Nancy A. Baker

The Comparative Effectiveness of Combined Lumbrical Muscle Splints and Stretches on Symptoms and Function in Carpal Tunnel Syndrome

OBJECTIVE To compare the effectiveness of an intensive lumbrical splint/stretch combination with 3 less intensive lumbrical splint/stretch combinations on carpal tunnel symptoms and function. DESIGN Randomized Clinical Trial. SETTING Outpatient hand therapy clinics. PARTICIPANTS Volunteers (N=124) with mild to moderate carpal tunnel syndrome. INTERVENTIONS A 4-week home regimen of nocturnal splints (lumbrical splints or cock-up splints) combined with stretches (lumbrical intensive or general) performed 6 times daily. MAIN OUTCOME MEASURES The effect of the intervention on carpal tunnel symptoms and function was examined with the Carpal Tunnel Symptom Severity and Function Questionnaire (CTQ) and Disabilities of the Arm, Shoulder, and Hand (DASH). We also evaluated whether subjects obtained surgery at 24 weeks. RESULTS There were significant main effects over time for all outcome measures at 4, 12, and 24 weeks. There was a significant interaction effect for the CTQ-Function and DASH at 12 weeks. Post hoc analyses indicated significant differences between the lumbrical splint/general stretch and general splint/lumbrical stretch groups and the other 2 groups. At 24 weeks, a significantly greater percentage of subjects in the general splint/lumbrical stretch group achieved a clinically important improvement on the CTQ-Function. By 24 weeks, only 25.5% of subjects had elected to undergo surgery. CONCLUSIONS A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline. Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment.

A Methodology for Developing Evidence about Meaning in Occupation: Exploring the Meaning of Working.

Using research-based evidence to support practice is becoming a standard of care. Although occupational therapists believe that occupation can be used as a therapeutic agent to promote health and well-being in their clients, there is only limited research to support this. One reason for this is the difficulty in quantitatively constructing “occupation” for research. This article describes one method that can be used to quantitatively measure meaning, an important indicator of occupation. This study explicates the “meaning” of working as examined through three interconnected constructs of work meaning (work centrality, societal norms about working, and valued work outcomes) and provides an exemplar study in which these three constructs were used to examine the meaning of working in a group of telecommunication workers. The Meaning of Working Survey was used to gather information from 170 telecommunication workers. Data from the survey were analyzed using both descriptive methods and cluster analysis. By evaluating these three constructs, it was possible to identify trends and patterns of the meaning of working for this group of workers. They did not view work as a central life role and viewed working as a constraint or a reciprocal arrangement. They valued benefits and wages over intrinsic outcomes. The cluster analysis revealed that meaning was generally related to external outcomes. The discussion focuses on how this methodology for measuring meaning could be used to develop research on the meaning of occupation and its effect on health outcomes. This study provides occupational therapy researchers with one quantitative methodology for examining the meaning of working and an exemplar on how that methodology has been used in research on meaning and occupation.

Effects of computer keyboarding on ultrasonographic measures of the median nerve.

BACKGROUND Keyboarding is a highly repetitive daily task and has been linked to musculoskeletal disorders of the upper extremity. However, the effect of keyboarding on median nerve injuries is not well understood. The purpose of this study was to use ultrasonographic measurements to determine whether continuous keyboarding can cause acute changes in the median nerve. METHODS Ultrasound images of the median nerve from 21 volunteers were captured at the levels of the pisiform and distal radius prior to and following a prolonged keyboarding task (i.e., 1 hr of continuous keyboarding). Images were analyzed by a blinded investigator to quantify the median nerve characteristics. Changes in the median nerve ultrasonographic measures as a result of continuous keyboarding task were evaluated. RESULTS Cross-sectional areas at the pisiform level were significantly larger in both dominant (P = 0.004) and non-dominant (P = 0.001) hands following the keyboarding task. Swelling ratio was significantly greater in the dominant hand (P = 0.020) after 60 min of keyboarding when compared to the baseline measures. Flattening ratios were not significantly different in either hand as a result of keyboarding. CONCLUSION We were able to detect an acute increase in the area of the median nerve following 1 hr of keyboarding with a computer keyboard. This suggests that keyboarding has an impact on the median nerve. Further studies are required to understand this relationship, which would provide insight into the pathophysiology of median neuropathies such as carpal tunnel syndrome.

Robust Tracking of the Upper Limb for Functional Stroke Assessment

We present a robust 3-D parts-based (PB) tracking system designed to follow the upper limb of stroke survivors during desktop activities. This system fits a probabilistic model of the arm to sequences of images taken from multiple angles. The arm model defines shapes and colors of limbs and limb configurations that are more or less likely. We demonstrate that the system is 1) robust to cluttered scenes and temporary occlusions, 2) accurate relative to a commercial motion capture device, and 3) capable of capturing kinematics that correlate with concurrent measures of post-stroke limb function. To evaluate the PB system, the functional motion of seven stroke survivors was measured concurrently with the PB system and a commercial motion capture system. In addition, functional motion was assessed by an expert using the Fugl-Meyer Assessment (FMA) and related to recorded kinematics. Standard deviation of differences in measured elbow angles between systems was 5.7^; deviation in hand velocity estimates was 2.6 cm/s. Several statistics, moreover, correlated strongly with FMA scores. Standard deviation in shoulder velocity had a significant correlation coefficient with FMA score below -0.75 when measured with all systems.

