An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale-A randomized controlled trial.

STUDY DESIGN: A nonblinded randomized controlled trial. INTRODUCTION: Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC). PURPOSE OF THE STUDY: To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects. METHODS: A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI) or a physical exercise-based occupation-focused intervention. The primary outcome, functioning, was measured using the Disability of the Arm, Shoulder and Hand questionnaire. Primary endpoint was at three months. Patients were followed up for a year. RESULTS: No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times. CONCLUSIONS: OBI as delivered in this study was not superior to physical exercise-based occupation-focused intervention in this patient group. However, in taking a client-centered approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice.

Evidence of internal construct validity of SOC-13 total score, for use in hand therapy.

PURPOSE: The objective was to examine whether the 13-item Sense of coherence scale (SOC-13) can be reported as a unidimensional interval-scale metric, when new approaches based on the Rasch model to address local item dependency are applied, and to determine whether an interval-scale scoring can be made available. METHODS: Data were derived from two samples of patients with hand-related disorders (merged n = 915). Rasch analyses of the SOC data were conducted using item-level analysis and a testlet approach. RESULTS: Initial item-level analysis of the SOC-13 confirmed previous findings of misfit to the Rasch model. In resolving local dependency by constructing three testlets, which corresponded to the three components of the SOC construct, fit to the Rasch model (χ2(df) = 43.11 (27), p = 0.163) and unidimensionality of the SOC-13 could be established. A transformation table was successfully created to convert the SOC-13 raw ordinal score to corresponding Rasch interval-scaled values. CONCLUSIONS: The results of this study indicate that data obtained by the SOC-13 can be regarded as essentially unidimensional, and an interval-scale transformation table of the SOC-13 total scores was developed, for use in clinical practice and research on coping resources in patients with hand-related disorders.

The 13-item Sense of coherence scale (SOC-13) comprises three complexly interrelated componentsTo assess coping resources in patients with hand-related disorders, an interval-scale transformation table of the SOC-13 total scores can be used.

Accuracy of radiographic measurements of fracture-induced deformity in the distal radius.

Background: Management of the distal radius fracture (DRF) is to some extent based on radiographic characterization of fracture displacement. It remains unclear, however, if the measurements used to quantify displacement are accurate. Purpose: To quantify accuracy of two radiographic measurements: dorsal/volar tilt and fracture compression, measured indirectly as ulnar variance (UV), using radiostereometric analyses (RSA) as reference standard. Material and Methods: Twenty-one fresh frozen non-fractured human cadaveric forearms (right = 11, left = 10) were thawed and eligible for inclusion. The forearms were mounted on a custom made platform that allowed for controlled forearm rotation, and they underwent two rounds of imaging (both rounds consisted of RSA and radiographs). In round one, the non-fractured forearms were radiographed. In round two, artificial DRF´s with compression and dorsal angulation were created and imaging procedures repeated. Change in tilt and UV between the non-fractured and later fractured forearms was defined as fracture-induced deformity. Deformity was measured radiographically and additionally calculated using RSA. Bland Altman analyses were used to estimate agreement between radiographically measured, and RSA calculated, fracture-induced deformity. Results: Our results indicated that radiographs underestimate the amount of fracture-induced deformity. Mean measured differences (bias) in dorsal tilt deformity between radiographs and RSA were -2.5° for both observers. The corresponding values for UV were -1.4 mm and -1.5 mm. Conclusion: Quantifying fracture-induced deformity on radiographs underestimated the actual deformity when compared to RSA calculated deformity. These findings suggest that clinicians, at least in part, base fracture management and potentially corrective surgery on inaccurate measurements.

Dorsal Tilt of the Distal Radius Fracture Changes With Forearm Rotation When Measured on Radiographs.

Purpose: This study examined the impact of pronation and supination on the reliability of the radiographically measured values of dorsal tilt, radial inclination (RI), and ulnar variance (UV) in cadaveric forearms with artificially created distal radius fractures. Methods: We prepared 21 human cadaveric forearms (11 right and 10 left) for radiostereometric analysis (RSA) by insertion of tantalum markers. Distal radius fractures were created midway between the marker segments. Radiographs and RSA images were taken at different degrees of supination and pronation. The precise degree of forearm rotation was calculated using RSA software. Two observers (H.B.T. and T.T.) independently measured tilt, RI, and UV on all radiographs in a blinded and randomized fashion. Univariate linear regression analyses were used to determine the relationship between forearm rotation and the measured radiographic values. Results: The radiographically measured value of tilt was significantly impacted by forearm rotation. Supinating or pronating the forearm by 10° decreased and increased, respectively, the radiographic value of dorsal tilt by approximately 3°. Conclusions: This study showed that the positioning of the fractured forearm during the radiographic procedure significantly impacted subsequent radiographic measurements of tilt. Dorsal tilt measurements increased (ie, fracture displacement measured more dorsal) with pronation and decreased (ie, fracture displacement measured more toward neutral, with less dorsal tilt) with supination of the forearm. However, measurements of RI (p = 0.12 and p = 0.55 for observer 1 and 2) and UV (p = 0.34 and p = 0.17, observer 1 and 2) were not significantly impacted by rotation. Clinical relevance: Treatment of a distal radius fracture is, at least to some extent, based on radiographic quantification of fracture deformity. Therefore, unreliable measurements may adversely influence clinical decision making.

