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The article focuses on predicting poor outcomes in distal radius fracture (DRF) rehabilitation based on factors like age, disability, sex, and psychosocial conditions. Topics include recommended assessments for pain and disability, screening for fall risk, and timing for initiating therapy and strengthening exercises during DRF recovery.

The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis. Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent t tests to discriminate between satisfied and dissatisfied patients. We classified 98% of the PSFS items in the International Classification of Function "activities" and "participation" domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46–0.68) and 0.47 (0.35–0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up. The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire. The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis. [ABSTRACT FROM AUTHOR]

An editorial is presented on the importance of considering sex and gender in health research through an intersectional lens. Topics include the role of intersectionality in understanding health disparities, the influence of sex and gender on health outcomes, and upcoming consensus recommendations from orthopedic journals on improving sex and gender reporting in research.

tOBJECTIVE: To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. tDESIGN: A systematic review with network metaanalysis (NMA) of randomized controlled trials. tLITERATURE SEARCH: We searched the Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS MEDLINE, PSYNDEX, and PsycINFO databases from inception to May 2023. tSTUDY SELECTION CRITERIA: Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. tDATA SYNTHESIS: We used Bayesian randomeffects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomization process, large trials (>100 patients per arm) and musculoskeletal condition. tRESULTS: Fifty-eight randomized controlled trials involving 10 278 participants (median sample size: 137; interquartile range [IQR]: 77--236) were included. Interactive voice response cognitive behavioral therapy (CBT; standardized mean difference [SMD] -0.66, 95% credible interval [CrI] -1.17 to -0.16), CBT in person (SMD -0.50, 95% CrI -0.97 to -0.04), and mobile app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-week follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT and telecare were superior to waitlist at 12-week follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. tCONCLUSION: Interactive voice response CBT and mobile app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and depression had over 98% probability of superiority than waitlist control at 12-week follow-up. Internet-delivered CBT and telecare had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-week follow-up. [ABSTRACT FROM AUTHOR]

Proximal humerus fracture (PHF) is a common upper extremity injury. PHF often causes prolonged disability and interferes with independent function. This study reviewed and summarized prognostic factors of recovery following PHF and classified them within the International Classification of Functioning, Disability and Health (ICF) with each domain sub-categorized by modifiability. Systematic review. We searched MEDLINE, CINAHL, EMBASE, and PsychINFO from the date of database inception to March 2019 and updated searches in December 2021. Studies included examining an association between prognostic factors and recovery with at least a 6-month follow-up. Two independent reviewers used the Quality in Prognosis Studies tool for methodological bias and levels of evidence. Designs showed wide variability in terms of characteristics of the included population, definition of recovery, assessment of prognostic factors, and outcome measures used. This prevented pooled estimates from being produced. Prognostic factors linked to ICF domains were possible. Twenty-three studies including 4323 participants aged ≥18 met inclusion criteria. The risk of bias was low (35%), moderate (30%), and high (35%) across the included studies. Moderate evidence showed a significant association between pre-fracture functional independence and post-fracture complications with recovery. Fracture type, structural deformity, medication use, age, and gender were prognostic factors with inconclusive evidence. We assigned a weak level of evidence to the remaining 20 factors due to limited data. Immediate rehabilitation, compliance to post-fracture rehabilitation exercise, task-oriented exercise, and pain self-efficacy (i.e., coping behavior) are modifiable and are tapped into the ICF contextual factors. An array of factors that fit within an ICF biopsychosocial framework have been investigated as potential mediators of outcomes after PHF. The evidence is incomplete conceptually and in terms of research design quality. Preoperative functional status is predictive of functional recovery emphasizing the importance of healthy aging. • Proximal humerus fracture (PHF) is a commonly injury causing prolonged disability. • Evidence for modifiable prognostic factors of recovery after PHF is lacking. • Preinjury functional status is predictive of recovery after PHF. • Biopsychosocial predictors should be considered in recovery plan after PHF. [ABSTRACT FROM AUTHOR]

• The PRWE is translated into Tamil with semantic equivalence. • The PRWE-T showed good reliability, internal consistency, and construct validity. • The PRWE-T can be used with Tamil-speaking patients, in clinical settings and research settings. [ABSTRACT FROM AUTHOR]

