Diagnostic Ultrasound in the Evaluation of Stiff Shoulder: Association of Axillary Recess Thickness with Standard Clinical Measures.

OBJECTIVES: Stiff shoulder, including primary and secondary types, poses diagnostic challenges due to vague definitions and criteria. This study evaluates the diagnostic potential of ultrasound-measured axillary recess (AR) thickness in shoulder stiffness. DESIGNS: In this cross-sectional study, 35 patients with unilateral shoulder stiffness were assessed. AR thickness was measured using high-resolution ultrasound. Parameters like passive range of motion (PROM), Numerical Rating Scale (NRS), and Constant-Murley (CM) score were evaluated to find correlations with AR thickness. RESULTS: The average age was 50.7 years, and mean BMI was 22.7. AR thickness in stiff shoulders (average 3.19 mm) was significantly higher than in unaffected shoulders (average 1.93 mm, p < 0.001). A cutoff of 3.0 mm for AR thickness yielded 73.3% sensitivity and 84.6% specificity for primary stiffness; 2.6 mm cutoff resulted in 57.9% sensitivity and 88.2% specificity for secondary stiffness. Significant correlations were found between AR thickness and PROM, especially in shoulder external rotation and extension. CONCLUSION: AR thickness measured by ultrasound might serve as a valuable diagnostic and evaluation parameter in shoulder stiffness.

Stress appraisal in the workplace and its associations with productivity and mood: Insights from a multimodal machine learning analysis.

Previous studies have primarily focused on predicting stress arousal, encompassing physiological, behavioral, and psychological responses to stressors, while neglecting the examination of stress appraisal. Stress appraisal involves the cognitive evaluation of a situation as stressful or non-stressful, and as a threat/pressure or a challenge/opportunity. In this study, we investigated several research questions related to the association between states of stress appraisal (i.e., boredom, eustress, coexisting eustress-distress, distress) and various factors such as stress levels, mood, productivity, physiological and behavioral responses, as well as the most effective ML algorithms and data signals for predicting stress appraisal. The results support the Yerkes-Dodson law, showing that a moderate stress level is associated with increased productivity and positive mood, while low and high levels of stress are related to decreased productivity and negative mood, with distress overpowering eustress when they coexist. Changes in stress appraisal relative to physiological and behavioral features were examined through the lenses of stress arousal, activity engagement, and performance. An XGBOOST model achieved the best prediction accuracies of stress appraisal, reaching 82.78% when combining physiological and behavioral features and 79.55% using only the physiological dataset. The small accuracy difference of 3% indicates that physiological data alone may be adequate to accurately predict stress appraisal, and the feature importance results identified electrodermal activity, skin temperature, and blood volume pulse as the most useful physiologic features. Implementing these models within work environments can serve as a foundation for designing workplace policies, practices, and stress management strategies that prioritize the promotion of eustress while reducing distress and boredom. Such efforts can foster a supportive work environment to enhance employee well-being and productivity.

External wrist ratio is not a proxy for internal carpal tunnel shape: Implications for evaluating carpal tunnel syndrome risk.

Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79-0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33-0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.

Perception of Whole Day Workload as a Mediator Between Activity Engagement and Stress in Workers with Type 1 Diabetes.

Associations between various forms of activity engagement (e.g. work, leisure) and the experience of stress in workers have been widely documented. The mechanisms underlying these effects, however, are not fully understood. Our goal was to investigate if perceived whole day workload accounted for the relationships between daily frequencies of activities (i.e. work hours and leisure/rest) and daily stress. We analyzed data from 56 workers with type 1 diabetes (T1D) who completed approximately two weeks of intensive longitudinal assessments. Daily whole day workload was measured with an adapted version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). A variety of occupations were reported including lawyer, housekeeper, and teacher. In multilevel path analyses, day-to-day changes in whole day workload mediated 67% (p<.001), 61% (p<.001), 38% (p<.001), and 55% (p<.001) of the within-person relationships between stress and work hours, rest frequency, active leisure frequency, and day of week, respectively. Our results provided evidence that whole day workload perception may contribute to the processes linking daily activities with daily stress in workers with T1D. Perceived whole day workload may deserve greater attention as a possible stress intervention target, ones that perhaps ergonomists would be especially suited to address.

