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Daily Living and Disability

Upper extremity disability assessment: DASH questionnaire interpretation, measurement limitations, and evolving PROMs.

Overview

Functional recovery following upper extremity trauma and disease is inextricably linked to psychosocial factors, which serve as the strongest determinants of health-related quality of life and disability [11]. Early retirement correlates with worsened disability, quality of life, and functional outcomes in patients undergoing replantation or revascularisation [1]. Conversely, Dupuytren's disease presents with known functional impairments, self-care limitations, and major psychosocial impacts, where safety and social issues of hand function are evident associations with functional recovery [4, 9]. In shoulder arthroplasty, patients frequently fail to utilize their maximum active abduction during activities of daily living [15].

Accurate assessment is critical for guiding individualized treatment and work adjustments. Inclusion of disability outcome measures facilitates activity-of-daily-living–oriented regimens in hand trauma [2], while careful evaluation of functional capacity and self-reported disability is warranted for osteoarthritis management [3]. Pain and function are the Michigan Hand Outcomes Questionnaire domains best able to discriminate between satisfied and dissatisfied patients [19]. However, the use of invalidated or unreliable patient-reported outcome measures may improperly estimate pain and functional status, potentially affecting treatment options, satisfaction, reimbursement, and quality of life [21]. The International Classification of Functioning, Disability and Health (ICF) framework promotes adequate outcome measures by targeting patient-centred goals and respecting patient needs [23].

Prosthetic interventions offer viable pathways to restore function and psychological well-being. Early and temporary finger prosthetics improve function with psychological benefits and help determine suitability for permanent devices before costly investment [22]. In a reported case, a 3D-printed prosthesis improved function by nearly two standard deviations while maintaining quality of life, demonstrating that 3D-printing is a viable, adaptable, and cost-effective alternative [14].

Anatomy & Pathophysiology

Thumb ray dysfunction in sensibility and mobility remains the primary functional disability following exploded hand syndrome [12]. Adults with untreated triphalangeal thumbs demonstrate adequate thumb movement but diminished strength for specific functions [16]. Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [48].

Functional Assessment: The ICF HandA provides a consensus on outcome measures and instruments to systematically assess function in patients with hand injuries and disorders [24]. Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions [32]. Kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with chemotherapy-induced peripheral neuropathy in clinical settings [36]. A novel instrument for the quantification of hand forces during a jar opening task can be used to better understand the hand kinetics associated with this task and joint protection strategies intended to reduce hand loads [38]. Reference values of intrinsic muscle strength of the hand of adolescents and young adults provide factors to be considered when evaluating hand function and therapeutic outcomes in both clinical and research settings [57]. High test-retest reliability of tip, key, and palmar pinch force sense in healthy adults can be achieved using standardized positioning and the proposed approach [62].

Kinematics and Mechanics: Dexterity is a subset of hand function defined as the coordination of voluntary movement to accomplish an actual or simulated functional task accurately, quickly, resourcefully, and adapting to the environment or change [43]. Simultaneous activation of the FDP and the intrinsic muscles results in an apparently more functional hand closing compared with FDP activation alone because of altered kinematics and larger fingertip-to-palm distances [45]. Current movement science supports the tight interaction of posture and upper extremity function through developmental time and in real time, such that one system cannot be considered separate from the other [54]. Biomechanical analysis showed a huge amount of force and pressure, several times larger than that of ring avulsion injury, results when a steer pulls on the thumb [55]. Touch screen technology has become increasingly relevant to hand function in modern society [56]. Knowing frequently used grasp types is essential for assessing grasp rehabilitation processes and developing hand prostheses [60].

Therapeutic Outcomes and Limitations: Classification and understanding of congenital hand and upper extremity disorders has vastly improved since the 1970s, with a primary focus on achieving optimal function through recognizing deformities, identifying surgical options, and managing patient expectations [26]. Fundamental muscle-tendon-joint mechanics studies allow for single-stage surgical reconstruction of hand function and early postoperative activity-based training in patients with cervical spinal cord injuries [53]. Targeted surgical intervention and undefined therapy intervention seemed to have little influence on activity and participation in hemiplegic cerebral palsy, although wrist/finger biomechanics and active range of motion improved [52]. Taping can be an effective option for repositioning the thumb and improves upper extremity function by controlling the thumb in palm mechanically and enabling sensorial input by maintaining the correct hand position [42]. The slopes of the force-generation and force-decay phases of the Force-Time curve did not validly measure the sincerity of effort in participants with upper extremity injury, perhaps because they were protective of their injured hand and exerted only submaximal effort even at their best grip attempt [40].