The Single Assessment Numeric Evaluation (SANE) is a single item patient reported outcome measure (PROM) of function, in where patients rate how normal they feel in relation to a specific joint or problem. Although validated for some orthopedic conditions, it is not yet validated for a population with shoulder pathologies; nor have other studies explored the content validity. This study aims to understand how 1) patients with shoulder conditions interpret and calibrate responses to the SANE and 2) how they define normal. This study uses cognitive interviewing, a qualitative methodology that focuses on the interpretation of questionnaire items. Patients with rotator cuff disorders (n = 10), clinicians (n = 6) and measurement researchers (n = 10) were interviewed using a talk aloud structured interview that evaluated the SANE. All interviews were recorded and transcribed verbatim by one researcher (R.F). Analysis was done through an open coding scheme using a previously established framework for classification of interpretation variances. Overall, the single-item SANE was well received by all participants. Through the interviews, the themes of: Comprehension (20% of participants), Reference Point (20% of participants), Relevance (10% of participants), and Perspective Modifiers (50% of participants) emerged as potential sources of interpretation variances. Clinicians indicated this tool facilitates discussion when trying to create realistic recovery expectations for patients post-operatively. The word "normal" was defined by the themes of: 1) levels of current pain compared to pre-injury, 2) personal expectations of recovery and 3) pre-injury activity levels. Overall, respondents found the SANE to be cognitively simple, but it was clear that the interpretation of the question and what factors calibrated their responses were highly variable between respondents. The SANE is perceived favorable by patients and clinicians, while providing a low response burden. However, the construct being measured may vary between patients. [ABSTRACT FROM AUTHOR]

The article offers a discussion on the importance of considering the quintuple aims in hand therapy research, which focus on improving patient experience and outcomes, provider work role experience, cost efficiency, and equity. Topics include the relevance of the quintuple aims framework in evaluating clinical research, the use of metrics like effect size to measure research impact, and the alignment of two of the quintuple aims with the value concept in healthcare.

In response to the inherent critical incident exposures experienced by firefighters, various mental health education programs have been developed. The purpose of this study was to explore the perceptions of firefighters who took such programs to understand differences/similarities across these programs. We recruited 14 participants, who had taken or delivered two or more programs for firefighters (Resilient Minds (RM), Road to Mental Readiness (R2MR), and Before Operational Stress (BOS)). Participants participated in semi-structured interviews, which explored information that they learned, recalled, used, and their preferences. Data was analysed using thematic analysis. Participants believed that all programs had some shared teaching methods, goals, skills, and topics; however, each program had key focuses/distinctive features. RM was said to be largely group participation and focused on assisting yourself, peers, and citizens. R2MR and BOS was said to be largely lecture style with a focus on the self. 70 % of participants who took RM (n = 7) and one other course preferred RM due to the specificity of training to firefighters, more active teaching methods, and focus on practical skill development. Others (43 %) had no program preference. Participants suggest that a tiered approach to mental health education would benefit firefighters. All programs were seen as helpful. Despite some congruency in goals and content, most firefighters preferred RM because the content was fire-specific, and the pedagogical approach was seen as more active and engaging. Program characteristics are important to facilitate appropriate program selection, as such, programs should be explicit about these aspects. • RM was mostly group participation and focused on assisting yourself/peers/citizens. • R2MR and BOS was largely lecture style with a focus on the self. • 7/10 preferred RM; fire-specific, interactive, and taught practical skills. • 6/14 had no program preference; they believed all were beneficial. • Participants suggest a tiered approach to mental health training would be best. [ABSTRACT FROM AUTHOR]

The article presents the discussion on creating evidence-based practice guidelines for management of patients with musculoskeletal impairments. Topics include evidence-based practice including diagnosis, prognosis, intervention, and assessment of outcomes of musculoskeletal disorders commonly managed by orthopaedic, sports, and hand physical therapists; and subject to change as scientific knowledge and technology advance and patterns of care evolve.

