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Study Design Structured literature synthesis. Introduction Hand therapists and researchers have numerous options when selecting outcome measures for patients with wrist pathologies. An evidence-based approach to determining which measures are used most often can inform choices. Purpose of the Study To describe how frequently outcome measures are used in recent randomized controlled trials of patients with wrist diagnoses. Identifying assessment design and related International Classification of Functioning, Disability and Health (ICF) domains provides additional consideration for selection. Methods Systematic PubMed and Cumulative Index to Nursing and Allied Health Literature searches for the time frame between January 2005 and March 2015 captured measures used in randomized controlled trials researching wrist-specific fractures, ligament injuries, nerve injuries, arthritis/arthroplasty, or stress injuries/wrist pain. Results Three most frequent measures used within each diagnostic category are detailed with assessment design described and ICF domain identified. Across diagnoses, grip/pinch strength and Disabilities of Arm, Shoulder and Hand were the most frequently used physical and patient-reported outcome measures, respectively. The Jebsen–Taylor Hand Function Test was the most frequently used performance measure. Discussion and Conclusions Consideration of the evidence, ICF domains, wrist diagnoses, and assessment design can help hand therapists select the measure most appropriate for use. Level of evidence 2a.

Clinical measurement.Few studies describe the responsiveness of functional outcomes measures in patients sustaining hand fractures.1--To explore the responsiveness of three function-oriented Patient Report Outcome (PRO) measures with a cohort of hand fracture patients. 2--To examine patients' PRO preference.60 participants with 74 hand fractures at an outpatient hospital-based hand therapy clinic consented to participate in this study. They completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) at three trials: T1 (evaluation), T2 (one month later), and T3 (two months later). Participants also identified which PRO they felt best reflected their hand use and which was easiest to complete. Descriptive statistics, analyses of variance (ANOVA), effect size, and standardized response mean (SRM) were employed to describe participants, determine functional change between trials, and examine and compare PRO responsiveness. Questionnaire preference at T1 was reported.Participants demonstrated functional improvement, as measured by the DASH, PRWHE, and MHQ. T1 scores: DASH = 41.85 (SD ± 22.78), MHQ = 50.13 (SD ± 18.36), and PRWHE = 48.18 (SD ± 22.07). T2 scores: DASH = 22.11 (SD ± 18.18), MHQ = 69.89 (SD ± 15.93), and PRWHE = 22.62 (SD ± 18.15). T3 scores: DASH = 17.56 (SD ± 18.01), MHQ = 75.37 (SD ± 19.19), and PRWHE = 22.40 (SD ± 19.04). Each PRO demonstrated significant test score differences between trials (p.001). Large responsiveness (≥.80) was noted between T1 and T2: (effect size: .98-1.23; SRM: 1.31-1.49) and T1 and T3 (effect size: 1.21-1.54; SRM 1.49-1.84). Smaller responsiveness effects were noted between T2 and T3 (effect size: .35-.64, SRM: .38-.81). No significant differences between questionnaire responsiveness were found. Patients reported PRWHE easiest to complete and MHQ best reflecting their hand use.DASH, MHQ, and PRWHE were each able to describe functional limitations in this cohort of patients with hand fractures. In capturing improvement over time they demonstrated comparable responsiveness in assessing change in patients with hand fractures.2c.

Study design Exploratory, Survey Design. Introduction A gap in current knowledge exists regarding how therapists evaluate patient difficulty participating in life situations. Purpose The goal is to explore how therapists measure participation. Methods A survey questionnaire was developed, piloted, and tested for reliability and validity. Convenience sample of 249 participants responded, providing information about assessment tools employed, problems and goals identified, indications for patient discharge, and participants' demographics. Results Participants used tools to measure body structures/functions, and informal discussion about daily activities, daily to weekly. Participation measures were employed monthly or less. Participation was noted more often in goals than problems identified in case study vignettes. Body structures/functions and participation were considered equally when anticipating patient discharge. Conclusions Evaluations principally employed tools and identified problems relevant to impairments in body structures/functions. Yet, when looking forward, setting goals and anticipating discharge, patients' participation needs were also attended. Level of evidence 2c

A cross-sectional, quantitative study of clinical measurement utility. New technological advances can challenge the efficacy of even the most widely accepted and respected tests. For example, grip strength instruments offer digital or computerized displays, precision scoring, and varied interfaces that differ from traditional Jamar™ dynamometers (Lafayette, IN). This test case explores how the opportunity to view grip strength scores during testing can influence outcomes. One hundred forty-six healthy subjects, aged 18-24 years, were tested for grip strength under visual feedback and no visual feedback conditions, using the JTech Grip Dynamometer (Salt Lake City, UT). Participants achieved a small, yet statistically significant, 1.74 lb stronger grip score with visual feedback (p0.002). The order of grip testing conditions yielded no statistically significant differences (p=0.559). These findings suggest the need to consider how new features, unavailable with the analog Jamar™ dynamometer and unaccounted for in existing clinical guidelines could potentially influence grip scores.Not applicable.

This study aims to compare the effects of pressure garment work gloves (PGWGs) and standard-pressure garment gloves (SPGGs) on functional hand use in individuals with hand burns. A quasi-experimental, repeated-measure design was used. Each glove was worn for one week prior to testing. Grip strength, hand function, functional sensation, and functional task scores were assessed. Participants were asked to report which glove they preferred and why. Two individuals with three burned hands underwent this study. Grip and pinch strengths and functional sensation were decreased overall with the PGWG. However, better performance was noted with functional tasks involving gross and static fine-motor movements, and simple, dynamic fine-motor movements. These findings were found to be significant using a Cochran's test for related observations. Moreover, there was unanimous participant preference for the PGWG. In conclusion, use of PGWGs facilitated select functional performance, warranting further investigation.

tion problems 16% and participation goals 45% of the time. However, both body structures and functions (M5 3.14, SD5 +/.68) and participation (M5 3.17, SD5 +/.73) were considered weekly to daily when determining discharge from therapy. Conclusion: Findings demonstrate that participants most frequently used performance based tools to assess body structures/functions, but informal methods to consider participation. Participation appeared more often in goals set than in problems identified in case vignettes. However, when anticipating patient discharge, therapists gave impairment and participation equal consideration. This study breaks new ground in that it is the first to address the clinical reasoning process relative to the use of participation among practicing therapists. Its findings provide an insight into how participation is a dynamic part of the evaluation process, underused until time-sensitive, physical issues are addressed, with reliable and valid participation tools seldom used.