Classification

MACS: The Manual Ability Classification System (MACS) is utilized to evaluate the functional capacity of children with cerebral palsy in handling objects during daily activities [18].

Zancolli: In patients with upper-extremity spasticity associated with cerebral palsy, treatment with neuromuscular electrical stimulation and dynamic bracing can result in a 1 to 3 level advancement within the Zancolli classification, correlating with marked improvement in upper-extremity function [61].

ICF HandA: The ICF HandA establishes a consensus on outcome measures and instruments designed to systematically assess function in patients presenting with hand injuries and disorders [24].

Other Considerations: Early retirement is associated with worse disability, quality of life, and functional outcomes following replantation or revascularisation of the upper extremity [1]. Dupuytren's disease is linked to known functional impairments, limitations on self-care, and major psychosocial impacts [4]. Amputation level correlates with physical function but not with quality of life or pain measures following amputation for musculoskeletal tumours [5]. Demographic variables, including advanced age, low family income, and multiple medical conditions, significantly influence scores on numerous scoring systems for knee symptoms [50]. Classification of angular measurements according to tested systems does not reflect the patient's perspective, limits measurement precision, and adds little value after flexor tendon repair [59]. The QoL questionnaire is a more appropriate instrument than the DASH for clients with stenosing flexor tenosynovitis, unless the clients are in the severe (grade 3) category [39]. Certain domains and categories from the ICF are not covered by the DASH [51]. Inclusion of disability outcome measures in hand trauma evaluation can expand the clinician's view toward individualized, activity-of-daily-living–oriented treatment regimens [2]. Classification and understanding of congenital hand and upper extremity disorders have vastly improved since the 1970s, with a primary focus on achieving optimal function through recognizing deformities, identifying surgical options, and managing patient expectations [26]. A comprehensive overview of orthoses, amputations, and prostheses details terminology, principles of operation, design types, and management of associated complications to guide clinical decision-making [63].

Clinical Presentation

Functional assessment in hand trauma and arthropathy must extend beyond impairment to include patient-reported disability and quality of life. Early retirement correlates with worse functional outcomes and quality of life following upper extremity replantation or revascularisation [1]. While amputation level predicts physical function after musculoskeletal tumour resection, it does not correlate with quality of life or pain measures [5]. Conversely, psychological factors are the strongest determinants of health-related quality of life and disability in hand injury patients [11], influencing patient-reported status more significantly than performance-based functional measures [6].

Evaluation of upper limb capacity is critical for tailoring management across diverse pathologies. In osteoarthritis, assessing functional capacity and self-reported disability guides advice on exercises and work adjustments [3]. For Dupuytren's disease, known functional impairments and limitations in self-care necessitate addressing major psychosocial impacts [4]. Patients with hand-arm vibration syndrome present with a spectrum of functional, social, emotional, and psychological disability [17]. Similarly, dual-task interference significantly impacts daily life in Parkinson's disease, particularly in those with severe disease or upper extremity involvement [20].

Specific diagnostic tools and clinical findings define the scope of disability in these populations. The MACS classification effectively evaluates how children with cerebral palsy handle objects during daily activities [18]. In exploded hand syndrome, while general outcomes are favorable, thumb ray dysfunction in sensibility and mobility remains the primary functional disability [12]. Adults with untreated triphalangeal thumbs demonstrate adequate movement but diminished strength for specific functions [16]. For wrist and hand pain, pain interference is a key factor linking impairment severity to self-reported disability [33].

Outcome measurement and intervention response vary by condition and treatment modality. The QuickDASH measures disability or symptom severity with precision comparable to the DASH across various arm disorders [35]. In the Michigan Hand Outcomes Questionnaire, pain and function are the domains best able to discriminate between satisfied and dissatisfied patients [19]. Splinting for partial thumb amputation yields clinically significant functional improvements and enhanced patient perception of disability despite minimal changes in impairment [13]. Patients with scleroderma show clinically significant improvements in body function and activity participation following paraffin and exercise treatment [7]. Early identification of sarcopenia is essential to prevent negative consequences such as disability and death in hospitalized elderly patients [10]. Finally, disability outcome measures can expand clinician perspectives toward individualized, activity-of-daily-living–oriented treatment regimens for hand trauma [2].

