Biomedical subjects

Joy C MacDermid

Publications and source records attributed to Joy C MacDermid.

At least 37 records · Page 2Linked to original sources

PubMed2002

Estimating the population at risk for Ontario Workplace Safety and Insurance Board-covered injuries or diseases.

Difficulty in quantifying the population at risk for a work-related injury or disease limits the usefulness of workers' compensation data for surveillance. This article presents a method of obtaining estimates of the Ontario Workplace Safety and Insurance Board (OWSIB)- covered workforce using the Canadian Labour Force Survey (LFS). The method involves extracting that class of worker most likely to be insured by the OWSIB and using actual hours worked to estimate full-time equivalents at risk. Compared to population at risk estimates readily available from published tables, the refined crude estimate was 26% lower and ranged from 15 to 79% lower depending on the age group. The percentage decrease from published estimates was generally greater for women compared to men, particularly in the 25 to 39 year age categories. Consequently, the method of deriving population at risk estimates should be considered when comparing rates across sexes, ages, industries or occupations.

Adolescent↗

PubMed1999

Validity of pain and motion indicators recorded on a movement diagram of shoulder lateral rotation.

This study examined criterion and construct validity of passive range of motion (PROM) and pain variables recorded on a Maitland-style movement diagram. Passive lateral rotation of the shoulder was assessed in 34 patients with a variety of shoulder pathologies. Two experienced manipulative physiotherapists performed the testing in a randomised block design. The physiotherapists were blinded to all clinical information and ROM measures. The criterion comparators were a blinded goniometric measure of PROM and pain scores from the Shoulder Pain and Disability Index (SPADI). Correlation coefficients between PROM recorded on the movement diagram and goniometry were high (r = 0.79 to 0.94). Moderate correlations were observed between the patient's pain scores recorded on the SPADI and the physiotherapist's recording of pain onset (r = -0.43 to 0.69) and intensity (r = 0.58 to 0.72). Impairment measures from the movement diagram were moderately related to patient-rated shoulder disability (r = 0.50 for ROM and -0.56 for pain). Movement diagrams of passive shoulder rotation can provide valid information on motion and pain.

Journal Article↗

PubMedDate not supplied

The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life.

The purposes of this study were to determine the reliability of strength and self-reporting measures, the relationship of different strength measures to function, and the impact of rotator cuff pathology on patients' quality of life. Patients with nonoperated rotator cuff pathology (n = 36) and unaffected control subjects (n = 48) were assessed by use of the LIDO dynamometer to determine isometric and isokinetic (concentric and eccentric) strength of the shoulder rotators. The Shoulder Pain and Disability Index and Short Form-36 were self-reported by patients. Intraclass correlation coefficients (ICCs) were used to assess reliability, and Pearson correlations and multiple linear regression were used to determine the relationship between strength and function. The findings of this study include the following: (1) measures of self-reported physical disability had high reliability (ICC = 0.89); (2) the LIDO dynamometer reliably measured internal and external shoulder rotation strength in both concentric and isometric modes of testing (ICC = 0.78-0.94), whereas eccentric muscle actions had lower reliability; (3) all shoulder rotation strength measures were predictive of disability, with isometric external rotation strength being the most predictive (r = 0.56); and (4) the presence of rotator cuff pathology was highly predictive of impaired physical health quality of life (R(2) = 0.71, P < .001).

Adult↗

PubMedDate not supplied

Responsiveness of self-report scales in patients recovering from rotator cuff surgery.

A consecutive series of patients (n = 149) completed 4 self-reporting scales (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire; Simple Shoulder Test [SST]; Western Ontario Rotator Cuff [WORC] questionnaire; and Short Form 36 [SF-36]) during the week before rotator cuff repair and 6 months after surgery. Patients were divided into 3 groups: those who had a positive response on all 3 upper extremity scales (n = 86) were classified as positive responders, those who did not demonstrate a consistent direction of response across scales were labeled as equivocal responders (n = 36), and those with a negative response across all 3 scales were labeled as negative responders (n = 15). Standardized response means (SRMs) were calculated. The WORC questionnaire (SRM, 2.0) and SST (SRM, 1.8) were most responsive to detecting improvement, followed by the DASH questionnaire (SRM, 1.6). The SF-36 was least responsive, with the largest effect on health being noted in the SF-36 subscale on bodily pain (SRM, 1.1). Pearson correlations indicated moderate associations between change scores across upper limb scales (r = 0.68-0.72) and lower associations with SF-36 physical summary scores (r = 0.40-0.50). Mental health scores were lower at baseline and changed more negatively in patients who did not have a positive response to surgery. No best scale can be identified at this time.

