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

OBJECTIVES: To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS). DESIGN: An assessor-blind randomised controlled trial. SETTING: Hospital-based hand therapy clinics. PARTICIPANTS: Fifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks. OUTCOME MEASURES: The standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen's manoeuvre test, Tinel's sign and the Boston CTS Questionnaire. RESULTS: Both groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen's manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength. CONCLUSION: Splinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6 months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs. TRIAL REGISTRATION NUMBER: ISRCTN13189602.

Manifestation of Generalized Anxiety Disorder and Its Association With Somatic Symptoms Among Occupational and Physical Therapists During the COVID-19 Pandemic.

Purpose: The purpose of the study was to examine the level of generalized anxiety disorder among occupational and physical therapists during treatment sessions and its association with somatic symptoms during the COVID-19 pandemic. Methods: A descriptive cross-sectional design was used in this study. Data were collected during the month of April 2021, and the study included occupational and physical therapists who practiced during COVID-19 from March 2020 to March 2021. The generalized anxiety disorder scale (GAD-7) and a modified patient health questionnaire (mPHQ-15) were used to examine self-reported anxiety and somatic symptoms among the study participants. The independent t-test was used to determine differences between groups based on GAD-7 and mPHQ-15 results. Spearman's correlation test and chi-squared test were used to find the relationships between different variables such as anxiety and somatic symptoms. Results: The study (n = 98 participants) included 56 occupational and 42 physical therapists. An 84% response rate was achieved. GAD-7 final score was µ = 9.21 ± 5.63 with 27% reporting no anxiety, 14% mild, 38% moderate, and 21% severe. Independent t-tests on GAD-7 scores showed significant differences between therapist specializations [t(96) = -2.256; p = 0.026] and between therapists residing with or without their parents [t(96) = -2.536; p = 0.013]. The mPHQ-15 final score was µ = 9.52 ± 5.54 with 13% reporting no symptoms (n = 13), 20% mild (n = 20), 38% moderate (n = 37), and 29% severe (n = 28). GAD-7 and mPHQ-15 scores were moderately positively correlated [r(96) = 0.569; p <0.000]. The chi-squared test showed a significant association between GAD-7 levels of anxiety and mPHQ-15 levels of somatic symptoms [x2(9, N = 98) = 70.62 p <0.000]. Therapists reported that the quality (76%) and effectiveness (20%) of their rehabilitation services were negatively impacted by the COVID-19 pandemic. Conclusion: The majority of study participants experienced moderate to severe anxiety and associated somatic symptoms. During COVID-19, ongoing psychological counseling of healthcare professionals such as occupational and physical therapists is required to maintain positive mental health. Implications for practice are presented.

In vivo evidence of lumbricals incursion into the carpal tunnel in healthy hands: An ultrasonographic cross sectional study.

INTRODUCTION: During finger flexion, the tendons of flexor digitorum profundus migrate proximally, along with their attached lumbrical muscles. This incursion was suggested to extend into the Carpal Tunnel. Ultrasonographic imaging can be used to assess in vivo soft tissue behavior and incursion. PURPOSE OF THE STUDY: To clinically quantify the lumbrical muscles incursion in different finger positions. STUDY DESIGN: Cross sectional, observational study. METHODS: The lumbricals of 20 healthy adults with no history of hand injuries were evaluated with neuromuscular ultrasound imaging (n = 160 lumbricals). The lumbrical muscles migration was measured as the participants actively moved their fingers from full extension to 50% flexion, and 100% flexion. RESULTS: Of the 160 lumbricals measures, the incursion occurred at 18.1% of fingers at 50% finger flexion, and increased to 79.4% during full finger flexion. The lumbricals migrated a total of 2.99 cm after full finger flexion, and ended up 0.76 cm (SD = 0.86 cm) inside the Carpal Tunnel. The metacarpophalangeal joint range of motion of the index finger at the point where the lumbricals entered the distal border of the Transverse Carpal Ligament was 84.4° (SD = 6.8°). The Carpal Tunnel cross-sectional area during finger extension was 1.68 (0.35) cm2, and increased to 1.81 (0.33) cm2 after full finger flexion. CONCLUSION: This study showed direct evidence of lumbrical incursion into the Carpal Tunnel during finger flexion. The cross-sectional area of the Carpal Tunnel increased during full finger flexion in comparison to full finger extension, supplementing the evidence of increase content within the Carpal Tunnel. The findings of this study have significant clinical implications for the conservative treatment of the Capral Tunnel Syndrome.

