Understanding the implications of hand impairments in light of the International Classification of Function model.

BACKGROUND: Incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely in hand therapy practice. PURPOSE: (a) Explore correlations between body functions, activities and participation (A&P), and quality of life (QOL); (b) assess the extent to which personal factors and body functions contribute to variations in A&P and QOL; (c) compare the QOL of individuals with and without hand impairment (HI). STUDY DESIGN: Cross-sectional. METHODS: Seventy-seven patients (Mean age=43.70 SD=17.56; 47 males and 30 females) with chronic and acute hand impairment were recruited from two hand clinics and matched with healthy participants. Assessments were administered to participants in their first visit to the hand clinic. QOL was measured with the World Health Organization QOL questionnaire; A&P with the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire; pain with the Patient-Rated Wrist/Hand Evaluation; hand function with The Functional Dexterity Test, Jamar Dynamometer and Pinch Gauge. RESULTS: Significant correlations were found between QOL and A&P, dexterity, and pain, as well as between A&P and hand strength and pain. Personal factors, hand function, and pain collectively explained 28.9% of QOL variance and 61.4% of A&P variance. Pain emerged as the sole significant contributor to QOL variance, while both hand function and pain significantly influenced A&P variance. Comparisons between the study group and controls highlighted significant differences in QOL domains, with the HI group reporting lower perceived QOL in physical, social, and environmental domains. CONCLUSION: The significance of adopting a comprehensive approach in HI intervention was highlighted. A complex interplay of factors across different levels of the International Classification of Functioning, Disability and Health (ICF) framework imply that clinicians should avoid fixating exclusively on isolated factors or specific domains.

Effectiveness of the static progressive Joint Active System splint in improving upper extremity joint stiffness.

PURPOSE: Injuries to the upper extremity often result in stiffness. The joint capsule may lose its elastic properties, limiting motion. Most modalities for increasing motion are based on capsule stretching, and usually involve physical or occupational therapy. We tested the hypothesis that the Joint Active System static-progressive splint is helpful in increasing range of motion in stiff joints after failure of other treatments. METHODS: Candidates for the Joint Active System splint were mostly patients with upper extremity trauma that required surgery, if they plateaued after therapy but still had stiffness. A retrospective review was performed of all patients from 2015 to 2019 that met our inclusion criteria. Etiologies of stiffness and patient demographics were documented. Range of motion was recorded before and after treatment and, when available, functional scores were calculated. RESULTS: Forty-four patients were treated with the Joint Active System splint; 5 were excluded, leaving 39 for analysis: 15 elbow, 14 wrist and 10 proximal interphalangeal joints. All patients had received therapy before using the Joint Active System and 11 had tried a dynamic splint in addition to therapy. All joints showed significant improvement in motion after treatment: from 66.5° to 95.7° in the elbow, 63.5° to 81.1° in the wrist and 33.2° to 51.8° in the proximal interphalangeal joint. When functional scores were available before and after treatment, there was significant improvement for both elbow and wrist. Even when the Joint Active System was started many months after injury, it was effective. CONCLUSIONS: Despite reaching a plateau with therapy, the Joint Active System static-progressive splint is effective in improving range of motion in elbow, wrist and finger joints with stiffness following injury or surgery. TYPE OF STUDY: Retrospective case series. LEVEL OF EVIDENCE: Therapeutic, level IV.

A broad perspective on breast cancer: Participation, quality of life and return to work throughout the recovery process.

BACKGROUND: Studies found that women with breast cancer struggle with significant physical and mental challenges that affect their participation in daily living, social and work activities. Although women express their need for rehabilitation, in Israel there has been scant research on the nature of these needs. OBJECTIVE: To examine the implications of breast cancer for Israeli women in terms of their quality of life, body function, activities and participation in all facets of life, including work. METHODS: The sample was composed of women diagnosed with breast cancer. The data were collected through: (a) an online electronic survey assessing cancer-related quality of life (QoL), function and disability, fatigue and sensory-motor functions, (n = 120) followed by (b) face-to-face interviews and assessments (n = 20), and a healthy control group (n = 61). RESULTS: Women with breast cancer reported significantly lower QoL compared to the healthy control group. They reported higher levels of disability in areas such as, cognition, mobility, upper extremity, as well as overall difficulties in self-care, doing routine household activities and return to work. Roughly one-third of the women did not return to work. Interestingly, our sample did not perceive a decline in terms of their social support or networks, the women stated that family and social support were major enabling factors. CONCLUSION: The results show that breast cancer has short and long-term functional effects on most facets of these women's life. The women's social support system served as an enabling factor. Many women expressed their frustration at the lack of rehabilitation services for their condition and needs in Israel.

Grip strength in healthy Israeli adults: Comparison to internationally reported normative data.