* OBJECTIVES: To (1) describe the nature and content of the current literature on preoperative education programs for patients preparing for orthopaedic surgery, (2) assess the completeness of reporting program descriptions, and (3) report gaps within the literature. * DESIGN: Scoping review * LITERATURE SEARCH: We searched the CINAHL, Embase, PubMed, Cochrane Reviews, PsycINFO, Web of Science, and Google Scholar databases for studies that (1) addressed preoperative education in elective orthopaedic surgery or (2) provided descriptions or evaluations of a preoperative program, including the content or outcomes of the program. * STUDY SELECTION CRITERIA: Articles were included if they addressed preoperative patient education focused on an elective orthopaedic surgery and any of the (1) descriptions of an education program including any theoretical frameworks, content, or delivery, or (2) evaluations of the process of a preoperative educational program. Studies were excluded if they were treatment programs with the goal of resolving the problem occurring prior to surgery (eg, rehabilitation or pain management prior to surgery). * DATA SYNTHESIS: We used the template for intervention description and replication (TIDieR) checklist and guide to assess the completeness of reporting of the content of educational programs. Content was synthesized descriptively and by intervention mapping. The results informed of a draft operational definition of preoperative education that we refined based on expert consultation. * RESULTS: Forty-six articles were included. There was variation in study designs, target populations, and intervention content. Preoperative education was defined in 1 out of 5 studies. Thirteen studies used a platform of video-based modules to deliver their program; 3 studies implemented virtual platforms. Results from the TIDieR checklist indicated that 30% of studies tracked adherence to and fidelity of their programs. A definition and conceptual map indicated that the length of stay, functional abilities, patient knowledge, and satisfaction were expected benefits. * CONCLUSION: Poor reporting of content, rationale, and frameworks for preoperative programs in orthopedics may explain why systematic reviews have not found support for their value. Future trials must improve rigor in design and reporting. [ABSTRACT FROM AUTHOR]

This study investigated the effects of the use of online approach in teaching language on distance learning to pre-school pupils. A quasi-experimental design was used in the study with a two-way test using pretest and posttest. We divided the respondents into two groups: the control and the experimental group. A group of respondents exposed in Reading Apps during and a group of respondents in a traditional way of teaching. The researchers were catered at the school where we conducted the study. A normality test also was used to determine the datasets. The study revealed that the group of respondents who are exposed in ICT integrated lessons obtained score higher than the group in traditional teaching strategy. With these findings, the study concluded that the effects of Online Education in teaching reading to kindergarten learner are substantially operative, statistically supported based on the data sets given. It is recommended that the administration of the institution as well as the higher official in Department of Education must view and support thus implement this ICT integrated teaching strategy as an effectual tool to aid the literacy needs of kindergarten learners. The education system should redouble its effort in enhancing the teaching techniques suited for the kindergarten learner. [ABSTRACT FROM AUTHOR]

• Majority of the outcome measures used speed as a criterion for performance. • Newer outcome measures increasingly focus on representing daily activities and qualitative aspect of performance. • No outcome measure included in this review covered all the theoretical aspects and scope of dexterity and hand function. • As the terms: hand function and dexterity are not clearly defined, clinicians and researchers need to ensure that the outcome measure they select reflects the attribute they want to measure. Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity. This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions. Scoping review, with qualitative content analysis. MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function. Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks. Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decision-making for diagnosis and treatment, and planning for successful return to work. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. [ABSTRACT FROM AUTHOR]

Stereotypical representations of Black women have endured throughout various forms of media for decades, with one of the most recent platforms being reality television programming. The theory of encoding and decoding posits dominant stereotypes are essential in television encoding. Using critical discourse analysis, this paper demonstrates that the dominant ideologies in the eleventh season of The Real Housewives of Atlanta are social class norms and negative depictions of Black women. I present evidence that shows RHOA continues to reinforce upper/middle-class ideologies while perpetuating these negative stereotypes. With Black women being the highest consumers of Black reality television, the constant hypersexualization, hyperaggression, and self-sacrificing representations of Black women often endorse stereotypes consistent with these representations while upper-middle-class ideologies often lead to the implicit denials of social injustices that are as a result of class distinctions. [ABSTRACT FROM AUTHOR]

Clinical measurement study: Level of evidence (N/A) The Shoulder Pain and Disability Index (SPADI) is a self-reported outcome measure of pain and disability related to shoulder pathology. In comparison to Classical Test Theory (CTT), Rasch analysis offers a more rigorous examination of the measurement properties of a scale. This study utilizes Rasch analysis to evaluate the psychometric properties of the SPADI to propose potential modifications and avenues for future investigation. SPADI scores (n = 212) from participants one-year post rotator cuff repair were collected from an outpatient specialty clinic. Fit to the Rasch model, unidimensionality of the subscales, and areas of bias were evaluated. Both the pain and disability subscales satisfied the requirements of the Rasch model with very minimal modifications and demonstrated unidimensionality. The person separation index was found to be high (P >.80), indicating reliability and internal consistency. Sex and the affected dominant side influenced how people scored on the SPADI (Differential item functioning (DIF)). The findings suggest some patients in our sample have difficulty discriminating between item responses, particularly within the middle of the scale. Rasch analysis supports the clinical measurement properties of consistency and reliability, previously determined by CTT methods. • SPADI pain subscale satisfies Rasch model requirements. • SPADI disability scale was rescored to satisfy Rasch requirements. • Sex and dominant side affected influenced how people scored on the SPADI. [ABSTRACT FROM AUTHOR]

Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes. The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2–7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared. Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class. In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries. Prognostic IV. [ABSTRACT FROM AUTHOR]

Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies. A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score. The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies. CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis. [ABSTRACT FROM AUTHOR]

This is a cross-sectional study. The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons–elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice. To use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e. One hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement. A total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475–driving (35%) and D440–fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%. This study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section ('d' categories) of the ICF, this validated that these PROMs measure this conceptual domain. The PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e. • PREE and pASES-e cover functional aspects that are important to elbow injury patients. • The PREE provided more comprehensive coverage of patients' functional concerns. • Exercising and driving were not covered by PREE or pASES-e. [ABSTRACT FROM AUTHOR]

Compressive ulnar neuropathy at the elbow is the second most common compressive neuropathy. Nerve transfers are used for severe ulnar neuropathies as a means of facilitating recovery. Hand therapy and rehabilitation after nerve transfers have not been extensively explored. The aim of this repeated case study was to describe the responses, functional outcome, and neuromuscular health of three participants after the supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor nerve transfer do describe the hand therapy and recovery of 3 cases reflecting different recovery potential mediators, trajectories, and outcomes. Repeated case study. Three participants of similar age (76-80 years) that had severe ulnar neuropathy who underwent surgical treatment including a SETS AIN to ulnar motor nerve surgery were purposively selected from an ongoing clinical trial, based on their response to the surgical and the rehabilitation intervention (large, moderate, and small improvements). Clinical evaluations included measuring range of motion, strength testing, and clinical tests (ie, Egawa's sign) and, subjective assessment of rehabilitation adherence., Quick Disability of Arm, Shoulder and Hand and decomposition-based quantitative electromyography were performed at >23 months to evaluate patients. All the three participants completed the surgical and hand therapy interventions, demonstrating a variable course of recovery and functional outcomes. The Quick Disability of Arm, Shoulder and Hand scores (>23 months) for participants A, B, and C were 68, 30, and 18, respectively. The person with the least improvement had idiopathic Parkinson's disease, dyslipidemia, history of depression, and gout. Comparison across cases suggested that the comorbidities, longer time from neuropathy to the surgical intervention, and psychosocial barriers to exercise and rehabilitation adherence influenced the recovery process. The participants with the best outcomes demonstrated improvements in his lower motor neurons or motor unit counts (109 and 18 motor units in the abductor digiti minimi (ADM) and first dorsal interosseous, respectively) and motor unit stability (39.5% and 37.6% near-fiber jiggle in the ADM and first dorsal interosseous, respectively). The participant with moderate response to the interventions had a motor unit count of 93 for the ADM muscle. We were unable to determine motor unit counts and measurements from the participant with the poorest outcomes due to his physical limitations. SETS AIN to ulnar motor nerve followed by multimodal hand therapy provides measurable improvements in neurophysiology and function, although engagement in hand therapy and outcomes appear to be mediated by comorbid physical and psychosocial health. • Metabolic and neurological comorbidities and time of surgery may influence functional outcomes. • Patients' social connectivity and mental health status may influence program adherence. • Therapist factors that improve therapeutic alliance may increase program adherence. • Improvements with motor unit health were also observed with improved hand function. [ABSTRACT FROM AUTHOR]

Repeated case study. Complete rupture of the distal biceps tendon occurs mostly within the middle-aged male population. Surgical repair is traditionally recommended. Given the potential for complications, questions remain whether surgical repair is indicated. To explore non-operative management for full distal biceps tendon ruptures. Two participants with complete tears of the distal biceps tendon confirmed with magnetic resonance imaging/ultrasound had chosen to not undergo surgical repair. First, a 48-year-old police officer was an avid weight lifter and recreational athlete. Second, a 43-year-old detailer has minimal physical activity participation other than work duties and light recreational sports. Strength testing was performed immediately after rupture and at 24 weeks after a structured physical therapy program focused on strengthening and stretching the elbow flexors and supinator. Initial strength deficits of 17/21% in flexion and 13/19% for supination were detected. In both patients, flexion and supination strength returned to normal limits when compared with the opposite upper extremity. After intervention, functional and disability scores were normal in both cases, and both patients reported return to preinjury repetitive work and weight training. Although patients are typically counseled that a reason for surgical repair after biceps rupture is substantial loss of flexion and supination strength, these cases indicate that full recovery of strength and function is possible through rehabilitation. These cases question the traditional wisdom that a surgical repair is needed for all distal biceps ruptures. Level of Evidence: Therapy, level 5. ICD-10 Code: M66.3. • Distal bicep tears are relatively rare, however, most common within the middle-aged male population. • Many questions remain regarding this condition including whether surgical repair is necessary for all ruptures. • Significantly high complications rates have been reported regarding this surgical procedure (as high as 63%). • The two cases presented highlight that a full recovery of strength and function is possible through physical therapy without the need for surgery. • This questions traditional wisdom whether surgical repair is needed for all distal biceps ruptures. [ABSTRACT FROM AUTHOR]

