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      Determining functional activity profiles in patients with upper extremity disorders: is there effect modification by hand-grip strength?

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          Abstract

          Purpose

          The purposes of this study were to investigate the effect of hand-grip strength (HGS) on the Disabilities of the Arm, Shoulder, and Hand (DASH) score in women with upper extremity musculoskeletal disorders (UEMDs) living in rural communities and examine whether upper extremity diseases affected upper extremity functional activity in each group (normal/low HGS) and whether grip strength (GS) was an effect modifier in upper extremity functional activity.

          Methods

          A total of 239 women older than 60 years who had completed a medical workup for epicondylitis, rotator cuff tears, and/or hand osteoarthritis were included in the final study. Functional activity was assessed by DASH, and muscle strength was measured by GS. Low HGS was defined according to the Asian Working Group for Sarcopenia (HGS <18 kg in women). Pearson correlation analysis was performed to evaluate the relationship between HGS and the DASH score. A multiple regression analysis was performed after defining DASH as a dependent variable and dividing subjects into two groups (low HGS and normal HGS). Statistical analyses were performed using SPSS Statistics V.24.

          Results

          HGS in the participants correlated with the DASH score ( r=−0.320, P<0.001). In the low HGS group, waist circumference ( B=−0.526, P=0.010) and the DASH score were significantly correlated. In addition, DASH scores were statistically significantly increased as the number of upper extremity diseases increased to 2 ( B=11.592, P=0.016) and 3 ( B=15.716, P=0.001). The DASH score in the normal HGS group was correlated with the Patient Health Questionnaire-2 score ( β=2.680, P<0.001) after adjusting covariates.

          Conclusion

          We found that HGS in UEMD patients affected health-related quality of life as measured by the DASH. Maintaining hand muscle strength may improve patient functional activity in age-related UEMDs.

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          Most cited references 18

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          Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study.

          to investigate the relationship between grip strength and health-related quality of life (HRQoL). cross-sectional survey within a cohort study design. the county of Hertfordshire in the UK. a total of 2,987 community-dwelling men and women aged 59-73 years of age. grip strength was used as a marker of sarcopaenia and measured using a Jamar dynamometer. HRQoL was assessed using the eight domain scores of the Short Form-36 (SF-36) questionnaire, and subjects in the lowest sex-specific fifth of the distribution were classified as having 'poor' status for each domain. men and women with lower grip strength were significantly more likely to report a poor as opposed to excellent to fair overall opinion of their general health (GH) [odds ratio (OR) per kilogram decrease in grip strength = 1.13, 95% CI = 1.06-1.19, P < 0.001 in men, 1.13, 95% CI = 1.07-1.20, P < 0.001 in women]. Among men, after adjustment for age, size, physical activity and known co-morbidity, decreased grip strength was associated with increased prevalence of poor SF-36 scores for the physical functioning (PF) (OR per kilogram decrease in grip strength = 1.03, 95% CI = 1.01-1.06, P = 0.007) and GH domains (OR = 1.03, 95% CI = 1.01-1.05, P = 0.01). Similar associations were seen in women. our findings suggest that lower grip strength is associated with reduced HRQoL in older men and women. This does not appear to be explained by age, size, physical activity or co-morbidity and may reflect the link between sarcopaenia and generalised frailty. Individuals with sarcopaenia may benefit from interventions to improve muscle mass and strength before the onset of chronic disorders usually associated with impaired HRQoL.
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            Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study.

            To describe the prevalence and longitudinal course of radiographic, erosive and symptomatic hand osteoarthritis (HOA) in the general population. Framingham osteoarthritis (OA) study participants obtained bilateral hand radiographs at baseline and 9-year follow-up. The authors defined radiographic HOA at joint level as Kellgren-Lawrence grade (KLG)≥2, erosive HOA as KLG≥2 plus erosion and symptomatic HOA as KLG≥2 plus pain/aching/stiffness. Presence of HOA at individual level was defined as ≥1 affected joint. The prevalence was age-standardised (US 2000 Population 40-84 years). Mean (SD) baseline age was 58.9 (9.9) years (56.5% women). The age-standardised prevalence of HOA was only modestly higher in women (44.2%) than men (37.7%), whereas the age-standardised prevalence of erosive and symptomatic OA was much higher in women (9.9% vs 3.3%, and 15.9% vs 8.2%). The crude incidence of HOA over 9-year follow-up was similar in women (34.6%) and men (33.7%), whereas the majority of those women (96.4%) and men (91.4%) with HOA at baseline showed progression during follow-up. Incident metacarpophalangeal and wrist OA were rare, but occurred more frequently and from an earlier age in men than women. Development of erosive disease occurred mainly in those with non-erosive HOA at baseline (as opposed to those without HOA), and was more frequent in women (17.3%) than men (9.6%). The usual female predominance of prevalent and incident HOA was less clear for radiographic HOA than for symptomatic and erosive HOA. With an ageing population, the impact of HOA will further increase.
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              Minimal clinically important differences of 3 patient-rated outcomes instruments.

              Patient-rated instruments are increasingly used to measure orthopedic outcomes. However, the clinical relevance of modest score changes on such instruments is often unclear. This study was designed to define the minimal clinically important differences (MCIDs) of the Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH (subset of DASH), and Patient-Rated Wrist Evaluation (PRWE) questionnaires for atraumatic conditions of the hand, wrist, and forearm. We prospectively analyzed 102 patients undergoing nonoperative treatment for isolated tendinitis, arthritis, or nerve compression syndromes from the forearm to the hand. By phone, patients completed the DASH, QuickDASH, and PRWE at enrollment and at 2 weeks (n = 78 used in the analysis) and 4 weeks (n = 24 used in the analysis) after initiating treatment. Patients reporting clinical improvement each contributed a single data point categorized as no change (n = 41), minimal improvement (n = 30), or marked improvement (n = 31) via a validated anchor-based approach. We calculated the MCID as the mean change score for each outcome measure in the minimal improvement group. The MCID (95% confidence interval) for the DASH was 10 (5-15). The MCID for the QuickDASH was 14 (9-20). The MCID was 14 (8-20) for the PRWE. The MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement. The MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores. Longitudinal changes on the DASH of 10 points, on the QuickDASH of 14 points, and on the PRWE of 14 points represent minimal clinically important changes. We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients. These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures. Diagnostic III. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Clin Interv Aging
                Clin Interv Aging
                Clinical Interventions in Aging
                Clinical Interventions in Aging
                Dove Medical Press
                1176-9092
                1178-1998
                2018
                15 November 2018
                : 13
                : 2351-2358
                Affiliations
                [1 ]Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, parkks@ 123456gnu.ac.kr
                [2 ]Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, furim@ 123456daum.net , parkks@ 123456gnu.ac.kr
                [3 ]Center for Farmer’s Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, furim@ 123456daum.net , parkks@ 123456gnu.ac.kr
                [4 ]Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
                [5 ]Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
                [6 ]Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea, furim@ 123456daum.net
                Author notes
                Correspondence: Jun-Il Yoo, Department of Orthopaedic Surgery, Gyeongsang National University Hospital, 90 Chilamdong, Jinju, Gyeongnamdo, Republic of Korea, Tel +82 55 750 8688, Fax +82 55 754 0477, Email furim@ 123456daum.net
                Ki Soo Park, Department of Preventive Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju, Republic of Korea, Tel +82 55 772 8095, Fax +82 55 772 8099, Email parkks@ 123456gnu.ac.kr
                Article
                cia-13-2351
                10.2147/CIA.S187066
                6241862
                © 2018 Kim et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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