Direct, quantitative clinical assessment of hand function: usefulness and reproducibility.
Methods of assessing functional impairment in arthritic hands include pain assessments and disability scoring scales which are subjective, variable over time and fail to take account of the patients' need to adapt to deformities. The aim of this study was to evaluate measures of functional strength and joint motion in the assessment of the rheumatoid (RA) and osteoarthritic (OA) hand. Ten control subjects, ten RA and ten OA patients were recruited for the study. All underwent pain and disability scoring and functional assessment of the hand using measures of pinch/grip strength and range of joint motion (ROM). Functional assessments including ROM analyses at interphalangeal (IP), metacarpophalangeal (MCP) and wrist joints along with pinch/grip strength clearly discriminated between patient groups (RA vs. OA MCP ROM P<0.0001), pain and disability scales were unable to. In the RA there were demonstrable relationships between ROM measurements and disability (R2=0.31) as well as disease duration (R2=0.37). Intra-patient measures of strength were robust whereas inter-patient comparisons showed variability. In conclusion, pinch/grip strength and ROM are clinically reproducible assessments that may more accurately reflect functional impairment associated with arthritis.
Goodson
Alexander
A
Musculoskeletal Department, Faculty of Medicine, Imperial College London, Charing Cross Hospital Campus, London W6 8RF, UK.
McGregor
Alison H
AH
Douglas
Jane
J
Taylor
Peter
P
D000203:Activities of Daily Living; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006227:Hand Deformities, Acquired / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index