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.

Applications of wearable sensors in upper extremity MSK conditions: a scoping review.

PURPOSE: This scoping review uniquely aims to map the current state of the literature on the applications of wearable sensors in people with or at risk of developing upper extremity musculoskeletal (UE-MSK) conditions, considering that MSK conditions or disorders have the highest rate of prevalence among other types of conditions or disorders that contribute to the need for rehabilitation services. MATERIALS AND METHODS: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews guideline was followed in this scoping review. Two independent authors conducted a systematic search of four databases, including PubMed, Embase, Scopus, and IEEEXplore. We included studies that have applied wearable sensors on people with or at risk of developing UE-MSK condition published after 2010. We extracted study designs, aims, number of participants, sensor placement locations, sensor types, and number, and outcome(s) of interest from the included studies. The overall findings of our scoping review are presented in tables and diagrams to map an overview of the existing applications. RESULTS: The final review encompassed 80 studies categorized into clinical population (31 studies), workers' population (31 studies), and general wearable design/performance studies (18 studies). Most were observational, with 2 RCTs in workers' studies. Clinical studies focused on UE-MSK conditions like rotator cuff tear and arthritis. Workers' studies involved industrial workers, surgeons, farmers, and at-risk healthy individuals. Wearable sensors were utilized for objective motion assessment, home-based rehabilitation monitoring, daily activity recording, physical risk characterization, and ergonomic assessments. IMU sensors were prevalent in designs (84%), with a minority including sEMG sensors (16%). Assessment applications dominated (80%), while treatment-focused studies constituted 20%. Home-based applicability was noted in 21% of the studies. CONCLUSION: Wearable sensor technologies have been increasingly applied to the health care field. These applications include clinical assessments, home-based treatments of MSK disorders, and monitoring of workers' population in non-standardized areas such as work environments. Assessment-focused studies predominate over treatment studies. Additionally, wearable sensor designs predominantly use IMU sensors, with a subset of studies incorporating sEMG and other sensor types in wearable platforms to capture muscle activity and inertial data for the assessment or rehabilitation of MSK conditions.

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.

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.

Trigeminal neuralgia: IncobotulinumtoxinA (Xeomin), can it decrease the pharmacological intervention? (A case series).

Background: Trigeminal neuralgia is one of the most disabling facial pain syndromes. In recent years' new therapeutic strategy, incobotulinumtoxin A has emerged. The aim of the current study was to determine the time and duration of pain in 3 cases with pharmacological treatment and incobotulinumtoxin A. Case presentation: In three patients with different onsets, trigeminal neuralgia was diagnosed. Pain severity was assessed by the visual analogue scale. Patient demographics and clinical data were filled in a checklist. They were females with age ranging from 39 to 49 years. Two patients had normal MRI and one patient had no any recent MRI. One center and specialist injection Xeomin 50 units for one time. Despite long time oral treatment, their symptoms had no significant improvement, but after incobotulinumtoxin A injection, pain frequency, severity and duration decreased in patients. Conclusion: Result showed that the frequency, severity and duration of pain attacks was efficiently decreased by incobotulinumtoxin A with low side-effects. Its complication and side-effect should be considered in the future.

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.

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.

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.

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.

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).

Clinimetric testing of the Persian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires in patients with lateral elbow tendinopathy.

PURPOSE: To evaluate the longitudinal validity and responsiveness of the Persian version of Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) in patients with lateral elbow tendinopathy (LET). METHODS: Sixty-four patients with LET completed the PRTEE, DASH, and Global Rating of Change Scale (GRC) at baseline and six weeks. The external and internal responsiveness, floor and ceiling effects, minimal detectable change (MDC) and minimal clinically important difference (MCID) were calculated. RESULTS: No ceiling and floor effects were detected for either the PRTEE or DASH. External responsiveness as an indicator to detect the relationship between change in the measured and external indicator of change was acceptable for both, but higher for the PRTEE (AUC = 0.90; CI: 0.83-0.97) vs. DASH (AUC = 0.80; CI: 69-90). Internal responsiveness to detect intervention related changes indicated slightly superiority in responsiveness for PRTEE. The relative efficiency (1.21), standard effect size (1.14 PRTEE vs. 1.03 DASH), and standard response mean (1.34 PRTEE vs. 1.10 DASH). The MDC were 11 and 12, and MCID were 20 and 18 for the PRTEE and DASH, respectively. CONCLUSIONS: Both the DASH and PRTEE were responsive in detecting improvement in patients with LET. The PRTEE was shorter, more efficient, and slightly more responsive which supports its use as a core outcome measure in evaluating patients with LET.Implications for RehabilitationThe Patient-Rated Tennis Elbow Evaluation (PRTEE) compared with the Disability of the Arm, Shoulder, and Hand (DASH) is a shorter questionnaire with higher psychometric and clinimetric properties for evaluating the patients with lateral elbow tendinopathy.This supports the use of the PRTEE in evaluating patients with elbow tendinopathy.

