Saurabh P. Mehta

Concurrent Validation of the Dash and the Quickdash in Comparison to Neck-specific Scales in Patients With Neck Pain

Study Design. Concurrent validity study. Objective. To examine the validity of the Disabilities of Arm, Shoulder, and Hand (DASH) and the QuickDASH in patients with neck pain in comparison with the Neck Disability Index (NDI), the Cervical Spine Outcome Questionnaire (CSOQ), and the Visual Analogue Scale (VAS) for pain. To examine the agreement between the DASH and the QuickDASH and assess whether the QuickDASH can be used instead of full DASH in patients with neck pain. Summary of Background Data. NDI is commonly used for measuring neck-related disability in patients with neck pain; but it does not offer to assess the potential for upper extremity disability. Methods. Patients with neck pain (N = 66) were assessed on one occasion. They completed the NDI and the DASH, and 42 of them completed the CSOQ. The QuickDASH scores were extracted from the full DASH. Correlations were tested between both versions of the DASH, the NDI, the subscales of the CSOQ, and the VAS-pain. Correlations were considered high with r >0.75. Ranked item difficulty analysis was performed for both versions of the DASH and the NDI. The Bland and Altman technique was used to assess the nature and size of score differences between 2 versions of the DASH. Results. Item ranks identified the DASH and the QuickDASH items to be as problematic to patients as NDI items. Both the versions of DASH showed high correlation (0.82-0.83) with the NDI and moderate correlation with the CSOQ and VAS-pain. The mean QuickDASH scores were higher (2.77 points) compared to the full DASH. Conclusion. Though the QuickDASH reported higher disability compared to the full DASH in this patient group, high correlation between the QuickDASH and the NDI and agreement between both versions of the DASH provide preliminary evidence that the QuickDASH can be used to measure upper extremity disability in patients with neck pain.

Cross-cultural Adaptation and Psychometric Testing of the Hindi Version of the Patient-rated Wrist Evaluation

UNLABELLED The purpose of this study was to perform cross-cultural adaptation and Hindi translation of the patient-rated wrist evaluation (PRWE) and assess psychometric properties of the PRWE-Hindi. Cross-cultural adaptation and Hindi translation of the PRWE was performed using standardized guidelines. Intraclass correlation coefficient (ICC) was used for assessing test-retest reliability, and Cronbachs alpha (CA) was used for assessing the internal consistency of the PRWE-Hindi. Construct validity was assessed by examining the correlations between the PRWE-Hindi and grip strength, wrist range of movements, and self-reported pain and disability. A total of 50 patients with distal radius fracture were recruited and assessed three times (baseline, two to three days later, and four to five weeks later). PRWE-Hindi demonstrated excellent test-rest reliability (ICC=0.81) and internal consistency (CA=0.89). Moderate to low correlations (r<0.7) were observed between the PRWE-Hindi and other measures of pain and disability. Our results indicated that PRWE-Hindi is a reliable and valid tool and can be used in patients with wrist/hand injuries whose primary language is Hindi. LEVEL OF EVIDENCE N/A.

SySTeMATIC RevIew oF HoMe PHySIoTHeRAPy AFTeR HIP FRACTuRe SuRGeRy

OBJECTIVE To compare the benefits of home physiotherapy, institution-based physiotherapy and no physiotherapy following hip fracture surgery. DESIGN Systematic review and meta-analysis of randomized controlled trials. METHODS Two reviewers independently extracted data from 5 included studies. Standardized mean differences were pooled for health-related quality of life and performance-based outcomes. Review Manager Version 5 was used for data analysis. RESULTS Analysis of the 5 included studies indicated that home physiotherapy was better than no physiotherapy and similar to outpatient physiotherapy in improving patient-reported health-related quality of life. Performance-based outcomes were marginally better following outpatient physiotherapy compared with home physiotherapy 3 and 6 months after surgery. The risk of bias was high for most outcomes due to methodological issues in the included studies. DISCUSSION There was a trend of better results with increasing intensity of physiotherapy intervention, but this did not convert into significant effect sizes. The results of this review do not build a strong consensus for recommending one mode of physiotherapy over the others. The quality of evidence was low mainly due to the high risk of bias in the included studies. CONCLUSION In light of no strong consensus, physiotherapists should continue to follow their current workplace practice policies for determining suitable discharge settings.

