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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Outcomes at 3 Months of a Place and Active Hold Method of Flexor Tendon Rehabilitation Following Zone II Injury.

Background: Previous studies have shown that outcomes following a place and active hold (PAH) are better than a passive flexion protocol after a two-strand core-suture repair of flexor tendons injuries in zone II. This study aims to determine the outcomes of a PAH protocol of flexor tendon rehabilitation following a four-strand core-suture plus an epitendinous suture repair of the flexor digitorum profundus (FDP) combined with a simple horizontal loop repair of the flexor digitorum superficialis (FDS). Methods: This is a prospective study of patients with complete injury to both flexor tendons in zone II. All tendons were repaired with a simple horizontal loop for FDS and four-strand core-suture plus epitendinous suture for FDP. The PAH protocol was used postoperatively for 6 weeks. The outcome was evaluated using flexion contracture and total active motion (TAM), interpreted using Strickland criteria and categorised as excellent, good, fair and poor at 6 weeks and 3 months. The linear regression model was used to determine predictors of outcomes. Results: The study included 32 patients with flexor tendon injury in 46 fingers. No repairs ruptured, and 24 (52%) digits achieved good or excellent motion 6 weeks after surgery using the Strickland criteria. According to the Strickland criteria, 41 (89%) digits ranked as excellent and good with no poor result at a 3-month follow-up. Four patients had 5-10° of flexion contracture. Age was the predictor of TAM at 6 weeks and accounted for 13% of its variation. Improvement of TAM from 6 weeks to 3 months was related to age and flexion contracture at 6 weeks. Conclusions: The PAH protocol can be considered a safe technique for flexor rehabilitation after four-strand core-suture repair of FDP in zone II. Level of Evidence: Level IV (Therapeutic).

Assessing the content based on ICF and quality based on COSMIN criteria of patient-reported outcome measures of functioning in breast cancer survivors: a systematic review.

PURPOSE: To identify currently used patient-reported outcome measures (PROMs) to evaluate disability in breast cancer survivors (BC) and critically evaluate their content and measurement properties. METHODS: Four electronic databases (PubMed, EMBASE, CINAHL, Scopus and Google Scholar) were searched from 2001 to February 2021. PRISMA guidelines were followed. The content of the included PROM was evaluated by linking the items of the questionnaires to the International Classification of Functioning, Disability and Health (ICF) Core Set for BC using standard linking rules. Methodological quality and measurement properties were assessed using the COSMIN checklist. Qualitative synthesis was used to summarize the evidence on content validity and measurement properties. The overall quality of evidence on each measurement property was provided using GRADE principles. RESULTS: Ten eligible studies reported measurement properties of seven PROMs. The content of included PROMs mostly focused on disability (70% of items), and less on body function and structure (23%) or environmental factors (6%). There was high linkage to The Comprehensive Core Set for BC, Q-DASH (100%), UEFI (95%) and DASH (92%). The Core Set Unique Disability Representation for DASH, and WHODAS2 was 39% and BCSQ-BC, Lymph-ICF was 34%. BCSQ-BC, and Lymph-ICF represented 32, and 20% of the content of the Core Set for BC, respectively, however, the other questionnaires covered less than 20% of the content of the Core Set. High quality of evidence supports sufficient results for internal consistency, testretest, and measurement error for BCSQ-BC, Lymph-ICF, DASH and WHODAS2. CONCLUSIONS: Despite a lack of evidence on all-important clinical measurement, two generic (DASH and WHODAS2) and two disease-specific (BCSQ-BC, Lymph-ICF) PROM demonstrated emerging evidence of adequate measurement properties. The stronger alignment of the BCSQ-BC to the breast cancer ICF core set makes it preferable is a disease-specific measure. The Lymph-ICF is recommended where lymphedema is a specific focus. The DASH and WHODAS2 might be most useful where patients with a variety of upper extremity conditions, including breast cancer survivors, are being evaluated in the clinic or research study.