Investigations

Plain radiography: Radiological osteoarthritis following a mallet finger fracture mirrors the natural degenerative process in the distal interphalangeal joint and is accompanied by a decrease in range of motion, yet this does not clinically affect patient-reported outcome measures [75]. In patients with osteoarthritis of the hands, careful evaluation of upper limb functional capacity and self-reported disability is warranted to provide advice regarding exercises or adjustments at work [3].

Other Considerations: Early retirement is associated with worse disability, quality of life, and functional outcome after replantation or revascularisation of the upper extremity [1]. Psychological factors appear to affect disability (patient-reported health status) more than they affect performance-based measures of function [6] and are the strongest determinants of health-related quality of life (HRQOL) and disability in patients with hand injury [11]. Inclusion of disability outcome measures in the evaluation of hand trauma regimens may help expand the clinician's view to more individualized, activity-of-daily-living–oriented treatment regimens [2]. While general outcomes were good for exploded hand syndrome, thumb ray dysfunction in sensibility and mobility remained the main functional disability [12]. The mean DASH score was moderately elevated at 15 after hand injury from powered wood splitters, indicating that many of these patients have sequelae [30]. Disease activity was associated with hand function impairment in rheumatoid arthritis patients with variable follow-up [31]. Higher baseline functional impairment was not associated with better treatment adherence in persons diagnosed with thumb base osteoarthritis [73]. Digital pain extent was not associated with any psychological measure nor with pain-related disability in people with chronic musculoskeletal pain [76]. Moderate-severe hallux valgus deformity and hallux valgus-related pain impaired physical function independent of knee osteoarthritis [77]. Despite recurrence, the mean postoperative deformity following osteotomy of the thumb delta phalanx in Rubinstein–Taybi syndrome was significantly better than preoperatively, and the majority of patients' families subjectively reported good function [78].

Functional Assessment: Participants with scleroderma experienced clinically significant improvements in body function/structure measurements of hand function and in their ability to participate in activities following paraffin and exercise treatment [7]. Bilateral above-the-knee amputees from the Vietnam War led relatively normal, productive lives within the context of their physical limitations [8]. Splint use for partial thumb amputation demonstrated clinically significant changes over time with minimal changes in impairment, indicating enhanced function and improved patient perception of disability [13]. Function improved by nearly two standard deviations while quality of life was maintained in a participant using a 3D-printed prosthesis [14]. Patients were not able to take advantage of their maximum active abduction during the range of motion in activities of daily living following shoulder arthroplasty [15]. Reporting active extension deficit or using patient-reported outcome measures may minimize the impact of dynamism in Dupuytren's contractures [29].

Treatment

Non-Operative

Conservative management is a primary consideration for several upper extremity conditions. For stiff digits, initial nonsurgical treatment is warranted, though results may be poorer in severe or chronic contractures; surgery should be considered if limited improvement occurs after 3 to 6 months of conservative management [49]. Patients with acute calcific periarthritis of the hand who continue conservative treatment demonstrate pain relief and reduced calcification for up to 6 months, suggesting this approach be tried for at least that duration before surgical options [58]. Nonoperative treatment for Boutonniere deformity can achieve one to two grades of range of motion improvement, although the deformity may persist even after dedicated conservative management [65]. Physical therapies represent the most robustly assessed non-surgical treatments for early Dupuytren's disease, yet current studies are underpowered, providing insufficient evidence of efficacy [47]. Therapeutic activities mimicking activities of daily living improve hand function more effectively than standard rehabilitation activities in young adult patients with hand injuries [34]. Hand therapy results in statistically and clinically significant improvements in pain, grip strength, upper extremity function, and health-related quality of life for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome [46]. Children receiving Botulinum A toxin injections demonstrate clinically meaningful short-term improvements in upper extremity function [41]. A non-pharmacological treatment gap exists in osteoarthritis care, with most patients reporting no pain or mild pain and having not received non-pharmacological treatment prior to surgical consultation [68].

