitors, quantity or even quality of DNA which are of importance in profiling archeological remains. Our method will help to determine if PCR failure is due to presence of inhibitors or lack of amplifiable DNA either because of degradation, minute amount or absence of human DNA.

Psychometric Properties of the Persian Version of the ID-Pain Questionnaire.

Background: The Identification Pain questionnaire (IDPQ) is one of the recommended tools by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain for neuropathic pain screening. This study aimed to translate, cross-culturally adapt, and validate the Persian version of the IDPQ. Methods: First, the IDPQ was translated based on the recommended guidelines. Afterward, the internal consistency (Cronbach's alpha coefficient), test-retest reliability (intraclass correlation coefficient), construct validity (compared to the Douleur Neuropathique 4 [DN4] questionnaire), and discriminant validity (Receiver operating curve analysis) of the IDPQ-P were evaluated. A total of 90 patients with neuropathic (n=50) and nociceptive pain (n=40) were enrolled in the study. In the next 72 h after the initial assessment, 30 patients (15 with neuropathic and 15 with nociceptive pain) completed the IDPQ-P. Results: No modifications were needed in the process of translation and cultural adaptation. Cronbach's alpha coefficient was obtained at 0.47 for all patients, indicating poor internal consistency. The intraclass correlation coefficient was estimated at 0.97, showing excellent test-retest reliability. A high correlation was found between the DN4 questionnaire and IDPQ-P (0.74), showing acceptable construct validity. The area under the curve was 0.94 (95% CI: 0.88-0.99) and 0.92 (95% CI: 0.85-0.99) when the physician's diagnosis and the DN4 cut-off value were used as the reference standard, respectively. The optimal cut-off value of ≥ 2 demonstrated the highest sensitivity (98%) and specificity (79%). Conclusion: The IDPQ-P can be used in the clinical setting as an accurate and quick screening tool to diagnose patients with neuropathic pain. Sufficient test-retest reliability, construct validity, discriminant validity, and high diagnostic accuracy were found for the IDPQ-P.

A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation.

PURPOSE: To critically appraise, summarize, and synthesize the evidence on the psychometric, translation and/or cross-cultural adaptation properties of the Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE). MATERIALS AND METHODS: Four electronic databases were searched from 1998 to February 2021. Studies addressing psychometric, translation and/or cross-cultural adaptation properties were included. Two independent reviewers extracted data and assessed methodological quality of the studies using the COSMIN checklist. Where possible, meta-analysis was conducted to pool the estimates of each measurement property. Otherwise, qualitative synthesis was conducted. The overall quality of evidence on each measurement property was provided using GRADE principles. RESULTS: Forty-four studies were eligible for data extraction. The PRWE/PRWHE has been translated into 21 languages. The best factor structure was a one-dimensional construct with three unidimensional subscales. High-quality evidence supports very good structural and cross-cultural validity, internal consistency, test-retest reliability, measurement error, and hypothesis testing for construct validity against DASH in wrist and hand injuries. However, low-quality evidence supports acceptable responsiveness property. The minimal clinically important difference for the PRWE/PRWHE was 24 points for patient-level comparisons and 17 for groups. CONCLUSION: High-quality evidence supports the use of PRWE/PRWHE as a reliable, valid, and structurally sound questionnaire to assess pain and disability in patients with various wrist and hand injuries. Registration code: CRD42020180250IMPLICATION FOR REHABILITATIONSThe PRWE/PRWHE is a reliable and valid anatomical region-specific measure to assess pain and disability in patients with wrist and hand injuries.Each individual subscale of the PRWE/PRHWE (pain, specific activities, and usual activities) can be used separately as a measure of pain and disability.Change scores less than 9/100 in the total score, should be considered as measurement error, not real change. Changes in the total score between 17 and 24/100 could be assumed as the minimal clinically important change in the condition of patients over time. The PRWE/PRWHE is available in 21 different languages and has been successfully adapted into highly diverse cultures. This point could be considered as one of the merits of using PRWE/PRWHE in clinical settings in multi-lingual and multi-cultural countries, when clinicians need a psychometrically sound patient reported wrist/hand measure. .

Psychometric properties of the Persian version of the neuropathic pain questionnaire.

PURPOSE: In this study, we aimed to translate, cross-culturally adapt, and validate the Persian version of the Neuropathic Pain Questionnaire (NPQ-P). METHODS: We translated the NPQ to the Persian language based on the recommended guidelines. Measurement properties (internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient), construct validity (compared to DN4 questionnaire), and discriminant ability (Receiver operating curve analysis)) of the NPQ-P were evaluated. A total of 101 patients were enrolled in the study. RESULTS: No modification was needed in the translation and cultural adaptation process. High Cronbach's alpha (0.81) and ICC (0.94) supported good reliability of the NPQ-P. The correlation coefficient between the NPQ-P and DN-4 questionnaires was 0.42, indicated moderate construct validity of the NPQ-P. The NPQ-P demonstrated acceptable discriminant ability (AUC: 0.76 (95% CI: 0.66-0.84)). A total score of -0.3 indicated the highest Youden index with a corresponding sensitivity of 0.84 and specificity of 0.64 for the NPQ-P. CONCLUSION: The NPQ was successfully translated to the Persian language and indicated acceptable reliability, diagnostic accuracy, and discriminant ability. The NPQ-P can be used in a clinical setting adjunct to physical examinations and electrodiagnostic tests for a quick screening to distinguish between patients with neuropathic and non-neuropathic pain.IMPLICATIONS FOR REHABILITATIONNeuropathic Pain Questionnaire (NPQ) can be used for a quick screening to discriminate between patients with neuropathic and nociceptive pain.Persian version of the NPQ (NPQ-P) is a reliable and accurate tool with acceptable discriminant ability.The NPQ-P should be used in clinical setting adjunct to physical examinations and electrodiagnostic tests.