BACKGROUND: Grip strength is frequently used in research and clinical work and is commonly compared to normative data in clinical settings. To enable accurate interpretation of grip strength values, normative reference values should be close to the demographic, occupational, cultural and geographic characteristics of the individual tested. OBJECTIVE: Investigate the effects of gender, age, work-group and hand dominance on grip strength for the Israeli population, and to compare the grip strength to two normative studies from the United States. METHODS: A cross sectional study. The grip strength of 637 healthy adults was measured using a Jamar dynamometer. The effects for age, gender, hand dominance, and work strain were investigated. Israeli sample results were compared to US norms. RESULTS: Within the Israeli sample, a significant age effect was found for both men and women. This effect was most apparent among the 70+ age groups, in which grip strength was weaker than all the other groups. Males were significantly stronger than females, in both hands, and the dominant hand was significantly stronger, regardless of gender. Results also demonstrated a medium to large effect for type of work on grip strength portraying high manual strain workers to have stronger grip strength. Overall, the grip strength in the Israeli sample was weaker than both US samples. CONCLUSION: Clinicians should be cautious when comparing grip strength to published norms from a different culture/geographical region. The amount of manual strain invested in various occupational roles should be considered in the assessment and intervention process.

Musculoskeletal disorders among dental hygienist and students of dental hygiene.

OBJECTIVES: The purpose of the present study was to present an up-to-date report on the prevalence of musculoskeletal complaints in dental hygienists and dental hygiene students in Israel. It examined the areas of the body that were most frequently affected and the intensity of pain in both groups. The possible differences between groups and the likelihood that musculoskeletal symptoms in students can be attributed to their workload. METHOD: A modified version of The Nordic Musculoskeletal Questionnaire (NMQ) was used to assess reports of Musculoskeletal disorders (MSD) in general and in different body areas. A numerical pain scale was administered to evaluate pain intensity. RESULTS: Two hundred and five women participated in the study: 85 experienced dental hygienists, 17 dental hygiene students and 103 students in a non-clinical track (control group). MSD reports were the most common in the neck (60%), upper back (52%) and lower back (61%). This tendency was seen across all three groups. Hygiene students differed significantly from the control group in terms of number of body areas with MSD and for pain intensity. By contrast, no significant differences were found between dental hygienists and hygiene students, CONCLUSIONS: The findings suggest that dental hygienists and students are at high risk of developing MSD. The high prevalence of MSD among hygiene students underscores the need to commence intervention prior to the initiation of fieldwork.

Long-term functional outcome of trigger finger.

PURPOSE: The purpose of this study was to explore the long-term functional outcomes of trigger finger (TF) as perceived by the patient. METHODS: Three study groups were included in the study: prolonged follow up TF group (at least 1-year post-treatment) (PF-TF), patients with acute TF and a control group. The first group was recruited retrospectively and included all patients who were diagnosed with TF in one orthopedic clinic and were contacted by phone, 109 agreed to participate. The acute TF and healthy controls participated in a previous controlled study. The Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) and numeric pain scale (NPS) were the main outcome measures. RESULTS: Both TF groups reported significantly higher levels of disability, particularly in activities requiring strength and more severe pain in comparison with the control group. The acute TF group reported significantly higher levels of disability and pain than the PF-TF group. Seventy-two percent of acute TF group reported moderate to severe pain, in comparison with 37% of the PF-TF group. CONCLUSION: According to these data, substantial long-term disability and pain persist in both the acute and chronic settings. Implications for rehabilitation Recovery from TF may be a prolonged process and a long term follow up should be considered in clinical practice. The present study found that TF leads to significant disability, therefore, activity and participation should be addressed in practice. Assessment of TF interventions should include outcomes that address the client's perspective using standardized measures of disability, such as the QuickDASH.

Evaluating Hand Function in Clients with Trigger Finger.

BACKGROUND: Trigger finger (TF) is a common hand pathology frequently encountered in hand clinics. Occupational therapists predominantly assess TF symptoms as opposed to using standardized hand functioning assessments. The purpose of this study was to assess the construct validity of dexterity and grip strength assessments for clients with TF. METHOD: Sixty-three participants with TF and 66 healthy controls were administered the Functional Dexterity Test (FDT), Purdue Pegboard Test (PPT), and Jamar® Hydraulic Hand Dynamometer (JD) and completed the Disabilities of Arm Shoulder and Hand questionnaire (DASH). TF symptoms were graded using the Quinnell classification. RESULTS: Statistically significant differences were found between the groups in dexterity and grip strength. A statistically significant difference between the three TF grades was found on the PPT. All three test scores were moderately correlated with the DASH scores. CONCLUSION: This study provides innovative evidence for the validity of common hand function assessments for individuals with TF and recommends incorporating these tools in clinical practice. Further research is needed with larger samples and better representation of each TF clinical grade.

[STENOSING FLEXOR TENOSYNOVITIS - COMMON PRACTICE OF FAMILY PHYSICIANS, ORTHOPEDIC AND HAND SURGEONS].