Gender differences in quality of life, physical activity, and risk of hypertension among sedentary occupation workers.

PURPOSE: This study aimed to explore gender differences among sedentary occupation workers with regard to their quality of life (QoL), physical activity, and risk for high blood pressure, and to identify factors associated with QoL. METHODS: A convenience sample of 2562 employees from randomly selected ten ministries in Kuwait completed self-administered questionnaires. Collected data included employees' socio-demographic characteristics, levels of QoL (using World Health Organization QoL-Brief tool), and physical activity (using the New Zealand Physical Activity Questionnaire Short Form), and anthropometric measures of weight, height, and blood pressure. Multinomial regression analysis, Chi-square, ANOVA, and student's t tests were implemented. A p value of 0.05 was considered significant. RESULTS: Participants' mean age was 35.3 years. QoL mean scores were total QoL (74.7), physical health (81.1), psychological health (75.4), social relationship (71.1), and environment (70.8). Females showed worse level of QoL, better physical activity, and higher prevalence of hypertension relative to males. Multinomial regression analysis revealed that female gender, low educational attainability, poor income, high job ranks, shorter working years, obesity, physical inactivity, hypertension, or having at least one chronic illness significantly correlated to fair and poor QoL. CONCLUSION: Sedentary occupation workers reported modest level of QoL and were at high risk of hypertension. Socio-demographic factors, physical activity, and health status were correlated to QoL. Gender differences existed in QoL, physical activity, and risk of hypertension. Improving employees' QoL through adopting strategies to promote healthy lifestyle in work settings should be activated. Further studies are recommended to explore cultural factors that drive gender differences in QoL.

Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective.

This exploratory study was aimed at evaluating the current status of global occupational therapy practice on the use of assessments for clients with cognitive impairments and providing recommendations for ongoing evidence. We targeted international occupational therapy clinicians working with clients experiencing neurocognitive impairments. 323 occupational therapists from a wide range of clinical practice areas participated in the study. A large number of therapists used noncognitive specific assessments with a focus on functional approaches. The most commonly used standardized assessments were the COPM (56.7%), followed by MMSE (54.2%) and MoCA (45.5%), while the nonstandardized assessments were clinical observation (38.4%) and generic ADL assessment (34.1%). The use of main assessments was significantly different across world regions (p < 0.05), as were the reasons for choosing them (p < 0.05). The occupational therapists' use of assessment tools with clients suffering from neurocognitive impairments is inconsistent across the globe. The identification of international best practices for selecting and implementing proper outcome measures is warranted. It is essential to promote the development of an occupational therapy initiative to support the use of appropriate assessments at the international levels to facilitate consistent best practice.

Knowledge about and Attitudes of Interdisciplinary Team Members toward Occupational Therapy Practice: Implications and Future Directions.

OBJECTIVES: In Kuwait, knowledge and attitudes of the health care teams toward occupational therapy practice (OTP) have not been investigated. This current study sought to explore the knowledge about and attitudes of interdisciplinary team members toward OTP. SUBJECTS AND METHODS: This cross-sectional study involved developing and validating a tool to serve the purpose of the study. We used a modified Delphi method to develop a tool that assessed occupational therapy (OT) knowledge (OT areas of practice, domains, and philosophy) as well as attitudes toward OTP. Descriptive statistics were utilized, and nonparametric tests were used to compare knowledge and attitudes along with the demographic data. RESULTS: A convenience sample of 98 participants from various disciplines participated in this study. The tool was found to have an adequate content validity for a total of 27 items and satisfactory reliability (internal consistency); Cronbach's α-values for the knowledge and attitudes subscales were 0.88 and 0.74, respectively. The overall knowledge level of OTP among the participants was limited, whereas their attitudes were favorable. Characteristics of being a female (p = 0.01), a nurse (p = 0.02), and working experiences ≥10 years (p = 0.01) contributed significantly to the knowledge of OTP. The results further indicated that participants working in general hospitals (p = 0.02) and working with occupational therapists (p < 0.001) showed significantly better attitudes toward OTP. CONCLUSION: For effective collaborative practice and better patients' outcomes, the study findings recommend the development of interprofessional initiative committees targeting educational settings as well as clinical environments.

MS People's Performance and Satisfaction With Daily Occupations: Implications for Occupational Therapy.

