Predicting hand function in older adults: evaluations of grip strength, arm curl strength, and manual dexterity.

BACKGROUND: Hand function is critical for independence in activities of daily living for older adults. AIMS: The purpose of this study was to examine how grip strength, arm curl strength, and manual dexterous coordination contributed to time-based versus self-report assessment of hand function in community-dwelling older adults. METHODS: Adults aged ≥60 years without low vision or neurological disorders were recruited. Purdue Pegboard Test, Jamar hand dynamometer, 30-second arm curl test, Jebsen-Taylor Hand Function Test, and the Late-Life Function and Disability Instrument were administered to assess manual dexterous coordination, grip strength, arm curl strength, time-based hand function, and self-report of hand function, respectively. RESULTS: Eighty-four adults (mean age = 72 years) completed the study. Hierarchical multiple regressions show that older adults with better arm curl strength (ß = -.25, p < .01) and manual dexterous coordination (ß = -.52, p < .01) performed better on the time-based hand function test. In comparison, older adults with better grip strength (ß = .40, p < .01), arm curl strength (ß = .23, p < .05), and manual dexterous coordination (ß = .23, p < .05) were associated with better self-report of upper extremity function. CONCLUSIONS: The relationship between grip strength and hand function may be test-specific. Grip strength becomes a significant factor when the test requires grip strength to successfully complete the test tasks. Arm curl strength independently contributed to hand function in both time-based and self-report assessments, indicating that strength of extrinsic muscles of the hand are essential for hand function.

Splinting flexor tendon injuries.

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the American Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

A history of splinting: to understand the present, view the past.

The purpose of this study was to identify, using an intensive literature review, the primary historical factors and events that shaped the evolution of current splinting technique and practice. Publication dates determine the chronological order of events, and splints are defined according to the ASHT Splint Classification System. Purposes of splinting are analyzed and listed according to frequency of citation in splint manuals and books, and a historical review of splinting practice describes splints, events, and persons who influenced the evolution of splinting from the time of Hippocrates through the 20th century. Factors influencing splint development include disease, political conflict, advancements in medicine and technology, agency and organizational decision making, centers of practice, and availability of information. Infection, polio, war, technology, plastics, surgical advances, soft tissue remodeling, anatomy, biomechanics, government agencies, hand centers, seminars, professional organizations, publications, and a classification system have all played important roles in 20th century splinting practice.

The efficacy of splinting for lateral epicondylitis: a systematic review.

To determine the efficacy of using splinting as a treatment for lateral epicondylitis (LE), a systematic review of the literature was conducted on Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PEDro, and Cochrane databases using pertinent key words and phrases. Hand searches of article references were also used to ensure that as many relevant articles as possible were identified. Searches were limited to articles published in English. Articles that did not involve splinting (or terminology derivative thereof) as treatment intervention for LE were excluded. From 98 potential articles, 58 were considered strong inclusion candidates. These articles were copied and further triaged according to predefined criteria, resulting in 22 articles that were numbered randomly and blinded. Three reviewers appraised these articles, eliminating 11 of the articles because they did not meet essential criteria of randomization, control group, and/or inferential statistical analysis. Using MacDermid quality scores, the 11 remaining articles were rated by three reviewers. Consensus between the three reviewers was achieved for all quality scores for all 11 articles included in the review. Adjusted quality scores ranged from 44.5 to 16.5 with a mean of 26.3 points. For accurate comparison and consistency of terminology, splints described in the included articles were first classified according to the ASHT Splint Classification, expanded and refined version, and next according to their inherent material properties. Six splints in five classification categories were identified. Discussion of the results from the 11 included studies was organized according to splint category and further separated into strength, pain, and load applied sections. This review identified one Sackett level 1b study and ten Sackett level 2b studies that offer early positive, but not conclusive, support for the effectiveness of splinting lateral epicondylitis. None of the reviewed studies received a perfect quality score, and the wide range of quality scores attests to the fact that considerable improvement of future studies is essential.