Female↗

PubMedDate not supplied

Changes in postural risk and general health associated with a participatory ergonomics education program used by heavy video display terminal users: a pilot study.

To determine if a brief, participatory ergonomics education program was associated with changes in work posture and general health of heavy video display terminal (VDT) users, 23 full-time VDT users participated in an on-site, small-group, 60-minute ergonomics education session and 1 week later an individual 15-minute follow-up session at their workstation. Posture was assessed by a blinded tester who scored videotape records to complete the Postural and Repetitiveness Risk Factors Index (PRRI), and general health status was assessed via self-administered Short-Form 36 Health Survey (SF-36) questionnaire before the intervention and again 5 weeks later. Five weeks after the 60-minute session, PRRI scores were 19% lower than were preintervention scores (p < 0.01), indicating lower postural risk. SF-36 physical (2% higher) and mental (4% higher) component scores were not statistically different, however, before and after intervention (p > 0.05). Although the participatory ergonomics education program was associated with improved work posture (PRRI scores) after 5 weeks, general physical and mental health (SF-36 scores) did not change within this time period. These results suggest that a participatory ergonomics program, which is of short duration and minimally disruptive to the normal workplace routine, may have a rapid effect on improving work posture. Although awkward posture is thought to be a risk factor for work-related musculoskeletal disorders, multigroup and long-term randomized trials are required to establish the effectiveness of participatory ergonomics programs in reducing the incidence and severity of musculoskeletal disorders associated with heavy VDT use.

Adult↗

PubMedDate not supplied

A research agenda for hand therapy.

A survey, to which 401 hand therapists responded, was conducted to establish research priorities in the field of hand therapy and to investigate barriers to hand therapy research. Results indicated that reimbursement issues, particularly those generated by managed care, were reported to have adversely affected quality of patient care, job satisfaction, job security, and ability to conduct research. Research priorities were defined in this study, and the need for clinical trials to determine the effectiveness of hand therapy interventions was found to be urgent. Research questions identified by respondents reflected both the traditional disorders treated by hand therapists, such as tendon repairs, and a greater concern with issues concerning cumulative trauma. Barriers to research were reported by respondents, and ways in which professional organizations could meet clinicians' needs in conducting and utilizing research were highlighted.

Adult↗

PubMedDate not supplied

Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy.

A hand therapy clinic used a systematic process to select an outcome tool for routine use. After a literature review of available instruments, the choice had been narrowed to two instruments: the Disability of the Arm, Shoulder, and Hand (DASH) and the Patient-Rated Wrist Evaluation (PWRE). The PRWE was modified to attribute to the hand/wrist. A cohort of 60 patients (36 hand problems, 24 wrist problems) completed a DASH and PRWHE at their initial clinic visit and three months later. Standardized response means (SRMs) and effect sizes indicated a large treatment effect. The PRWHE had slightly higher responsiveness than the DASH (SRM=1.51 vs. 1.37). Because this level of responsiveness was obtained with fewer items, it was considered more efficient. A supplementary esthetics question was less responsive than either scale, but was thought to be an important option for selected patients. On completion of the trial period, the therapists unanimously selected the PRWHE with a supplemental esthetics question to be routinely used in measurement of outcomes.

Disability Evaluation↗

PubMedDate not supplied

Quantitative vibration threshold testing in carpal tunnel syndrome: analysis strategies for optimizing reliability.

Tuning forks and electronic vibrometers have been used to quantify vibration sensation thresholds, which are thought to be affected early in carpal tunnel syndrome (CTS). The purpose of this study was to identify a reliable testing procedure for a newly designed, computer-controlled vibrometer (PCV50; Ztech, Salt Lake City, UT). Fifty-two patients (mean age 48+/-8 years) with electromyographically confirmed CTS were tested on one occasion. The computer-controlled vibrometer, with a fixed frequency of 50 Hz, used stepwise changes in amplitude to determine vibration sensation threshold. Each patient had three vibrometer measures (trials) taken on the pulp of the third digit of their right and left hands during the first test session and were retested by a single repetition 40 to 60 minutes later (retest). Intraclass correlation coefficients (ICCs) were used to examine several data analysis strategies. The strategy that generated the highest ICCs for both the right and left hands assumed that the first trial was a learning or practice attempt, and compared the average of the second and third trials with the score from the second session (ICC=0.86 and 0.89, respectively). The computer-controlled vibrometer offered an easily administered, quantitative, and comfortable means to assess median nerve function. Using this reliable testing procedure will allow for additional investigations to determine its usefulness in the early detection and accurate quantification of CTS-related impairment.

Adult↗

PubMedDate not supplied

An introduction to evidence-based practice for hand therapists.

