Swan neck deformities in rheumatoid arthritis: a qualitative study on the patients' perspectives on hand function problems and finger splints.

OBJECTIVE: To identify hand function problems and the reasons for choosing a specific finger splint in patients with rheumatoid arthritis (RA) and swan neck deformities. METHODS: A qualitative study was performed alongside a randomized, controlled cross-over trial comparing the effectiveness of two types of finger splints (the silver ring splint [SRS] and the prefabricated thermoplastic splint [PTS]) in 50 patients with RA and swan neck deformities. Questions on the patients' main hand function problem and reasons for choosing a specific splint type were performed at baseline and after using each splint. The qualitative analyses included the identification of meaning units and (sub)concepts related to hand function problems and splint preferences. RESULTS: RA patients with swan neck deformities experience problems with flexion initiation, painful proximal interphalangeal joint hyperextension, grip activities and comprehensive hand function activities. Reasons for preferring or not preferring a specific type of finger splint included: effect, ease of use, appearance, comfort and side effects. Apart from the splint slipping off and a negative attitude towards the appearance of the splint, which appeared to be more frequently mentioned in connection with the SRS, no clear pattern of positive or negative appreciation of either type of splint could be distinguished. CONCLUSION: RA patients with swan neck deformities experience a variety of problems, including impairments in functions and limitations in daily activities. With the prescription of finger splints, a substantial number of potentially positive and negative consequences of their use need to be taken into account.

Effectiveness of two finger splints for swan neck deformity in patients with rheumatoid arthritis: a randomized, crossover trial.

OBJECTIVE: To compare the effectiveness and acceptability of silver ring splints (SRS) and commercial prefabricated thermoplastic splints (PTS) in treating swan neck deformities in patients with rheumatoid arthritis (RA). METHODS: Consecutive patients with RA and a mobile swan neck deformity were included in a randomized, crossover trial. In 2 different sequences, patients used both splints for 4 weeks, with a washout period of 2 weeks. Afterward, patients used the preferred splint for another 12 weeks. The primary outcome measure was dexterity measured with the Sequential Occupational Dexterity Assessment (SODA). Secondary outcome measures included other measures of hand function, satisfaction with the splints, and splint preference. RESULTS: Fifty patients were included, and 47 (94%) of those completed the study. Eighteen patients (36%) had 1 swan neck deformity, whereas the other patients had 2 or more. The improvement of the total SODA score with the SRS (11.2; 95% confidence interval [95% CI] 8.1, 14.3) and PTS (10.8; 95% CI 7.5, 14.1) was similar (difference -0.5; 95% CI -2.2, 1.2). In addition, there were no significant differences in change scores regarding the other clinical outcome measures, or satisfaction. Twenty-four patients preferred the SRS, 21 preferred the PTS, and 2 patients chose neither. A comparison in the 12-week followup period yielded similar clinical outcomes, with the exception of a significantly higher score in 3 items of satisfaction in the SRS group. CONCLUSION: For patients with RA and a mobile swan neck deformity, SRS and PTS are equally effective and acceptable.

Community education for stroke awareness: An efficacy study.

BACKGROUND AND PURPOSE: This study examined the effectiveness of a slide/audio community education program aimed at increasing knowledge of stroke risk factors, stroke warning signs, and action needed when stroke warning signs occur. The program targets audiences at higher risk for stroke, especially individuals who are black or >50 years of age. METHODS: Subjects were 657 adults living in the community or in senior independent-living settings. The study examined the effectiveness of the program when presented alone and when accompanied by discussion (facilitation) led by a trained individual. Knowledge of stroke risk factors and warning signs was assessed using parallel pretests and posttests developed and validated specifically for the study. RESULTS: ANCOVA indicated that neither pretesting nor facilitation had a significant effect on posttest measures of knowledge. Paired t tests of groups receiving both the pretest and posttest demonstrated significant increase in knowledge (mean increase, 10.87%; P<0.001). ANCOVA indicated that these gains in knowledge were similar across subjects of different sex, race, age, and educational level. No significant differences could be ascribed to facilitation. CONCLUSIONS: The data indicate that the slide/audio program is effective in increasing knowledge of stroke risk factors, warning signs, and necessary action in subjects of varying ages, races, and education. Pretesting and facilitation did not significantly affect the short-term acquisition of information. The slide/audio program appears to offer a short, easily used educational experience for diverse communities, whether as a stand-alone program or with facilitated discussion.