BACKGROUND: The trigger finger is a common condition of the hand that is treated by family physicians, orthopedic and hand surgeons. The patients suffer from pain, triggering of the finger and may develop a flexion contracture of the finger, causing significant functional limitations. AIM: The objectives of this study were to evaluate factors involved in the diagnosis and treatment of this condition, as well as the differences in treatment between specialists. METHODS: The different specialists were asked to rate the importance of symptoms, examination and imaging studies regarding the decision to refer a patient for surgery as well as suggest the treatment of a hypothetical patient complaining of typical symptoms. RESULTS: In the 158 questionnaires collected, the complaint of limited finger range of motion and previous treatment were rated most important. Family physicians stated that age, occupation and rate of recent triggering were considered to be additional important factors (p=.0003). In comparison with hand surgeons, family physicians reported localized tenderness as important, and the need for passive release of the finger locked in flexion as less important (p=.0003). Family physicians were more likely to treat with NSAID [p= 0.0002), orthopedic surgeons with steroid injections (p=0.0004 and hand surgeons with surgery (p=0.0001). CONCLUSIONS: According to this survey, we found differences in the acquaintance of physicians of different backgrounds with the clinical staging of trigger finger, specifically, the significance of finger contracture and indications for surgery. This information may guide training of physicians in all fields.

Using the international classification of functioning to examine the impact of trigger finger.

PURPOSE: To evaluate the impact of trigger finger (TF) on hand motor function, activity and participation (A&P) and quality of life (QOL), and to evaluate the association between personal factors (age and gender, disease severity) and body functions (dexterity and strength) with A&P and QOL in patients with TF. METHODS: Sixty-six patients with TF (study group) and 66 healthy volunteers (control group) participated in the study. TF symptoms were graded using the Quinnell classification. A&P was evaluated using the Disabilities of Arm Shoulder and Hand questionnaire and the QOL using the World Health Organization Quality of Life questionnaire. Dexterity was evaluated using the Functional Dexterity Test and the Purdue Pegboard Test; hand strength was evaluated using the Jamar Dynamometer and Pinch Gauge. RESULTS: The comparisons between the study and control groups revealed significant differences in all measures. The study group reported lower perceived QOL, A&P and reduced hand strength and dexterity. Hierarchical regression analyses revealed that (a) the severity of TF contributed significantly to the explained variance of QOL, while demographics and hand functioning did not; (b) demographics, TF severity and hand function all contributed significantly to the explained variance of A&P. CONCLUSION: The findings of the study point to the importance of addressing the functional implications and QOL of individuals with TF. Implications for Rehabilitation Although trigger finger is considered to be a mild hand pathology, it has a wide-ranging impact on hand functioning, daily activities and quality of life. Clinicians should include assessments of these outcomes in the treatment of individuals with trigger finger. Treatment efficacy should be evaluated with International Classification of Functioning outcomes, and not limited to symptomatology.

Stenosing flexor tenosynovitis: Validity of standard assessment tools of daily functioning and quality of life.

STUDY DESIGN: Cross-sectional. INTRODUCTION: Stenosing flexor tenosynovitis (SFT) is a common hand disease, yet there is a lack of valid standard assessments for this population. PURPOSE OF THE STUDY: Validation of assessment for the evaluation of disability and quality of life related to SFT clinical severity. METHODS: Sixty five participants with SFT were matched to 71 controls. Participant's symptoms were graded using the Quinnell classification. Disability and quality of life were evaluated using the DASH and WHOQOL-BREF questionnaires. RESULTS: Small to moderate correlations were found between SFT grade and the DASH and WHOQOL-BREF. Both questionnaires differentiated between the first and third clinical grades and between SFT and healthy groups. DISCUSSION: Both questionnaires are useful tools to distinguish between participants with SFT and controls and between mild and severe clinical grades. CONCLUSION: The DASH and WHOQOL-BREF may be implemented in the clinical management and research of SFT. LEVEL OF EVIDENCE: Diagnostic III.

Occupation-based assessments and treatments of trigger finger: a survey of occupational therapists from Israel and the United States.

The purpose of this study was to describe the reported evaluation and treatment methods commonly administered by occupational therapy (OT) specialists in hand therapy for patients with trigger finger (TF). Sixty-one therapists from Israel and the United States completed an electronic survey. Sixty-nine per cent of the therapists reported evaluating TF symptoms (body function level) as part of their assessment protocol; however, only 25% reported the use of occupation-based measures for the assessment of people with TF. All therapists reported using orthoses to treat TF, yet significant differences were found between the groups regarding the frequency of using physical agent modalities, exercise and activity modifications. The results of the study point to the limited use of occupation-based assessments and to a lack of consensus regarding treatment guidelines for TF. The study is limited by a restricted sample size and a low response rate from US therapists, which warrant caution in generalization of the findings. Further research is needed to study the broad implications of TF in order to inform the assessment of TF in OT and to establish the foundations for future treatment efficacy studies.