Evidence-based practice (EBP) is a methodologic approach to clinical practice in which evidence is used to reach an informed decision when making a diagnosis, selecting a diagnostic test, picking an intervention, or determining a prognosis. Finding the best evidence through searching and critical appraisal of the methodologic quality of clinical evidence are essential steps. Matching clinical recommendations to the level of supporting evidence is expected. Clinicians' expertise and patient values are also valued components of decision making in an EBP approach. Hand therapists can adopt an EBP approach but must be prepared to deal with the challenge of uncertainty when evidence is lacking.

Evidence-Based Medicine↗

PubMedDate not supplied

Applying evidence on outcome measures to hand therapy practice.

Standardized outcome measures can enhance clinical decision making in hand therapy. Processes in which evidence is used to make decisions on individual patients with respect to the patient's level of impairment and disability as well as the significance of any changes observed after interventions are consistent with an evidence-based approach. Evidence can enhance clinical decision making and provide objective criteria for goal setting and evaluation. The authors review the necessary concepts and approaches to applying evidence on outcome measures using a vignette that describes a patient with rotator cuff pathology who has provided a Disability of the Arm, Shoulder, and Hand (DASH) score during clinical assessment.

Disability Evaluation↗

PubMedDate not supplied

The quality of clinical practice guidelines in hand therapy.

Clinical practice guidelines (CPGs) should consist of treatment recommendations that assist hand therapists in providing high-quality cost-effective care to specific patients based on the highest level of available evidence. This requires CPGs to be developed using a rigorous process based on evidence, appraisal of both original studies and expert opinion, and a process for multiple reviewers to evaluate the draft CPG. This study identified CPGs relevant to hand therapy and then evaluated their quality using the AGREE quality assessment tool. The majority of guidelines were not evidence-based and were of extremely low quality. Two guidelines were produced using a rigorous process that emphasized comparative clinical trials. These were able to provide only a single treatment recommendation, that ultrasound is effective for calcific tendinitis of the shoulder. Hand therapists need to move away from opinion- or clinic-based protocols and toward more evidence-based treatment guidelines. However, the value of treatment guidelines must be tested, not assumed, regardless of the development process.

Hand↗

PubMedDate not supplied

Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review.

The purpose of this study was to determine the effectiveness of hand therapy interventions for carpal tunnel syndrome (CTS) based on the best available evidence. A qualitative systematic review was conducted. A literature search using 40 key terms was conducted from the earliest available date to January 2003 using seven databases. Articles were randomly assigned to two of five reviewers and evaluated according to predetermined criteria for inclusion at each of the title, abstract, and article levels. Included studies were independently scored by two reviewers using a structured effectiveness quality evaluation scale and also graded according to Sackett's Levels of Evidence. There were 2027 articles identified from the literature search, of which 345 met the inclusion criteria. Twenty-four studies were used to formulate 30 recommendations. Current evidence demonstrates a significant benefit (grade B recommendations) from splinting, ultrasound, nerve gliding exercises, carpal bone mobilization, magnetic therapy, and yoga for people with CTS.

Acupuncture Therapy↗

PubMedDate not supplied

The effectiveness of rehabilitation for nonoperative management of shoulder instability: a systematic review.

A systematic review of published evidence on conservative management was conducted in Medline, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Database of Abstracts of Reviews of Effects (DARE), Allied & Alternative Medicine (AMED), PubMed, and Cochrane. For each article, two of the four reviewers conducted abstract selection and critical appraisal. Disagreements were resolved through consensus and third review, if required. Level of evidence and quality on a 24-item quantitative critical appraisal form were determined for all articles meeting selection criteria. Outcomes considered included recurrence of instability and return to premorbid function. Overall, the quantity and quality of evidence were low. Immobilization for three to four weeks followed by a structured 12-week rehabilitation program of range of motion and glenohumeral and scapular stability exercises for patients with primary dislocations to maximize return to premorbid activity level is supported by weak evidence. Level II evidence suggests that recurrence is lower in patients managed with surgical as compared with conservative management. Further research is required to delineate the optimal approach to rehabilitation and its role in secondary prevention.

Biofeedback, Psychology↗

PubMedDate not supplied

Rehabilitation for patients with lateral epicondylitis: a systematic review.

The purpose of this systematic review was to determine the effectiveness of conservative treatments for lateral epicondylitis and to provide recommendations based on this evidence. Five reviewers searched computerized bibliographic databases for articles on the conservative treatment of lateral epicondylitis from the years 1983 to 2003. A total of 209 studies were located; however, only 31 of these met the study inclusion criteria. Each of the articles was randomly allocated to reviewers and critically appraised using a structured critical appraisal tool with 23 items. Treatment recommendations were based on this rating and Sackett's Level of Evidence. This review has determined, with at least level 2b evidence, that a number of treatments, including acupuncture, exercise therapy, manipulations and mobilizations, ultrasound, phonophoresis, Rebox, and ionization with diclofenac all show positive effects in the reduction of pain or improvement in function for patients with lateral epicondylitis. There is also at least level 2b evidence showing laser therapy and pulsed electromagnetic field therapy to be ineffective in the management of this condition. Practitioners should use the treatment techniques that have strongest evidence and ensure that studies findings are generalized to patients who are similar to those reported in primary research studies in terms of patient demographics and injury presentation.