A Systematic Review of the Measurement Properties of the Patient-Rated Wrist Evaluation

STUDY DESIGN Systematic review of measurement properties. OBJECTIVES To summarize the measurement properties of the Patient-Rated Wrist Evaluation (PRWE) questionnaire. BACKGROUND The PRWE is a region-specific outcome measure initially developed for assessing pain and function in individuals with distal radius fracture. However, subsequent research has expanded its use to other wrist/hand conditions. A systematic review of the measurement properties of the PRWE can enhance the understanding of its clinical applicability across different wrist/hand pathologies. METHODS The MEDLINE, Embase, and CINAHL databases were searched using predefined search terms. A hand search of the bibliography of the primary studies was performed. Studies assessing at least 1 measurement property of the PRWE, either in the English version or versions in other languages, were included in this review. Two raters performed data extraction and critical appraisal of the primary studies using standardized instruments. RESULTS A total of 22 primary studies met the inclusion criteria. The overall quality of the 22 studies ranged from 38% to 88%, with 9 scoring greater than 70%. Agreement between the raters who determined the quality of the studies was 0.75 (unweighted kappa). The measurement properties of the PRWE were summarized for different wrist/hand conditions. CONCLUSION The PRWE is reliable, valid, and responsive across many wrist/hand conditions. Future studies should focus on determining values for the minimal detectable change and clinically important differences for the PRWE across different patient populations.

Measurement Properties of the Lower Extremity Functional Scale: A Systematic Review

STUDY DESIGN Systematic review of measurement properties. BACKGROUND Many primary studies have examined the measurement properties, such as reliability, validity, and sensitivity to change, of the Lower Extremity Functional Scale (LEFS) in different clinical populations. A systematic review summarizing these properties for the LEFS may provide an important resource. OBJECTIVE To locate and synthesize evidence on the measurement properties of the LEFS and to discuss the clinical implications of the evidence. METHODS A literature search was conducted in 4 databases (PubMed, MEDLINE, Embase, and CINAHL), using predefined search terms. Two reviewers performed a critical appraisal of the included studies using a standardized assessment form. RESULTS A total of 27 studies were included in the review, of which 18 achieved a very good to excellent methodological quality level. The LEFS scores demonstrated excellent test-retest reliability (intraclass correlation coefficients ranging between 0.85 and 0.99) and demonstrated the expected relationships with measures assessing similar constructs (Pearson correlation coefficient values of greater than 0.7). The responsiveness of the LEFS scores was excellent, as suggested by consistently high effect sizes (greater than 0.8) in patients with different lower extremity conditions. Minimal detectable change at the 90% confidence level (MDC90) for the LEFS scores varied between 8.1 and 15.3 across different reassessment intervals in a wide range of patient populations. The pooled estimate of the MDC90 was 6 points and the minimal clinically important difference was 9 points in patients with lower extremity musculoskeletal conditions, which are indicative of true change and clinically meaningful change, respectively. CONCLUSION The results of this review support the reliability, validity, and responsiveness of the LEFS scores for assessing functional impairment in a wide array of patient groups with lower extremity musculoskeletal conditions.

Do women have poorer outcomes following total knee replacement

OBJECTIVE To investigate whether women have poorer pain and functional outcomes following total knee replacement (TKR) and to investigate factors that may contribute to this poorer outcome. METHODS In a cohort of 494 people, outcomes were the Pain and Function/Daily Activity subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 and 12 months post-surgery. Sequential multivariable regression analyses evaluated the following independent variables: (1) sex; (2) sex and age; (3) sex, age and pre-surgery score for respective outcome measures; and, (4) model 3 and body mass index (BMI), education, low back pain (LBP), depression, comorbidities, and symptomatic joint count. RESULTS The sample included 323 women and 171 men. Women were significantly worse on several factors pre-surgery: pain: 39.0 vs 44.9, P = 0.002; function: 47.7 vs 55.0, P < 0.0001; depression 5.6 vs 4.7, P = 0.006; obesity (BMI ≥30): 54.2 vs 36.3%, P = 0.0002; and, symptomatic joint count: ≥4: 61.3 vs 44.4%, P = 0.002. Women had worse outcomes for pain (72.2 vs 76.1, P = 0.04) and function (75.2 vs 80.5, P = 0.007) at 6 months. This effect was attenuated by adding pre-surgery pain/function. However, the magnitude of the association of pre-surgery pain/function was reduced when LBP, depression, BMI, education level, joint count and comorbidity count were added suggesting association with pre-surgery pain and function. Twelve month results were similar. CONCLUSION Women appear to have worse outcomes than men possibly due to a putative pre-operative profile across many factors. Consideration of TKR when impairments in pain and function are less severe along with interventions that address mood and comorbidity may improve outcomes for women having TKR.

The FIT-HaNSA Demonstrates Reliability and Convergent Validity of Functional Performance in Patients With Shoulder Disorders