Assessing the Potential for Error in Investigating Intraneural Vascularity: A Need for a Standardized Imaging Protocol.

Objective: This study examined the implementation of a Doppler sonography imaging protocol to assess intraneural blood flow, within the median nerve, in healthy individuals. Materials and Methods: A total of 176 participants were examined, and this involved 717 retrospective observations of the images collected. The implemented imaging protocol was assessed, and the data that were collected were cleaned and checked for fidelity and validity. Results: A large percentage of missing evidence (11%-35%) across proximal, mid, and distal carpal tunnel locations. Only a quarter of cases with evidence of intraneural blood flow had the strongest evidence of a power Doppler video clip, of which only three-quarters were valid. The study identified potential areas for improving the imaging protocol to reduce missing data and improve data quality. Conclusion: This study demonstrates the significance of a standardized imaging protocol to guide the sonographic acquisition of Doppler images and provides important insights into potential issues with data quality. The recommendations have the potential to help future studies assess intraneural blood flow in healthy populations in a more rigorous and reliable way. Incorporating the study's recommendations into a standardized protocol, there is potential to enhance the diagnostic accuracy of carpal tunnel syndrome and improve diagnosis and treatment.

Work and Industry Occupational Therapy Career Pathways: Understanding an Underrepresented Practice Area.

The involvement of occupational therapy (OT) providers in work and industry (W&I) has noticeably diminished despite the historical and ontological connection between work and occupation. Clear career expectations are necessary to introduce and retain the OT workforce in this underrepresented yet essential practice area. This study aimed to describe OT practitioners' experiences exploring and developing careers in the W&I practice area. We used an inductive thematic analysis in a multi-step, iterative process to explore experiences shared through comments and stories in response to an open-ended question in a cross-sectional online survey. Four semantic-level themes emerged, including career pathways, accumulation of expertise, professional identity, and challenges in W&I practice. Novel career paths revealed in the article underlined the limited recognition of W&I practice in OT. Structured career planning support is needed to promote the growth of this practice area.

Work and Industry Occupational Therapy Career Pathway: Understanding an Overlooked Practice AreaThis study investigated career experiences of occupational therapy practitioners in the work and industry (W&I) practice area. We studied answers to an open-ended question in a survey questionnaire. The findings revealed four main themes: career pathways, expertise development, professional identity, and challenges in W&I practice. The findings highlighted the need for structured career planning and better recognition and support to foster growth in this field.

Predicting Office Workers' Productivity: A Machine Learning Approach Integrating Physiological, Behavioral, and Psychological Indicators.

This research pioneers the application of a machine learning framework to predict the perceived productivity of office workers using physiological, behavioral, and psychological features. Two approaches were compared: the baseline model, predicting productivity based on physiological and behavioral characteristics, and the extended model, incorporating predictions of psychological states such as stress, eustress, distress, and mood. Various machine learning models were utilized and compared to assess their predictive accuracy for psychological states and productivity, with XGBoost emerging as the top performer. The extended model outperformed the baseline model, achieving an R2 of 0.60 and a lower MAE of 10.52, compared to the baseline model's R2 of 0.48 and MAE of 16.62. The extended model's feature importance analysis revealed valuable insights into the key predictors of productivity, shedding light on the role of psychological states in the prediction process. Notably, mood and eustress emerged as significant predictors of productivity. Physiological and behavioral features, including skin temperature, electrodermal activity, facial movements, and wrist acceleration, were also identified. Lastly, a comparative analysis revealed that wearable devices (Empatica E4 and H10 Polar) outperformed workstation addons (Kinect camera and computer-usage monitoring application) in predicting productivity, emphasizing the potential utility of wearable devices as an independent tool for assessment of productivity. Implementing the model within smart workstations allows for adaptable environments that boost productivity and overall well-being among office workers.

Current and future utility of ultrasound imaging in upper extremity musculoskeletal rehabilitation: A scoping review.

STUDY DESIGN: This study was a scoping review. BACKGROUND: Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment. PURPOSE OF THE STUDY: This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility. METHODS: Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility. RESULTS: Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians. CONCLUSION: Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.

Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals.

Objective: Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds. Methods: Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality. Results: The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm2 [6.09-6.84], 8.68mm2 [8.22-9.13], and 8.60mm2 [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (ß=0.03mm2, p=0.047). Men (9.42mm2, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm2, [7.01-8.42]). No difference was noted in laterality. Conclusion: A reference value for median nerve CSA in the carpal tunnel is 8.60mm2. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm2 for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.

Workers' whole day workload and next day cognitive performance.

Workload experienced over the whole day, not just work periods, may impact worker cognitive performance. We hypothesized that experiencing greater than typical whole day workload would be associated with lower visual processing speed and lower sustained attention ability, on the next day. To test this, we used dynamic structural equation modeling to analyze data from 56 workers with type 1 diabetes. For a two-week period, on smartphones they answered questions about whole day workload at the end of each day, and completed cognitive tests 5 or 6 times throughout each day. Repeated smartphone cognitive tests were used, instead of traditional one- time cognitive assessment in the laboratory, to increase the ecological validity of the cognitive tests. Examples of reported occupations in our sample included housekeeper, teacher, physician, and cashier. On workdays, the mean number of work hours reported was 6.58 (SD 3.5). At the within-person level, greater whole day workload predicted decreased mean processing speed the next day (standardized estimate=-0.10, 95% CI -0.18 to -0.01) using a random intercept model; the relationship was not significant and only demonstrated a tendency toward the expected effect (standardized estimate= -0.07, 95% CI -0.15 to 0.01) in a model with a random intercept and a random regression slope. Whole day workload was not found to be associated with next-day mean sustained attention ability. Study results suggested that just one day of greater than average workload could impact next day processing speed, but future studies with larger sample sizes are needed to corroborate this finding.

The role of therapist-patient relationships in facilitating engagement and adherence in upper extremity rehabilitation.

BACKGROUND: Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation. OBJECTIVE: To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services. METHODS: Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results. RESULTS: SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts. CONCLUSION: In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Modeling extracurricular activity participation with physical and mental health in college students over time.

Objective: To describe extracurricular activity participation and explore its relationship with college students' health. Participants: 159 college students majoring in dental hygiene or occupational therapy. Methods: Data were collected prospectively at baseline, one- and two-year follow-ups. Self-reported participation in extracurricular activities over the past six months was grouped into eight categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Physical and mental health were measured using SF-36, a valid tool measuring general health. Results: Participation in fitness, sports, creative arts, and work significantly decreased at one-year and two-year follow-ups (p < 0.01). Work/volunteer activity participation was associated with poorer physical health (ß = -1.4, 95% CI: (-2.2, -0.5), p < 0.01), but a change from nonparticipation to some participation in work/volunteer activity was associated with better mental health (ß = 2.6, 95% CI (0.3, 4.9), p = 0.04). Conclusions: Educators should consider the potential impact of maintaining extracurricular activities on college students' health when designing academic courses.

Lifestyle Redesign® Intervention for Psychological Well-Being and Function in People With Fibromyalgia: A Retrospective Cohort Study.

IMPORTANCE: Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. OBJECTIVE: To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function. DESIGN: Retrospective cohort study using a chart review method. SETTING: Outpatient clinic. PARTICIPANTS: Twenty-one adults with fibromyalgia (M age = 54 yr). INTERVENTION: A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach. OUTCOMES AND MEASURES: The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program. RESULTS: Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures. CONCLUSIONS AND RELEVANCE: The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia. What This Article Adds: Occupational therapy should be considered as a nonpharmacological intervention for adults with fibromyalgia to improve psychological well-being and function.

The field of human building interaction for convergent research and innovation for intelligent built environments.

Human-Building Interaction (HBI) is a convergent field that represents the growing complexities of the dynamic interplay between human experience and intelligence within built environments. This paper provides core definitions, research dimensions, and an overall vision for the future of HBI as developed through consensus among 25 interdisciplinary experts in a series of facilitated workshops. Three primary areas contribute to and require attention in HBI research: humans (human experiences, performance, and well-being), buildings (building design and operations), and technologies (sensing, inference, and awareness). Three critical interdisciplinary research domains intersect these areas: control systems and decision making, trust and collaboration, and modeling and simulation. Finally, at the core, it is vital for HBI research to center on and support equity, privacy, and sustainability. Compelling research questions are posed for each primary area, research domain, and core principle. State-of-the-art methods used in HBI studies are discussed, and examples of original research are offered to illustrate opportunities for the advancement of HBI research.

