Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). METHODS: The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. RESULTS: Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. CONCLUSION: Meta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. IMPACT: Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.

Effectiveness of Interventions to Promote Physical, Psychological, and Socioeconomic Well-being Outcomes of Parents of Children With Neurodevelopmental Disabilities: Protocol for a Systematic Review.

BACKGROUND: It is well recognized that parents of children with neurodevelopmental disabilities can experience a considerable burden of care associated with their child's disability, which can potentially impact their functioning and quality of life. Historically, the intervention efforts in pediatric rehabilitation have focused primarily on the child's development and well-being and much less on parental and family well-being. The impact that a child's diagnosis might have on parents remains unclear, and it is unknown how we can best support parents on their journey of childhood disability. It is, therefore, important to synthesize the published evidence on interventions for parents of children with neurodevelopmental disabilities so that clinicians can be better informed about the ways in which families they work with can be supported. OBJECTIVE: This manuscript presents the protocol for a systematic review of the effectiveness of interventions aiming to improve the physical, psychological, or socioeconomic well-being of parents of children with neurodevelopmental disabilities when compared to usual care or no care. METHODS: We will systematically search 4 databases (MEDLINE, Embase, PsycINFO, and CINAHL) from the year 2000 until the search date, for randomized controlled trials that evaluated the effectiveness of interventions to improve parental physical, psychological, or socioeconomic well-being. Two authors will independently screen the titles and abstracts, which will then be followed by full-text screening. After the eligibility assessment, two reviewers will independently extract data and conduct a risk of bias assessment using the Cochrane risk-of-bias tool. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. If the data allow, we will perform a pairwise meta-analysis or network meta-analysis. We plan to evaluate the coherence of the network with a global test by using the node-splitting method. RESULTS: As of May 30, 2022, there have been two searches of data initiated: in September 2020 for articles published since 2000 and an updated search in January 2022 for articles published since 2020. We have screened all the titles and abstracts and performed eligibility assessment. However, the final number of references is still not available due to the additional information needed for some of the potentially eligible studies. The results from this systematic review will be published in an indexed journal within a year after this protocol is published. CONCLUSIONS: This study is expected to identify a variety of programs to address the well-being needs of parents of children with neurodevelopmental disabilities and provide directions on how parents can best be supported within health care. Such interventions might help professionals and stakeholders in creating service delivery models that can enhance parental well-being and minimize the risks to their physical, psychological, and socioeconomic functioning. TRIAL REGISTRATION: PROSPERO CRD42021230706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=230706. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38686.

Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs.

BACKGROUND: Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity. PURPOSE: This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions. STUDY DESIGN: Scoping review, with qualitative content analysis. METHODS: MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function. RESULTS: Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks. CONCLUSIONS: Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.

Diagnostic accuracy of sensory and motor tests for the diagnosis of carpal tunnel syndrome: a systematic review.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy of the upper extremity. The previous systematic review of the diagnostic tests for CTS was outdated. The objective of this study was to compile and appraise the evidence on the accuracy of sensory and motor tests used for the diagnosis of CTS. METHODS: MEDLINE, CINAHL, and Embase databases were searched on January 20, 2020. Studies assessing at least one diagnostic accuracy property of the sensory or motor tests for CTS diagnosis were selected by two independent reviewers. Diagnostic test accuracy extension of the PRISMA guidelines was followed. Risk of bias and applicability concerns were rated using QUADAS-2 tool. Any reported diagnostic accuracy property was summarized. Study characteristics and any information on the accuracy of the sensory and motor tests for CTS diagnosis were extracted. RESULTS: We included sixteen clinical studies, assessing thirteen different sensory or motor tests. The most sensitive test for CTS diagnosis was the Semmes-Weinstein monofilament test (with 3.22 in any radial digit as the normal threshold) with sensitivity from 0.49 to 0.96. The tests with the highest specificity (Sp) were palmar grip strength (Sp = 0.94), pinch grip strength (Sp from 0.78 to 0.95), thenar atrophy (Sp from 0.96 to 1.00), and two-point discrimination (Sp from 0.81 to 0.98). CONCLUSIONS: The evidence was inconclusive on which sensory or motor test for CTS diagnosis had the highest diagnostic accuracy. The results suggest that clinicians should not use a single sensory or motor test when deciding on CTS diagnosis. TRIAL REGISTRATION: PROSPERO CRD42018109031 , on 20 December 2018.

Diagnosing Carpal Tunnel Syndrome: Diagnostic Test Accuracy of Scales, Questionnaires, and Hand Symptom Diagrams-A Systematic Review.