Neoprene splinting: dermatological issues.

Occupational therapists are expanding their use of custom and commercial soft splints fabricated from neoprene (polychloroprene), but little has been written regarding dermatological issues associated with this material. Skin contact with neoprene poses two dermatological risks: allergic contact dermatitis (ACD) and miliaria rubra (i.e., prickly heat). Allergic reaction to neoprene is generally ascribed to the accelerants used to manufacture the man-made rubber, specifically thiourea compounds and mercaptobenzothiazole (MBT). Symptoms of neoprene-related ACD include itching, skin eruptions, swelling, and hemorrhages into the skin. Miliaria rubra creates small, red, elevated, inflammatory papules and a tingling, burning sensation. Although neoprene hypersensitivity is rare, its incidence may grow as neoprene becomes a more commonly used material. It is recommended that therapists screen patients for a history of dermatological reactions to neoprene or other materials containing thiourea compounds or MBT and educate patients to discontinue splint use if dermatological symptoms develop. Therapists are also encouraged to notify splint manufacturers regarding all ACD reactions.

Commercial wrist extensor orthoses: a descriptive study of use and preference in patients with rheumatoid arthritis.

OBJECTIVE: To describe patients' functional uses of 3 commercial wrist orthoses, to describe patients' preference patterns for the orthoses, and to clarify orthotic attributes that are viewed positively and negatively. METHODS: Using a cross-over design, 42 patients with definite rheumatoid arthritis used each of 3 commercial orthoses for one week. There was a one-week wash-out between each week of use. At the end of the study, private semi-structured interviews were conducted with each participant. Data from close-ended questions were tabulated. Open-ended data were analyzed using qualitative methods. RESULTS: Patients reported that the 3 commercial wrist orthoses reduced wrist pain similarly, but that comfort and a sense of security during functional tasks were only found if the orthoses were comfortable and well-fitting. Most subjects preferred the padded, short forearm orthosis, though a small number found it uncomfortably warm, and many complained that it was difficult to use when wearing long-sleeved garments. Common complaints about the two elastic orthoses included chafing at the thumb webspace and chafing at the proximal closures. Longer forearm length was often perceived as providing unnecessarily high levels of wrist support. CONCLUSIONS: No single orthosis suited all subjects. Satisfaction with an orthosis appears to be based not only on its therapeutic effect, but also the comfort and ease of its use. To maximize patient satisfaction and improve the likelihood of appropriate fit and comfort, several styles of commercial orthoses should be available. The current trend toward restricted clinic stocks appears contrary to both therapeutic goals and patient satisfaction.

Finger dexterity and hand function: effect of three commercial wrist extensor orthoses on patients with rheumatoid arthritis.

OBJECTIVE: To investigate the effect of 3 commercial wrist orthoses on finger dexterity and hand function of patients with rheumatoid arthritis (RA). METHODS: Forty-two patients with definite RA participated in the cross-over study comparing 3 styles of commercial wrist orthoses. Finger dexterity and hand function of the dominant hand were assessed while splinted and unsplinted, at the initial session and after 1 week of intermittent orthosis use. Finger dexterity was assessed using two subtests from the Purdue Pegboard Test (Purdue) and hand function was assessed using the Jebsen-Taylor Hand Function Test (Jebsen-Taylor). RESULTS: Both finger dexterity and hand function were reduced by splinting; men and women were affected similarly. There was no difference in finger dexterity or hand function afforded by the 3 orthoses. Results on both the Purdue and Jebsen-Taylor tests showed a significant learning effect across time. CONCLUSIONS: The 3 commercial wrist orthoses studied reduce dexterity similarly and significantly. When commercial wrist orthoses are to be used during tasks that require maximum dexterity, this reduction should be weighed against the known benefits of splinting.

Immediate and short-term effects of three commercial wrist extensor orthoses on grip strength and function in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function. METHODS: Thirty-six patients with definite rheumatoid arthritis participated in the randomized, controlled, cross-over design study of 3 commercial wrist extensor orthoses. Dominant-hand dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted. Functional impact was assessed using a written questionnaire. RESULTS: All 3 commercial orthoses reduced grip strength when first donned. After a 1-week adjustment period, one orthosis, the Smith and Nephew Roylan D-Ring (Roylan), afforded splinted grip strength equal to that of the nonsplinted grip strength. The other 2 orthoses continued to reduce grip strength, and afforded splinted grip strength significantly below that of the Roylan. The Roylan was deemed comfortable by more subjects than the other orthoses. CONCLUSIONS: The belief that commercial orthotic use increases grip strength, either immediately or after 1 week, is not supported by this study's data. Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength.