People with multiple sclerosis (MS) face difficulties in performing daily occupations. The objectives of this study were to assess the performance of and level of satisfaction with daily occupations among people with MS, and to explore factors associated with their performance and satisfaction. A cross-sectional study was conducted among 200 MS individuals. The Arabic version of Satisfaction With Daily Occupations (SDO) scale was used. Mann-Whitney U, Kruskal-Wallis, Chi-square tests, and binary logistic regression were used for data analysis. SDO performance and satisfaction median scores were 10/14 and 51/70, respectively. Multivariate analysis revealed that unemployment and cognitive symptoms were associated with poor occupational performance. Furthermore, unemployment, being married, visual problems, and low endurance were significant correlates of poor satisfaction with performing daily occupations. Social and clinical factors contributed to dissatisfaction with the poor performance of daily occupations among people with MS. Intervention studies are needed to investigate the role of occupational therapy in improving the performance of daily occupations in people with MS.

Survey of cognitive rehabilitation practices in the state of Kuwait.

Background Rehabilitation professionals must be astute at recognizing, assessing, and treating individuals with cognitive deficits. No research is available to examine cognitive rehabilitation practices applied to individuals with neurological conditions in Kuwait. OBJECTIVES: To identify the use of cognitive assessments, the availability of resources, and the barriers to cognitive rehabilitation practices in Kuwait. Methods Face-to-face interviews were conducted with health care professionals working with adult individuals with neurological conditions. These professionals included occupational therapists, speech-language pathologists, psychiatrists, and neurologists. Results The most commonly used cognitive based assessments are MMSE (41%), and MoCA and LOTCA (15.2%). The only clinical assessment used is the Line-Bisection Test (2.2%). The most used occupation-based assessments are FIM (6.5%), COPM (4.3%), the Interest Checklist (2.2%), and the Barthel Index (2.2%). Resources related to cognitive rehabilitation in Kuwait that are unavailable to practitioners include journal clubs (91%), special interest groups (89%), and continuing education programmes (82.6%). Barriers to cognitive rehabilitation practice included lack of sufficient funds for continuing education, lack of time, lack of standardized assessments, and lack of inter-professional teamwork. Conclusion Many adults in Kuwait live with cognitive impairment. There is a need to develop appropriate evidence-based cognitive rehabilitation clinical guidelines in Kuwait.

The Cognitive Functions in Adults with Chronic Pain: A Comparative Study.

Background. Several studies have reported an association between chronic pain and reduction of cognitive abilities of adults living in Western cultures. No literature could be found on the relationship between chronic pain and cognition among Middle Eastern adults. Objective. To compare four of the most commonly reported cognitive domains [memory, attention, processing speed, and executive functioning] among Middle Eastern adults with and without chronic pain. Methods. This matched group comparative study included 69 community residing and functionally independent Middle Eastern adults. Forty participants had chronic pain and 29 were pain-free. We administered five standardized cognitive assessments that are independent of culture and language to measure variable tasks of memory, attention, processing speed, and executive functioning. The study was conducted in a rehabilitation research setting with a controlled environment. Results. Evidence of decreased cognitive processing was found in patients with chronic pain. The chronic pain participants performed significantly worse than the pain-free participants on the cognitive measures of long-term memory, selective attention, processing speed, and executive functioning. Conclusion. The effect of Middle Eastern culture on the cognitive abilities of patients with chronic pain was negligible. Despite the wide variations between Eastern and Western cultures, the performance of our Middle Eastern participants in this study was consistent with performance of Western adults reported in previous studies.

A Comparison of the Quality of Life of Arab Mothers of Children with and without Chronic Disabilities.

AIM: To compare the quality of life (QoL) of Arab mothers in Kuwait who had children with chronic disabilities and those whose children had no disabilities and provide recommendations for how occupational therapists can assist in enhancing the mothers' QOL. METHODS: The case group included 71 mothers of children with chronic disabilities and a control group of 86 mothers of children without disabilities. Mothers' QoL was assessed using the Arabic WHOQOL-BREF questionnaire and the support systems of mothers of children with disabilities using a support questionnaire. RESULTS: The QoL of mothers of children with disabilities was significantly lower than that of mothers of healthy children (p < .001) in all four domains of WHOQOL-BREF (physical health, psychological wellbeing, social relationships, and environment). Mothers of children with disabilities reported that they received most support from their nuclear family. There was a lack of formal support systems in place in Kuwait. CONCLUSION: Mothers of children with disabilities perceive their QoL as poor and they have limited support systems. Occupational therapists are encouraged to serve as a resource for families, sharing information including available services and community resources, and supporting mothers as competent caregivers.