STUDY DESIGN Psychometric study design. OBJECTIVES To assess the test-retest reliability and convergent validity of the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with shoulder disorders. BACKGROUND Performance tests that assess functional ability of patients with shoulder disorders can provide useful information for making clinical or return-to-activity decisions. No performance-based shoulder test has yet demonstrated sufficient relevance or clinical measurement properties. The FIT-HaNSA examines upper extremity performance during repetitive tasks that emphasize shoulder reaching and static postures and, therefore, has greater relevance for assessing performance. METHODS Thirty-six patients with shoulder disorders and 65 healthy controls were recruited for the study. The FIT-HaNSA, the Disabilities of the Arm, Shoulder and Hand questionnaire, the Shoulder Pain and Disability Index, isometric shoulder strength, and shoulder range of motion were assessed at baseline and repeated 2 to 7 days later. Test-retest reliability was described using intraclass correlation coefficient (ICC(2,1)) and standard error of measurement. Pearson correlation coefficients were used to examine the level of association between the FIT-HaNSA scores and the other measures. RESULTS The ICCs for test-retest reliability for the FIT-HaNSA ranged from 0.89 to 0.97 in the patient group and 0.79 to 0.91 in the control group. The FIT-HaNSA showed high correlation with the Disabilities of the Arm, Shoulder and Hand and the Shoulder Pain and Disability Index, and moderate correlations with shoulder range of motion and muscle strength. CONCLUSION The FIT-HaNSA demonstrated high test-retest reliability and convergent validity with other related outcomes in patients with shoulder disorders. Further longitudinal studies are required to evaluate the responsiveness of the FIT-HaNSA in patients with different upper extremity conditions.

Baseline Pain Intensity Is a Predictor of Chronic Pain in Individuals With Distal Radius Fracture

STUDY DESIGN Secondary analysis of cohort study. OBJECTIVE This study examined whether baseline pain intensity is a predictor of chronic pain and wrist/hand functions at 1 year following distal radius fracture (DRF). The study also examined the cutoff level for baseline pain intensity that best predicted chronic pain. BACKGROUND Many individuals experience wrist/hand pain and functional impairments for as long as 1 year after DRF. Early identification of individuals at risk of these adverse outcomes can facilitate the delivery of required interventions to mitigate the risk. METHODS Data for the Patient-Rated Wrist Evaluation (PRWE) pain and function subscales at baseline and 1 year after DRF, age, sex, injury to the dominant side, presence of comorbidity, education level, mechanism of fracture, smoking status, fall history, and energy of fracture were extracted from an existing data set. Multivariate regression analysis examined the utility of baseline pain intensity and the above variables in predicting pain and functional status at 1 year in individuals with DRF. Receiver operating characteristic curves examined the sensitivity/specificity of baseline pain intensity in predicting chronic pain and functional impairment. RESULTS Required data were available for 386 individuals. Baseline pain intensity was found to be a strong predictor of chronic pain, explaining 22% of the variance. A baseline score of 35 out of 50 on the pain subscale of the PRWE had the best sensitivity (85%) and specificity (79%) cutoff values for predicting chronic pain at 1 year after DRF. CONCLUSION Rehabilitation practitioners may be able to use a score of greater than 35/50 on the PRWE pain subscale to screen individuals at risk of chronic pain following DRF. LEVEL OF EVIDENCE Prognosis, level 4.

Home-Based Multidisciplinary Rehabilitation following Hip Fracture Surgery: What Is the Evidence?

Objective. To determine the effects of multidisciplinary home rehabilitation (MHR) on functional and quality of life (QOL) outcomes following hip fracture surgery. Methods. Systematic review methodology suggested by Cochrane Collboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided. Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT). Over the long-term, the MHR group showed greater improvements in balance confidence, functional status, and lower extremity muscle strength compared to NT group, whereas the effect on QOL and mobility was inconsistent across the studies. Several methodological issues related to study design were noted across the studies. Conclusion. The MHR was found to be more effective compared to the NT in improving functional status and lower extremity strength in patients with hip fracture surgery. Results of this review do not make a strong case for MHR due to high risk of bias in the included studies. Further research is required to accurately characterize the types of disciplines involved in MHR and frequency and dosage of intervention.

The implications of chronic pain models for rehabilitation of distal radius fracture

Distal radius fracture (DRF) is the most common fracture and usually occurs as a result of a fall. Most patients recover following DRF with minimal residual pain or disability; however, a small subset of patients continue to experience pain and disability even one year after the injury. Currently, there are no practice guidelines for early identification and treatment of patients who are potentially at greater risk of developing these adverse outcomes. As a result, hand therapy management of patients following DRF does not incorporate screening of these at-risk patients. The objective of this paper is to apply constructs from learned helplessness and cognitive-behavioural models of chronic pain in assessing the psychosocial risk profile of patients following DRF. We have also integrated key findings derived from studies addressing personal and life-style factors in assessing this risk profile. This framework is proposed as a basis to categorize patients as higher or lower psychosocial risk for developing chronic pain and disability following DRF. We outline a model depicting the RACE approach (Reducing pain, Activating, Cognitive reshaping, Empowering) towards the management of patients following DRF. The model suggests that patients with minimal psychosocial risk factors are managed based on their injury profile and those with higher psychosocial risk are treated with the risk-based RACE approach. Using a biopsychosocial RACE approach to prognosis and treatment, hand therapy intervention can be customized for patients recovering from DRF. In future, researchers can conduct clinical trials to compare the RACE-based treatment approach to routine hand therapy in mitigating the risk of chronic pain and disability in patients with elevated risk profile for adverse outcomes following DRF.