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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Pain and disability reported in the year following a distal radius fracture: a cohort study.

Background: Distal radius fractures are a common injury that cause pain and disability. The purpose of this study was to describe the pain and disabilities experienced by patients with a distal radius fracture in the first year following fracture.

Methods: A prospective cohort study of 129 patients with a fracture of the distal radius was conducted.

Distal biceps tendon repair: comparison of surgical techniques.

Purpose: Various surgical repair techniques for distal biceps tendon ruptures have been reported, however, the optimal technique is unknown.

Methods: Over a 4-year period 19 distal biceps tendon ruptures were repaired: 9 using a single anterior incision and 10 using a modified 2-incision Boyd and Anderson technique. The patients were followed-up prospectively and independently reviewed.

Endoscopic versus open carpal tunnel release: a randomized trial.

Purpose: This study compared the outcomes in patients assigned to either endoscopic carpal tunnel release (ECTR) or traditional open carpal tunnel release (OCTR).

Methods: An unbalanced randomized clinical trial (91 endoscopic, 32 open) was conducted. Short-term and long-term outcomes were evaluated by a blinded assessor.

Identifying cumulative trauma disorders of the upper extremity in workers' compensation databases.

Background: Impeding the use of workers' compensation databases for surveillance of cumulative trauma disorder of the upper extremity (CTDUE) is the lack of valid and reliable extraction strategies.

Methods: Using the Z795-96 Coding of Work Injury or Disease Information standard, an algorithm was developed to classify claims as definite, possible, or non-CTDUE. Reliability was assessed with standardized claim reviews.

Trapezial arthroplasty with silicone rubber implantation for advanced osteoarthritis of the trapeziometacarpal joint of the thumb.

Introduction: Arthritis in the trapeziometacarpal joint of the thumb can cause swelling and loss of motion. Treatment options include arthrodesis, replacement arthroplasty and interposition arthroplasty. Our objective in this clinical study was to determine outcomes after trapezial arthroplasty with a silicone rubber implant and the relationship between self-reported and measured outcomes.

Functional outcome of AO type C distal humeral fractures.

Purpose: To review the functional outcome of AO type C distal humeral fractures (bicondylar fractures) managed with dual orthogonal plate fixation.

Method: Twenty-three patients were reviewed retrospectively at a mean of 45.1 months.

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.

Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture.

A prospective cohort of 120 patients with distal radius fractures completed a baseline evaluation that determined their age, sex, education level, injury compensation status, AO fracture type, prereduction radial shortening, and postreduction radial shortening. Six months later patients self-reported pain and disability using the Patient-Rated Wrist Evaluation, and were tested for physical impairment (grip, wrist range of motion, and dexterity). Univariate and forward stepwise regression analyses agreed that the most influential predictor of pain and disability at 6 months was injury compensation.

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.

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.

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.