Psychometric properties and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation (PRTEE); a systematic review and meta-analysis.

PURPOSE: To synthesize and appraise the evidence on the translation, cross-cultural adaptation, and psychometric properties of the Patient-Rated Tennis Elbow Evaluation (PRTEE). METHOD: Five electronic databases were searched from 1999 to 2021. Two independent reviewers assessed the risk of bias and quality of the included studies using the COSMIN recommended guidelines. The overall quality of the evidence on each psychometric property was provided using the GRADE approach. RESULTS: Twenty-one studies met the criteria for inclusion in this review. The PRTEE was translated and cross-culturally adapted to 13 languages and cultures. High quality of evidence supports sufficient pooled results for test-retest reliability (0.96(CI: 0.94-0.97)), construct validity (against Disabilities of the Arm, Shoulder, and Hand (DASH): 0.81(CI: 0.76-0.85), against Visual Analogue Scale (VAS): 0.70 (0.62-0.74)), and responsiveness of the PRTEE. The overall rating of the structural validity and internal consistency (0.96(CI: 0.94-0.97)) was indeterminate, and the quality of evidence was low and moderate, respectively. Regarding measurement error, the overall rating of the summarized results (Standard error of measurement (SEM): 3.1 (1.8 to 4.4) and Minimal Detectable Change (MDC95): 8.9 (5.3-12.5)) was sufficient, and the quality of evidence was moderate. CONCLUSION: Moderate to high quality evidence supports adequate psychometric properties of the PRTEE in terms of internal consistency, test-retest reliability, measurement error, hypothesis testing for construct validity, and responsiveness.Implications for RehabilitationThe PRTEE can measure the construct of pain and disability at a single time-point and detect changes over time precisely.The PRTEE can be used in clinical setting for patients with acute, subacute, and chronic Lateral Elbow Tendinopathy (LET), athletes who suffer from elbow pain and tennis players.

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.

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.

A Systematic Review of Self-Reported Outcome Measures Assessing Disability Following Hand and Upper Extremity Conditions in Persian Population.

BACKGROUND: Disability following hand and upper extremity conditions is common. Patient-reported outcome measures (PROs) are used to capture patients' status subjectively. This review has aimed to synthesis the literature regarding the extent and methodological quality of translation, cross-cultural adaptation, and psychometric properties of the hand and upper extremity disability PROs in the Persian language. METHODS: Seven electronic databases (MEDLINE, EMBASE, Psychinfo, Scopus, ISI, Science direct, and Google Scholar) were searched until May 2020. Studies reporting cross-cultural adaptation and psychometric properties testing of the Persian validated disability PROs of the hand and upper extremity were identified. We appraised the eligible studies using Guidelines for the Process of Cross-cultural Adaptation of Self-report Measures and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. RESULTS: Out of 98 identified records, 22 studies on 17 PROs were reviewed. Most of the PROs (47%) were region-specific and the others were condition-specific (29%) and multi-region (24%). Most of the studies (67%) followed 80 to 100% of the recommended steps for cross-cultural adaptation and translation of a PRO. The evidence of internal consistency, test-retest reliability, and construct validity was available for all the PROs. Structural validity, measurement error, and responsiveness were evaluated for five, six, and four PROs, respectively. The overall risk of bias ranged from "inadequate" to "very good" for all studies. CONCLUSION: A reasonable number of PROs for the evaluation of hand and upper extremity disability are available in the Persian language. Although all of them are not of very good psychometric properties, they all have sufficient quality to be used in clinical settings.