The effect of forearm rotation on radiographic measurements of the wrist: an experimental study using radiostereometric analyses on cadavers.

BACKGROUND: Although dorsal/palmar tilt, radial inclination (RI), and ulnar variance (UV) are measurements commonly performed in wrist radiographs, the impact of forearm rotation on those measurements during the radiographic procedure is uncertain. Our aim was to determine the impact of supination and pronation on the reliability of measurements of tilt, RI, and UV. METHODS: Tantalum markers were inserted into the distal radius of 21 unfractured cadaver forearms. The forearms were radiographed in different degrees of supination and pronation. The exact degree of rotation was calculated with radiostereometric analyses. Tilt, RI, and UV were measured by two independent readers in a random and anonymised fashion. Association between forearm rotation and radiographic measurements was examined using linear regression. RESULTS: Forearm rotation significantly impacted the radiographically measured tilt. One degree of supination and pronation respectively increased and decreased palmar tilt with 0.68° and 0.44°, observers 1 and 2, respectively. As opposed to observer 1, observer 2 found that RI was significantly impacted by rotation with a slope of 0.08. Ulnar variance was not significantly impacted by rotation with linear regression slopes of 0.01° (95% confidence interval [CI] - 0.02-0.05, p = 0.490) and 0.02° (95% CI - 0.02-0.07; p = 0.288), observer 1 and observer 2, respectively. CONCLUSION: In unfractured forearms, the radiographically measured tilt was significantly affected by rotation. Palmar tilt increased with supination and decreased with pronation. Rotation significantly affected radial inclination, although of a magnitude that is probably not clinically relevant. No significant impact on UV was found.

Client-centred practice from the perspective of Danish patients with hand-related disorders.

PURPOSE: The objectives of this study were to investigate perceptions of client-centred practice among Danish patients with hand-related disorders engaged in rehabilitation at outpatient clinics, and to decide on domains to serve as a conceptual foundation for item generation in the development of a new, standardized questionnaire to evaluate the experience of client-centredness among patients with hand-related disorders. METHOD: Focus group interviews were held with 25 patients with hand-related disorders from six outpatient hand clinics in Denmark. Deductive content analysis was used to decide on domains for item generation. RESULTS: Patients found that information was paramount in understanding their situation and to feel empowered and motivated. They attached importance to participation in decision making so that rehabilitation was considered meaningful. Moreover, they thought rehabilitation should be individualized by taking their life situations and personalities into account. Six domains were found to be central to client-centred practice: patient participation in decision making, client-centred education, evaluation of outcomes from patient's perspective, emotional support, cooperation and coordination, and enabling occupation. CONCLUSIONS: The domains can be used in the further development of a Danish questionnaire to evaluate the experiences of client-centredness among patients engaged in rehabilitation at outpatient clinics for hand-related disorders. Implications for rehabilitation Patients with hand-related disorders wish for rehabilitation to be tailored to individual needs. The patient's life situation and personality, including coping ability, are important factors to consider in rehabilitation planning, interventions, and evaluations. Patients with hand-related disorders attach importance to information and require health professionals' support to manage their activities of everyday life. Patients with hand-related disorders ask for participation and shared decision making in rehabilitation planning.

Test-retest reliability of Antonovsky's 13-item sense of coherence scale in patients with hand-related disorders.

PURPOSE: To report on the distribution and test-retest reliability of Antonovsky's 13-item Sense of Coherence (SOC-13) Scale in patients with hand-related disorders (HRD). Links between the SOC-13 score and factors such as age, number of days between date of injury and start of rehabilitation, gender and educational level were explored. METHOD: Survey with test-retest, using self-administered questionnaire. SOC-13 was completed before starting rehabilitation at an outpatient clinic after 14 days and three months. Adult patients with HRD were included. RESULTS: A total of 170 participants completed the SOC-13 at baseline (median SOC 71, range 30-91). The Intra-class Correlation Coefficient between baseline and 14 days was 0.84 (n = 151), and baseline and three months was 0.79 (n = 113). Weak correlations were found between SOC and age rs = 0.17, p < 0.03. No correlation was found between SOC and number of days since injury rs = 0.01, p > 0.92. No difference was found in SOC score related to gender or educational level. CONCLUSIONS: The SOC-13 scale showed reliability for patients with HRD. There was a weak connection between age and SOC without clinical relevance. SOC-13 has the potential to be a powerful tool to measure the ICF component personal factors, which could have an impact on patients' rehabilitation outcomes. Implications for rehabilitation Antonovsky's SOC-13 scale showed test-retest reliability for patients with hand-related disorders. The SOC-13 scale could be a suitable tool to help measure personal factors.