Grip strength and finger dexterity across five styles of commercial wrist orthoses.

OBJECTIVE: Five styles of commercial static wrist extensor orthoses were compared to determine whether any style, or styles, afforded better power grip strength or finger dexterity. Because wrist extensor orthoses are intended for use during functional tasks, their influence on hand function is of great importance. METHOD: Twenty-three right-hand-dominant women without upper extremity dysfunction participated in this crossover study. Dominant-hand finger dexterity and power grip strength were evaluated while wearing each of five commercial orthoses-Kendall-Futuro #33 (Futuro), AliMed Freedom Long (AliMed Long), AliMed Freedom Short (AliMed Short), Smith & Nephew Rolyan D-Ring (Rolyan), and LMB Wrist Rest (LMB)--and while using the dominant hand without an orthosis (free hand). Finger dexterity was assessed with the unimanual subtest of the Purdue Pegboard. Grip strength was assessed with a Jamar hydraulic dynamometer. RESULTS: Four of the study orthoses (Futuro, AliMed Short, Rolyan, and LMB) afforded finger dexterity that did not differ significantly from that of the free hand. The AliMed Long orthosis slowed finger speed when compared with the speeds afforded by both the LMB orthosis and the free hand. The Rolyan orthosis permitted a power grip strength that was not significantly different from the free hand. The other four commercial orthoses reduced grip strength when compared with the strength observed when wearing a Rolyan orthosis and when gripping with a free hand. CONCLUSION: The five styles of commercial orthoses affect power grip and finger dexterity differently. When power grip or finger dexterity are priorities, differences among the orthoses furnish grounds for initial suggestions, although medical needs and patient preference should be the overriding factors in the final selection of an orthosis.

A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples.

BACKGROUND: The purpose of this study was to assess the sexual and psychosocial efficacy of clomipramine for rapid ejaculation. METHODS: Fifteen physically healthy, self-selected couples (men had a mean age of 38 years) who met six eligibility criteria and did not meet five exclusion criteria participated in a variable-length, repeated measures, randomized, double-blind, placebo-controlled crossover study with a 2-month follow-up period. Sexual and psychosocial assessments were conducted at baseline, after placebo, after 25 mg/day of clomipramine, after 50 mg/day of clomipramine, and at the 2-month follow-up point. The major outcome measures included stopwatch timing of ejaculation latencies, modified Case Western Reserve University Sexual Function Questionnaire, Symptom Checklist-90-R, Dyadic Adjustment Scale, State-Trait Anxiety Inventory, and the Harder Self-Esteem Inventory. RESULTS: Baseline mean ejaculatory latency was 81 seconds; 25 mg/day of clomipramine increased it to 202 seconds and 50 mg/day of clomipramine to 419 seconds. This resulted in significantly greater sexual satisfaction scores for men and their partners (men, p < .001; women, p < .05), improvements in partner coital orgasmic attainment, and greater relationship and emotional satisfaction for the men. Withdrawal of the drug caused ejaculatory latencies to return to baseline. CONCLUSION: Clomipramine appears to be effective in significantly lengthening ejaculatory latencies and increasing sexual and relationship satisfaction. It can be a cost-effective chronic therapy for selected patients. These impressive results should not be expected in a less carefully screened population of men concerned about the timing of their orgasm during intercourse.

Commercial wrist extensor orthoses. Hand function, comfort, and interference across five styles.

Commercial static wrist extensor orthoses are frequently used when joint support, rather than immobilization, is desired. This study compared hand function, comfort, and interference during daily tasks when 23 able-bodied women used their unencumbered dominant hands and when they wore each of five commercial static wrist extensor orthoses: Kendall-Futuro #33, AliMed Freedom Long, AliMed Freedom Short, Rolyan D-Ring, and LMB Wrist Rest. There was no significant difference in hand speeds among the orthoses for six of the seven tasks within the Jebsen-Taylor Hand Function Test. However, when subject comfort and interference during daily activities were considered in conjunction with speed, the shorter padded orthosis (represented by the Rolyan D-ring) appeared to be a desirable "first choice" among the commercial orthoses that were studied.