• Low to moderate quality evidence indicates variability in individual clinical examination tests used to screen for carpal tunnel syndrome in workers. • Diagnostic self-report tools consisting of hand diagrams and/or diagnostic questions provide low burden and high accuracy. • Across the studies, hand diagrams, provocative maneuvers, sensorimotor and questionnaires were evaluated, with the Kamath and Stothard questionnaire and the Katz hand symptom diagrams having the best overall Sn and Sp. • Screening of workers is different than verifying symptoms in clinical populations, and clinical tests used in 1 context may perform differently in another. To synthesize and appraise the evidence on the diagnostic accuracy of the clinical examination tests and questionnaires for screening carpal tunnel syndrome (CTS) among workers. Systematic review of diagnostic test accuracy Electronic search of 3 online databases (CINAHL, Embase, Medline) was done on August 31, 2020. Studies reporting the diagnostic accuracy of clinical examination tests in workers, compared to a reference standard test, were included. Diagnostic accuracy measures such as sensitivity (Sn) and specificity (Sp) were extracted and reported for different clinical examination tests. The risk of bias and applicability concerns were rated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool by 2 independent reviewers. Diagnostic tests accuracy extension of the PRISMA guidelines were followed. Twelve studies reporting on the diagnostic accuracy of the clinical examination tests for workers suspected of CTS were included. Fourteen different clinical examination tests were evaluated in the studies, including sensorimotor, provocative maneuvers, questionnaires, and hand symptom diagrams (HSD). Ten of the included studies had an either unclear or high risk of bias. The most accurate tests to diagnose CTS in workers were the Katz HSD (with Sn ranging from 38%-93%, and Sp ranging from 25%-89%) and Kamath and Stothard questionnaire (Sn and Sp = 100%). Combination of Katz HSD with either the Phalen's maneuver or the Tinel's sign resulted in excellent Sp (83% and 89%, respectively). Low to moderate quality evidence indicates variability in individual clinical examination tests used to screen for CTS in workers. Diagnostic self-report tools consisting of hand diagrams and/or diagnostic questions provide low burden and high accuracy. Still, they require more rigorous investigation about their value alone or in combination with clinical assessment tests. [ABSTRACT FROM AUTHOR]

To investigate the targeting, scaling, and structural validity of the Work Limitation Questionnaire (WLQ) using Rasch analysis. Secondary data analysis. Tertiary care hospital. The data were sourced from an upper limb specialty clinic of injured workers using the convenience sampling method and from a national randomized controlled trial investigating 2 surgical options for rotator cuff repair by formal, randomized selection (N=315). Not applicable. Work Limitation Questionnaire 25-item version (WLQ-25). The WLQ contains 25 items measuring a client's ability to perform specific job demands on a 5-point ordinal response scale ranging from 0 (difficulty none of the time) to 4 (difficulty all the time). The average of all 25 items is used as the total score, ranging from 0 to 4, where higher index scores indicate greater difficulty performing daily work. Subscales were used to assess time management, physical demands (PD), mental-interpersonal demands, and output demands. The Rasch analyses performed on the dataset included the test of fit of residuals, ordering of item thresholds, Person separation index, differential item functioning (DIF), dependency, and unidimensionality. The partial credit model was selected for the current Rasch analysis because the likelihood ratio test was significant at both the overall questionnaire and the subscale level (P <.001). The WLQ-25 did not fit with the Rasch model (χ2=1715.58; df =125; P <.001) and most of the thresholds were disordered. A series of steps were undertaken to improve the fit statistic, including item reduction (6 items) and response merging (9 items). DIF was absent in the revised scale based on sex, age, full- or part-time employment, and type of employment. Only 3 revised subscales, namely the PD, mental demands, and interpersonal demands subscales, demonstrated acceptable fit to the Rasch model. The WLQ-25 demonstrated substantial misfit from the Rasch model, which could not be fully mediated. The revised PD, mental demands, and interpersonal demands subscales could be used to assess these constructs. [ABSTRACT FROM AUTHOR]