OBJECTIVE: To summarize and evaluate research on the accuracy of clinical diagnostic scales, questionnaires, and hand symptom diagrams/maps used for diagnosis of carpal tunnel syndrome (CTS). DESIGN: Systematic review of diagnostic test accuracy. LITERATURE SEARCH: A comprehensive literature search of the MEDLINE, CINAHL, and Embase databases was conducted on January 20, 2020. STUDY SELECTION CRITERIA: Studies that assessed at least 1 diagnostic accuracy property of the scales, questionnaires, and hand symptom diagrams used for the diagnosis of CTS. DATA SYNTHESIS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Risk of bias and applicability concerns were assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Diagnostic accuracy properties were summarized. RESULTS: Out of 4052 citations after removing duplicates, 21 articles met the inclusion criteria. Twelve articles reported on the diagnostic accuracy of scales and questionnaires, including the Bland questionnaire, Kamath and Stothard questionnaire, 6-item carpal tunnel syndrome symptoms scale (CTS-6), Boston Carpal Tunnel Questionnaire, Wainner clinical prediction rule, and Lo clinical prediction rule. Positive likelihood ratios ranged from 0.94 for the Boston Carpal Tunnel Questionnaire to 10.5 for the CTS-6, and negative likelihood ratios ranged from 1.04 to 0.05 for the same diagnostic tools, respectively. Nine studies reported the diagnostic accuracy of the Katz and Stirrat hand symptom diagram. Positive and negative likelihood ratios ranged from 1.42 to 8 and from 0.78 to 0.05, respectively. Only 4 studies had high methodologic quality. CONCLUSION: Limited evidence supports high accuracy of the CTS-6, Kamath and Stothard questionnaire, and Katz and Stirrat hand symptom diagram. Other scales have lesser and more conflicting evidence. Further high-quality studies are necessary to examine the diagnostic accuracy of these tests to assist ruling in or ruling out CTS. J Orthop Sports Phys Ther 2020;50(11):622-631. Epub 16 Sep 2020. doi:10.2519/jospt.2020.9599.

The Near-Miss Effect in Slot Machines: A Review and Experimental Analysis Over Half a Century Later.

In games of chance, a near miss is said to occur when feedback for a loss approximates a win. For instance, obtaining "cherry-cherry-lemon" on a slot machine could be considered a near miss. Sixty-six years ago, B.F. Skinner first proposed the idea that near-miss events might reinforce continued play in slot machines, and despite some inconsistencies in the experimental literature, belief in this "near-miss effect" has remained strong. In the present manuscript, we will review this literature and present experimental assessments of the near-miss effect on the frequency of the gambling response. Experiment 1 used a tightly controlled resistance-to-extinction procedure in pigeons to evaluate the putative reinforcing effect of near misses relative to a control "far-miss" reel pattern. Experiment 2 extended Experiment 1's procedure to human participants. The results of both experiments failed to support the near-miss effect hypothesis. Experiment 3 used a further simplified procedure to assess the validity of the resistance-to-extinction paradigm when a probable conditional reinforcer was present on the reel stimuli. Although a clear conditional response was obtained from the reel, subsequent testing in extinction revealed no conditionally reinforcing function of this stimulus on operant response frequency.

Discrimination of acoustically similar conspecific and heterospecific vocalizations by black-capped chickadees (Poecile atricapillus).

Chickadees produce a multi-note chick-a-dee call in multiple socially relevant contexts. One component of this call is the D note, which is a low-frequency and acoustically complex note with a harmonic-like structure. In the current study, we tested black-capped chickadees on a between-category operant discrimination task using vocalizations with acoustic structures similar to black-capped chickadee D notes, but produced by various songbird species, in order to examine the role that phylogenetic distance plays in acoustic perception of vocal signals. We assessed the extent to which discrimination performance was influenced by the phylogenetic relatedness among the species producing the vocalizations and by the phylogenetic relatedness between the subjects' species (black-capped chickadees) and the vocalizers' species. We also conducted a bioacoustic analysis and discriminant function analysis in order to examine the acoustic similarities among the discrimination stimuli. A previous study has shown that neural activation in black-capped chickadee auditory and perceptual brain regions is similar following the presentation of these vocalization categories. However, we found that chickadees had difficulty discriminating between forward and reversed black-capped chickadee D notes, a result that directly corresponded to the bioacoustic analysis indicating that these stimulus categories were acoustically similar. In addition, our results suggest that the discrimination between vocalizations produced by two parid species (chestnut-backed chickadees and tufted titmice) is perceptually difficult for black-capped chickadees, a finding that is likely in part because these vocalizations contain acoustic similarities. Overall, our results provide evidence that black-capped chickadees' perceptual abilities are influenced by both phylogenetic relatedness and acoustic structure.