Efficacy and efficiency: self-designed versus instructor-designed study tools.

During the course of their education, occupational therapy students learn to administer complex structured assessments. For easier administration of these assessments, students design note cards, which then replace cumbersome test manuals during administration. This study considered whether students could learn test administration with equal efficiency and efficacy if given test administration note cards rather than having to design their own. The results showed that the subjects using instructor-designed cards earned written test and practical examination scores similar to those of the subjects using self-designed cards. The subjects using instructor-designed cards spent significantly less (p = .003) total time in study than did the subjects using self-designed cards. The difference in time between the two groups was attributable to the time spent designing note cards. Therefore, distribution of instructor-designed note cards appears to offer equally effective and significantly more efficient learning when compared with that produced when students design their own cards. The differences in efficacy and efficiency were similar for students of different learning styles (as classified by Witkin's field-dependence/field-independence continuum) [corrected].

Volumetric comparison of seated and standing test postures.

Published protocols for the volumetric assessment of upper-extremity edema differ regarding patients' posture. The present study was designed to determine the effect of posture on test-retest reliability and mean volume. Thirty women were tested in both seated and standing postures. For the dominant hand, test-retest reliabilities for the seated posture were identical to those for the standing posture. Test-retest reliability was slightly stronger for the nondominant hand in sitting than for the same hand in standing. Both postures afforded clinically acceptable test-retest reliabilities. The mean volumes in sitting were significantly lower than those in standing (p less than .0001), thus suggesting that volumetric measures should be considered discontinuous if the patient's test posture is altered. Mean volumes of the dominant hand averaged 9.3 ml more than those of the nondominant hand. It is suggested that this discrepancy be considered in the establishment of goals for edema control and in the determination of the need for continued edema treatment.

Wrist extensor orthoses: dexterity and grip strength across four styles.

Orthoses that are used to stabilize, protect, and support the wrist during functional activities often interfere with normal movement and, therefore, with hand function. This study compared the manual dexterity and grip strength of 20 female subjects while using a free hand and while wearing each of four wrist extensor orthoses: a Futuro prefabricated wrist brace (No. 33), a volar thumbhole orthosis, a volar orthosis with a radial connector bar, and a dorsal orthosis with distal transverse arch support. Of these orthoses, the Futuro prefabricated wrist brace afforded the best overall dexterity, although it was significantly slower (p less than .05) than the other orthoses in a writing subtest. Of the custom-made orthoses, the volar style with radial connector bar afforded the best overall dexterity. All of the orthoses significantly (p less than .01) reduced grip strength. The Futuro prefabricated wrist brace afforded the strongest grip strength of the four orthoses studied, and the volar thumbhole orthosis permitted the strongest grip among the custom-made orthotic styles.

The recruitment of occupational therapy students: a national survey.

This national survey was designed to study selected characteristics of entry level occupational therapy students and to compare recruitment variables in technical and professional students. The survey encompassed 116 programs with 1,843 students responding. Major findings include the following: the median age of professional students was 1 to 2 years older than that of technical students; the technical students had the larger percentage of older students; professional level students chose occupational therapy at an earlier age than did technical students; the majority of minority students were enrolled in technical programs; and students' initial exposure to occupational therapy differed between the technical and professional students: Technical students reported that their earliest contacts with the profession most often came from family friends, college and junior college contacts, high school counselors, and occupational therapy students, in that order. Professional level students reported that their most common initial contact came from occupational therapy students, family friends, parents, a volunteer or employment experience in the field, or health personnel in the field, in that order. Survey data form the basis for a discussion of potential expansion of recruitment strategies.

Academic misconduct: results of faculty and undergraduate student surveys.

Educators in health-related fields are particularly sensitive to academic misconduct because undergraduate students who falsify academic work in such fields can go on to endanger the health and well being of the very people they are meant to assist. This paper presents the results of a survey of 104 faculty and 314 undergraduate students regarding their experience with academic misconduct. Faculty and student definitions of misconduct are compared, the incidence of cheating within each category is reported, and the projected efficacy of methods for controlling misconduct are examined. Major findings include the following: faculty and students differed significantly in their definitions of 24 of the 36 described behaviors, 82% of the surveyed undergraduate students admitted to engaging in some form of academic misconduct during their college careers, few differences in cheating patterns were related to year in school (class) or gender, and faculty and students differed on the impact that changes in environment and procedure were expected to have on cheating.