Cognitive performance, creativity and stress levels of neurotypical young adults under different white noise levels.

Noise is often considered a distractor; however recent studies suggest that sub-attentive individuals or individuals diagnosed with attention deficit hyperactivity disorder can benefit from white noise to enhance their cognitive performance. Research regarding the effect of white noise on neurotypical adults presents mixed results, thus the implications of white noise on the neurotypical population remain unclear. Thus, this study investigates the effect of 2 white noise conditions, white noise level at 45 dB and white noise level at 65 dB, on the cognitive performance, creativity, and stress levels of neurotypical young adults in a private office space. These conditions are compared to a baseline condition where participants are exposed to the office ambient noise. Our findings showed that the white noise level at 45 dB resulted in better cognitive performance in terms of sustained attention, accuracy, and speed of performance as well as enhanced creativity and lower stress levels. On the other hand, the 65 dB white noise condition led to improved working memory but higher stress levels, which leads to the conclusion that different tasks might require different noise levels for optimal performance. These results lay the foundation for the integration of white noise into office workspaces as a tool to enhance office workers' performance.

(Re-)Defining ergonomics in hand therapy: Applications for the management of upper extremity osteoarthritis.

STUDY DESIGN: Invited literature review BACKGROUND: Arthritis is the leading cause of disability in adults, and research shows that people living with arthritis experience work instability, loss of independence, financial difficulties, and overall decreased quality of life. Current nonpharmacological treatments can be beneficial for short term relief; however, the evidence on these long-term treatments is limited. Ergonomic modifications have been used in the workplace to address musculoskeletal conditions to ensure proper fit of one's environment, and research shows that these modifications can decrease pain and injury and increase work productivity. A broader perspective on ergonomic approaches may be important to supporting individuals with arthritis within hand therapy. PURPOSE OF THE STUDY: This review proposes an expanded perspective on ergonomic approaches within hand therapy and explores published literature to identify potential benefits of applying ergonomic approaches for individuals with upper extremity arthritis. METHODS: A systematic search and screening process was conducted to identify articles that implemented an ergonomic approach for the support of individuals with upper extremity osteoarthritis or rheumatoid arthritis. RESULTS: A total of 34 articles described interventions that employed ergonomics including task-based or general ergonomics (n = 17), contextualized supports (n = 8), or holistic, lifestyle approaches (n = 9). Only one study focused solely on individuals with osteoarthritis, whereas interventions for individuals with rheumatoid arthritis showed positive outcomes across these categories. Situational learning, building of patient self-efficacy, and development of new habits and routines are vital for carryover and implementation to support performance in daily life. CONCLUSION: There is an opportunity for hand therapists to extend the scope of interventions provided as part of an ergonomic approach to supporting patients. Specifically, therapists can consider use of emerging technologies and telehealth that promote contextualization and follow-up for long-term outcomes.

Quality of Carpal Tunnel Syndrome Patient Education Handouts Available on the Internet: A Systematic Analysis of Content and Design.

