Discussion Rheumatoid arthritis is a systemic inflammatory disease in which most of the patients suffer from involvement of the hands 1. Traditionally, hand assessment in RA patients includes measures of impairment such as pain, stiffness, swelling, range of motion, and deformities. Although these measures of impairment provide information about the clinical status of patient and may give some opinion about hand function, they may not exactly demonstrate the amount of difficulty that the patients have in daily life. Therefore, a comprehensive assessment of hand function should include tasks simulating everyday functional activities It was designed for individuals with RA to evaluate the outcome of hand training programs 6. In this study, we evaluated the relationship between the GAT and disease activity, and hand-specific self-report questionnaires in patients with RA, and found acceptable degrees of correlation.
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Discussion Rheumatoid arthritis is a systemic inflammatory disease in which most of the patients suffer from involvement of the hands 1. Traditionally, hand assessment in RA patients includes measures of impairment such as pain, stiffness, swelling, range of motion, and deformities.
Although these measures of impairment provide information about the clinical status of patient and may give some opinion about hand function, they may not exactly demonstrate the amount of difficulty that the patients have in daily life. Therefore, a comprehensive assessment of hand function should include tasks simulating everyday functional activities It was designed for individuals with RA to evaluate the outcome of hand training programs 6.
In this study, we evaluated the relationship between the GAT and disease activity, and hand-specific self-report questionnaires in patients with RA, and found acceptable degrees of correlation. In the present study, the GAT had the strongest correlation with the self-report disability questionnaires. Dellhag and Bjelle 6 reported significant correlation between the GAT and the HAQ; however, they did not include a questionnaire specific to hand in their study.
Eberhardt et al. The correlation between the GAT and the HAQ, which is a generalized measure of disability, suggests that hand dysfunction has a considerable impact on general disability. Adams et al. We assessed the intensity of hand pain during the day both at rest and during ADL. Dellhag and Bjelle 6 measured the intensity of hand pain in two different conditions: with non-resisted motion and with resisted motion during the performance of GAT items.
Both were found to correlate significantly with the total GAT score. The intensity of stiffness in hands and the duration of morning stiffness were both correlated with GAT in our study. Dellhag and Bjelle 6 also reported a significant correlation between hand stiffness and GAT.
In another study, Vlieland et al. Hand function assessment included Jebsen test and the authors reported a significant correlation between stiffness of the hands and hand dysfunction. Muscle strength has been reported to be lower in RA patients compared to healthy controls 21 , Significant correlations between grip strength and general disability, 23 , 24 as well as hand dysfunction, 20 , 24 have been found in studies where hand function was evaluated by methods other than GAT.
In our study, GAT correlated significantly with both dominant and non-dominant hand grip strength. Dellhag and Bjelle 6 measured grip strength of only the dominant hand, and reported a significant correlation with GAT.
In three other studies, significant correlations between grip force and the GAT were found. Two of these studies were composed of only early RA patients, 19 , 25 and the third one18 included only patients with highly active disease with most of them having severe hand dysfunction. Several previous studies have reported weak to moderate correlations between disease activity and hand or upper extremity disability; however, hand disability was assessed with self-report questionnaires, not by GAT, in these studies.
The authors considered that this might have resulted from the fact that most of their patients already had severe hand dysfunction. Their study group was composed of patients all receiving anti-tumor necrosis factor anti-TNF therapy with high disease activity. Our study population included patients in remission as well as patients with low, moderate or high disease activity, although the number of patients with high disease activity was relatively low.
Weak correlations between disease activity and disability measures suggest that evaluation of hand disability may add important information to evaluation with traditional assessment methods.
Hand deformity is one of the main characteristics of RA. Most common deformities are buttonhole deformity, swan neck deformity, and ulnar deviation of the metacarpophalangeal joints. Different deformities may develop simultaneously in the same hand.
Johnsson et al. The results showed that hand deformities considerably affected both hand function and overall function. Vliet Vlieland et al. In our study, grip strength of patients with deformities was lower than that of patients without deformities, but the GAT scores did not differ significantly. Discrepancies between studies may result from the differences between assessment methods and study populations.
The prevalence of hand deformities was generally low in our study. In addition, we could not explore the relationship between the GAT scores and different types of deformity, since the number of patients in each subgroup of deformity was quite low.
In our study, finger flexion deficit of the dominant hand correlated significantly with GAT. This result is in line with the finding of Dellhag and Bjelle 6. In addition, they used the hand and wrist items of the Keitel Functional Test, which assesses joint limitations, and reported a significant correlation with GAT.
Three studies evaluated range of motion of the hand joints by Signals of Functional Impairment, in which the patient performs opening grip, pinch grip, and thumb opposition in addition to finger flexion 18 , 25 , There are several limitations of this study.
The number of patients with high disease activity in our study population was low, as assessed by the DAS In addition, the prevalence of deformities was lower than in most of the studies in the literature. It would have been optimal, if the study population had been more heterogeneous with regard to disease activity and hand deformities. In conclusion, weak to moderate correlations were found between the GAT and disease activity, and hand-specific self-report questionnaires in patients with RA.
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Duruoz Hand Index
Zolok Finding a clinical assessment scale — Physical Medicine and Rehabilitation We aimed to find out the effects of androgen deprivation therapy with LH-RH agonist on the hand function, quality of life, and mood of the patients with prostate cancer. J Back Musculoskelet Rehabil Sep 7. Forty-one patients were randomly assigned to acupuncture and control groups. Diruoz patients with a positive Tinel or Phalen sign were recruited. Forty patients with scleroderma and no other major medical hhand completed the DHI at 2 points in time to assess test-retest reliability. Patients who were injured by punching glass were significantly younger and more likely to injure their dominant hand. The correlation among bone mineral density of the hand, radiological findings and hand function.
Finding a clinical assessment scale - Physical Medicine and Rehabilitation