Acupuncture Therapy↗

PubMedDate not supplied

Effectiveness of workplace rehabilitation interventions in the treatment of work-related upper extremity disorders: a systematic review.

The purpose of this systematic review was to evaluate the available evidence on workplace rehabilitation interventions for work-related upper extremity disorders (WRUEDs). The literature search identified a total of 811 abstracts from Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EMBASE databases. The abstracts were independently assessed by four reviewers and 53 full-text articles were identified. Twenty-one studies were then randomly allocated to two pairs of reviewers. Using a 24-item critical appraisal form, the reviewers evaluated the articles for quality and level of evidence. During this process, an additional 13 articles were discarded, resulting in eight studies. The effectiveness of these studies was limited by small sample sizes, lack of standardized outcome measures, and inadequate reporting of interventions and results. The findings of this review indicate that the evidence for workplace interventions for WRUEDs has not been established. This systematic review provides a rigorous analysis of workplace interventions for WRUEDs and emphasizes the need for further research in this area.

Humans↗

PubMedDate not supplied

Clinical diagnosis of carpal tunnel syndrome: a systematic review.

The purposes of this systematic review were to examine the properties of clinical tests used in the diagnosis of carpal tunnel syndrome (CTS) and to provide estimates of their sensitivity and specificity. A literature search was conducted using two databases-PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from 1986 to June 2003, and hand-searching reference lists of retrieved articles. Two reviewers evaluated the papers for quality using an evaluation tool developed by one of the authors. Estimates of sensitivity and specificity were determined by averaging values across studies weighted by sample size. Although 60 studies were reviewed in detail, many were of poor quality (mean quality score was 6.6 of 12, with only 15 of 60 obtaining a score of 8 or greater). The most frequently studied test was Phalen's, with an overall estimate of 68% sensitivity and 73% specificity. Next was Tinel's, with estimates of 50% and 77%, and then carpal compression, with estimates of 64% and 83% for sensitivity and specificity, respectively. Two-point discrimination and testing of atrophy or strength of the abductor pollicis brevis proved to be specific but not very sensitive. The estimates determined in this review should help therapists choose clinical tests with the appropriate balance of sensitivity and specificity required for diagnosing carpal tunnel syndrome in their specific clinical environments.

Carpal Tunnel Syndrome↗

PubMedDate not supplied

Individual finger strength: are the ulnar digits "powerful"?

This study determined the test-retest reliability of a grip device that measures the contribution of individual fingers to grip strength and described the pattern of contribution in subjects without hand pathology. Subjects repeated a set of three maximal grip efforts on two occasions separated by two to seven days. Intraclass correlation reliability coefficients were high (>0.75) for eight out of ten strength measures. The percentage contributions of the index, middle, ring, and small fingers to grip were approximately 25%, 35%, 25%, and 14%, respectively. Grip and finger strengths were highly correlated. Anthropometric measures of body size or finger length were moderately correlated with strength measures. These data suggest that there is a predictable pattern by which individual fingers contribute to overall grip strength, which is partially related to body size. The ulnar side of the hand contributes to the smaller proportion of overall grip (approximately 60% radial, 40% ulnar). The clinical utility of finger strength measures should be explored.

Adult↗

PubMedDate not supplied

Recent progress in flexor tendon healing. The modulation of tendon healing with rehabilitation variables.

Until recently, attempts to optimize the postoperative regimen following intrasynovial flexor tendon repair had been essentially empirical, in that both the time and graduation of the exercise regimen have lacked clear conceptual guidelines. The magnitude of load applied in previous studies had not been clearly controlled, and similarly, the effects of increased repair site excursion and gap formation had not been evaluated in clinically relevant models. Recent experimental in vivo data on the application of force and excursion as independent variables by the authors and other investigators have helped to clarify the respective roles of these two variables. The goal of surgical treatment of intrasynovial flexor tendon lacerations is the achievement of a primary tendon repair of tensile strength sufficient to allow early controlled motion after surgery. The implementation of an appropriate postoperative rehabilitation protocol will, based on the experimental data discussed in this article, decrease the formation of intrasynovial adhesions, facilitate the restoration of the gliding surface, and stimulate the accrual of strength at the repair site.

Hand Injuries↗