Effect of Carpal Tunnel Syndrome on Grip and Pinch Strength Compared With Sex‐ and Age‐Matched Normative Data

To compare grip and pinch strength of individuals with carpal tunnel syndrome (CTS) to normative values before and after a combined splint/stretching intervention.

Discriminating Between Individuals with and without Musculoskeletal Disorders of the Upper Extremity by Means of Items Related to Computer Keyboard Use

Introduction Identifying postures and behaviors during keyboard use that can discriminate between individuals with and without musculoskeletal disorders of the upper extremity (MSD-UE) is important for developing intervention strategies. This study explores the ability of models built from items of the Keyboard-Personal Computer Style instrument (K-PeCS) to discriminate between subjects who have MSD-UE and those who do not. Methods Forty-two subjects, 21 with diagnosed MSD-UE (cases) and 21 without MSD-UE (controls), were videotaped while using their keyboards at their onsite computer workstations. These video clips were rated using the K-PeCS. The K-PeCS items were used to generate models to discriminate between cases and controls using Classification and Regression Tree (CART) methods. Results Two CART models were generated; one that could accurately discriminate between cases and controls when the cases had any diagnosis of MSD-UE (69% accuracy) and one that could accurately discriminate between cases and controls when the cases had neck-related MSD-UE (93% accuracy). Both models had the same single item, “neck flexion angle greater than 20°”. In both models, subjects who did not have a neck flexion angle of greater than 20° were accurately identified as controls. Conclusions The K-PeCS item “neck flexion greater than 20°” can discriminate between subjects with and without MSD-UE. Further research with a larger sample is needed to develop models that have greater accuracy.

Rater reliability and concurrent validity of the Keyboard Personal Computer Style instrument (K-PeCS)

This paper describes the inter-rater and intra-rater reliability, and the concurrent validity of an observational instrument, the Keyboard Personal Computer Style instrument (K-PeCS), which assesses stereotypical postures and movements associated with computer keyboard use. Three trained raters independently rated the video clips of 45 computer keyboard users to ascertain inter-rater reliability, and then re-rated a sub-sample of 15 video clips to ascertain intra-rater reliability. Concurrent validity was assessed by comparing the ratings obtained using the K-PeCS to scores developed from a 3D motion analysis system. The overall K-PeCS had excellent reliability [inter-rater: intra-class correlation coefficients (ICC)=.90; intra-rater: ICC=.92]. Most individual items on the K-PeCS had from good to excellent reliability, although six items fell below ICC=.75. Those K-PeCS items that were assessed for concurrent validity compared favorably to the motion analysis data for all but two items. These results suggest that most items on the K-PeCS can be used to reliably document computer keyboarding style.

The association between the meaning of working and musculoskeletal discomfort

Abstract This exploratory study was conducted to see if there was an association between the meaning of working and musculoskeletal discomfort and if that association was predictive of the severity of discomfort. Each of 170 telecommunication personnel at two sites completed a Meaning of Working Survey form and a Musculoskeletal Discomfort Questionnaire. Seven component composites of the meaning of working (work centrality, obligation, entitlement, comfort, promotion/power, expressive, and social support) were entered into a linear multiple regression model. The results suggested that there was a moderate, significant association ( R 2 =0.19, p =0.0002) between overall musculoskeletal discomfort and promotion/power as well as the control variables age, gender, job satisfaction, average hours worked, and site. A logistic linear regression found that these composites, along with social support, could accurately identify who was in a none/mild discomfort category or a moderate/severe discomfort category 72% of the time. The overall pattern suggested that females who worked longer hours, valued promotion and power and disliked social support were most likely to develop moderate to severe musculoskeletal discomfort. This study provides a preliminary exploration of the association between meaning and MSD in the workplace and provides one hypothesis why meaning may be associated with MSD. Relevance to industry The causes of musculoskeletal disorders (MSD) in the workplace are diverse and poorly understood. The meaning that working has to an individual may help to explain why certain psychosocial factors are associated with musculoskeletal discomfort and may eventually provide one way to intervene to reduce MSD.

Prevalence and risk factors for musculoskeletal problems associated with microlaryngeal surgery: a national survey.

Microlaryngeal surgery (MLS) presents ergonomic challenges to surgeons and potential risks for developing musculoskeletal symptoms (MSSx). This study describes prevalence and risk factors of MLS‐associated MSSx.

Problems experienced by people with arthritis when using a computer

OBJECTIVE To describe the prevalence of computer use problems experienced by a sample of people with arthritis, and to determine differences in the magnitude of these problems among people with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). METHODS Subjects were recruited from the Arthritis Network Disease Registry and asked to complete a survey, the Computer Problems Survey, which was developed for this study. Descriptive statistics were calculated for the total sample and the 3 diagnostic subgroups. Ordinal regressions were used to determine differences between the diagnostic subgroups with respect to each equipment item while controlling for confounding demographic variables. RESULTS A total of 359 respondents completed a survey. Of the 315 respondents who reported using a computer, 84% reported a problem with computer use attributed to their underlying disorder, and approximately 77% reported some discomfort related to computer use. Equipment items most likely to account for problems and discomfort were the chair, keyboard, mouse, and monitor. Of the 3 subgroups, significantly more respondents with FM reported more severe discomfort, more problems, and greater limitations related to computer use than those with RA or OA for all 4 equipment items. CONCLUSION Computer use is significantly affected by arthritis. This could limit the ability of a person with arthritis to participate in work and home activities. Further study is warranted to delineate disease-related limitations and develop interventions to reduce them.