OBJECTIVE: To evaluate the quality of carpal tunnel syndrome (CTS) patient education handouts and identify the best resources for patients and clinicians. DESIGN: A document content analysis of handouts identified through a systematic internet search using 8 search terms on Google and Bing and a hand search of professional association websites. SETTING: Not applicable. PARTICIPANTS: Documents (N=56) were identified from the top 50 search results across 16 individual searches. Included documents provided general patient education for CTS; descriptive websites, videos, and research studies were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Content analysis was conducted using the Information Score (IS) tool to evaluate completeness of information (0%-100%) and misleading treatment recommendations were identified. Design analysis was conducted using the Patient Material Assessment Tool for Printable Materials (PEMAT-P) (0%-100%) and 2 widely used readability formulas, Flesch Reading Ease and Flesch Kincaid Grade Level. Using these results, all handouts were rated with a summative 12-point scale. RESULTS: Of 805 unique search results, we included 56 CTS handouts. The average IS was 74.6%±17.9%, and 78.6% of the handouts mentioned non-evidence-based treatment recommendations. The average PEMAT-P score was 70.2%±10.9%, and the average readability grade level was 7.7±1.7. Only 3 handouts were identified as high quality based on the 12-point summative scores, 22 handouts had mixed quality, and 17 handouts had low quality on both content and design. CONCLUSIONS: Findings of this study suggest a lack of high-quality and easily understandable CTS patient education handouts. Most handouts contained unreliable treatment information. Improvements are needed to ensure patients' ability to understand and manage this condition.

Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety.

BACKGROUND: The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. METHODS: We recruited dental hygiene (DH) students (n = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (n = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasonography, and psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog scale for pain score greater than the minimal clinically important difference) between DH and OT students using Fisher exact test. We used mixed effects models to longitudinally compare the change in outcomes between 3 groups: DH students who develop and did not develop shoulder pain, and OT students. RESULTS: The incidence of shoulder pain is higher in DH students (relative risk = 4.0, 95% confidence interval [CI] 1.4, 11.4). After 1 year, DH students with pain had the greatest thickening of the supraspinatus (0.7 mm, 95% CI 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4 mm, 95% CI 0.1, 0.8) and OT students (0.9 mm, 95% CI 0.5, 1.2). Anxiety score increased 3.8 points (95% CI 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at 1 year (relative risk = 2.9, 95% CI 1.0, 8.6). CONCLUSION: Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and it thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

An ultrasound study of the mobility of the median nerve during composite finger movement in the healthy young wrist.

INTRODUCTION/AIMS: There is a lack of consensus regarding median nerve movement in the carpal tunnel during composite finger flexion in healthy individuals. In this study we examined the amount and direction of median nerve movement and differentiate nerve mobility between dominant and nondominant sides in a large, healthy, young adult cohort. METHODS: Sonographic videos of the median nerve during composite finger motion from extension to full flexion were analyzed in 197 participants without median nerve pathology. Displacement of the nerve's centroid was calculated based on a change in the relative location of the nerve. Longitudinal nerve sliding was categorized as none, independently from the tendons, or with the tendons. RESULTS: In short axis, median nerves moved within 1 mm vertically and 3 mm horizontally; no direction was predominant. About half of the nerves (52.5%) slid independently while 26.9% slid with the tendons; 21.3% did not slide at all. On the nondominant side, median nerves that slid with the tendons had a larger absolute vertical displacement than nerves that slid independently or did not slide at all (P < .01). Nerves on the dominant side moved in a radial direction more frequently than on the nondominant side (P = .02). DISCUSSION: Transverse nerve movement during composite finger flexion in healthy individuals varies widely with no clear pattern in the direction of transverse movement or amount of longitudinal sliding. These data provide a foundation for future research to better understand the biomechanical contribution of nerve movement to median nerve pathologies.

Validation of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) adapted for the whole day repeated measures context.

Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analysed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of 'mental strain'. Practitioner Summary: Using within-person longitudinal data, we found evidence supporting the validity of a measure evaluating whole-day workload (i.e. workload derived from all sources, not only paid employment) derived from the NASA-TLX. This measure may be useful to assess how day-to-day variations in workload impact quality of life among adults.Abbreviations: NASA-TLX or TLX: National Aeronautics and Space Administration Task Load Index; TLX-6: six item version of the NASA-TLX; TLX-4: four item version of the NASA-TLX, TLX-4v2: four item NASA-TLX version two; NIOSH: National Institute for Occupational Safety and Health; CFA: confirmatory factor analysis; T1D: type 1 diabetes; EMA: ecological momentary assessment; BG: blood glucose; SD: standard deviation; CV: coefficient of variation; RMSEA: root mean square error of approximation; CFI: comparative fit index; TLI: Tucker-Lewis Index; SRMR: standardized root mean square residual; AIC: Akaike information criterion; BIC: Bayesian information criterion; χ2: Chi-square statistic.