Factors associated with disability and pain intensity in patients with complex regional pain syndrome.

PURPOSE: To examine the associations between psychological factors (pain catastrophizing, pain-related anxiety, and fear of pain) and level of pain and disability in patients with complex regional pain syndrome (CRPS). METHODS: One hundred and two patients with CRPS were recruited from tertiary care centers with the different upper limb injuries were evaluated for pain, disability, and psychological factors. Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Patient Rated Wrist Evaluation (PRWE), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK-11), and Depression, Anxiety, and Stress Scale (DASS). The associations of pain and disability with presence of these behavioral and mental health factors were examined using bivariate and multivariable analyses. These models were adjusted for age, sex, injured dominant hand, and previous surgery. RESULTS: A higher pain catastrophizing score (ß = 0.55, p = 0.00) was associated with greater disability. A higher pain catastrophizing score (ß = 0.35, p = 0.001) and female gender (ß = 0.24, p = 0.01) were associated with greater pain at rest (PAR). A higher pain catastrophizing score and having a surgical history were associated with greater pain with movement (ß = 0.25, p = 0.02). Scores of ≥18.5 in PCS, ≥57.5 on TSK, and ≥15.5 on DASS were associated with higher risk of experiencing pain and disability. CONCLUSIONS: Pain catastrophizing, female sex, and surgical intervention are associated with poor outcomes. Physiologic, psychological factors, and treatment factors interact to influence outcomes. The results of this study further validate the associations of chronic pain and disability with pain catastrophizing in patients with CRPS. The novel finding of this study is introducing cut-off scores for TSK, PCS, and DASS as a screening tool to predict pain, functional limitations.Implication for rehabilitationPain catastrophizing has a vital role in the magnitude of disability and pain in patients with CRPS.The novel finding of this paper was the cut-off scores on the psychological evaluations that can enable using them as screening tool for bad outcomes in patients with CRPS.Cut off scores from different psychological evaluations can be used as a yellow flag for clinician's for detecting patients with increased risk of pain and disability.The identification of a cut-off can also have implications for implementing change in clinical practice by identifying the need for early and intensive interventions.

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.

Measurement properties of the Michigan hand outcomes questionnaire: Rasch analysis of responses from a traumatic hand injury population.

PURPOSE: This study aimed to use Rasch analysis to test the content, scoring, and measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ). METHODS: MHQ scores from 196 patients with hand and wrist conditions were collected in an outpatient hand rehabilitation facility. Rasch analysis was conducted to assess the fit statistics of MHQ to confirm the scaling structure of disability subscales, and to identify differential item functioning. RESULTS: The MHQ did not fit with the Rasch model (χ2 = 2376.78, df = 74, p < 0.001), and most thresholds of item responses were disordered. The original scoring algorithm derived from 5-point Likert response options was adjusted to 3-point Likert (10 items) and 4-point Likert (11 items) based on the visual inspection of the thresholds map. Differential item functioning was present in the revised scale based on the age, sex, and dominant hand. Only 3 revised subscales of the MHQ including activities daily living (one hand), aesthetics, and satisfaction showed acceptable fit to the Rasch model. Unidimensionality was achieved in all revised subscales. CONCLUSIONS: The overall MHQ had a substantial misfit from the Rasch model. Despite efforts of item reduction and rescoring, we did not reach a satisfactory solution. This calls into question the validity of the statistical evaluations performed on this scale using the traditional scoring.Implications for rehabilitationThe MHQ was designed to measure different dimensions of pain and disability but demonstrates multiple measurement problems that undermine it use in present form.It is not appropriate to sum all 37 items of the MHQ into a single score.Three subscales of activities daily living (one hand), aesthetics, and satisfaction can provide unidimensional subscales scores with interval level scaling if scored with our proposed Rasch-based revised scoring.The 27-item version of the MHQ is shown to have strong psychometric properties for administration with patients with hand injuries; however, it requires further validation.

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.

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. .