Operative

Indications: Surgical intervention is indicated for long-standing therapy-resistant complex regional pain syndrome type I, where amputation should not be ignored as a treatment option [70]. For Dupuytren's disease, safety and social issues of hand function and quality of life are associated with functional recovery after surgery and hand therapy [9]. Upper limb surgery for severe spasticity after acquired brain injury significantly improves the ease of care for non-communicative patients [69]. Early retirement is associated with worse disability, quality of life, and functional outcome after replantation or revascularisation of the upper extremity, highlighting the need for timely intervention [1].

Surgical Approach / Technique: To accurately determine the effectiveness of Dupuytren disease interventions from the patients' perspective, it is important to determine their impacts on both activity limitations and quality of life [37]. Assessment and treatment of psychosocial factors may improve surgical outcomes, correct pain-related misconceptions, decrease reported pain and disability, increase quality of life, and limit unnecessary interventions [64]. Incorporating a biopsychosocial approach into rehabilitation could lead to better functional outcomes in the prediction of disability in trigger finger [44].

Implant Selection: A 3D-printed prosthesis improved function by nearly two standard deviations while maintaining quality of life for a participant [14]. The use of early and temporary finger prosthetics improves function, provides psychological benefits, and helps determine if a patient will want or use a permanent prosthetic before investing in a costly item [22].

Alignment / Balancing Strategy: Amputation level is linked to physical function but not to quality of life or pain measures after amputation for musculoskeletal tumours [5]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [71].

Pain Management: Permanent results with a functional upper extremity and very satisfactory pain relief can be anticipated with intravenous regional anaesthesia using lidocaine and methylprednisolone for complex regional pain syndrome type I [67].

Adjuncts: There is a moderate correlation between financial distress and disability in patients with nonacute orthopaedic conditions, particularly in patients with low socioeconomic status [66].

Other Considerations: Disability outcome measures should be included in the evaluation of hand trauma regimens to facilitate individualized, activity-of-daily-living–oriented treatment [2]. Evaluation of upper limb functional capacity and self-reported disability is warranted to provide advice regarding exercises or adjustments at work for patients with osteoarthritis of the hands [3]. Patients were not able to take advantage of their maximum active abduction during the range of motion in activities of daily living following shoulder arthroplasty [15]. The use of invalidated or unreliable patient-reported outcome measures may improperly estimate patient pain and functional status, affecting treatment options, patient satisfaction, reimbursement, and/or quality of life [21]. The International Classification of Functioning, Disability and Health (ICF) can help promote the development of adequate outcome measures including activity limitation and participation restrictions by targeting patient-centred goals [23].

Complications

Other Considerations: Early retirement following replantation or revascularisation of the upper extremity is associated with worse disability, quality of life, and functional outcomes [1]. Disability outcome measures can expand clinician views toward individualized, activity-of-daily-living–oriented treatment regimens for hand trauma [2]. Evaluation of upper limb functional capacity and self-reported disability is warranted to provide advice regarding exercises or adjustments at work for patients with osteoarthritis of the hands [3]. Dupuytren's disease is associated with known functional impairments, limitations on self-care, and major impacts on the psychosocial area [4]. Safety and social issues of hand function and quality of life have an evident association with functional recovery after surgery and hand therapy in patients with Dupuytren's disease [9]. Reporting active extension deficit or using patient-reported outcome measures may minimize the impact of dynamism in Dupuytren's contractures [29]. A mean DASH score of 15 after hand injury from powered wood splitters indicates that many patients have sequelae [30].

Amputation level is linked to physical function but not to quality of life or pain measures after amputation for musculoskeletal tumours [5]. Bilateral above-the-knee amputees from the Vietnam War have led relatively normal, productive lives within the context of their physical limitations [8]. Psychological factors appear to affect patient-reported health status (disability) more than they affect performance-based measures of function [6]. Participants with scleroderma experienced clinically significant improvements in body function/structure measurements of hand function and in their ability to participate in activities following paraffin and exercise treatment [7]. Early identification of sarcopenia is essential to prevent negative consequences such as disability and death among hospitalized elderly patients [10]. Patients with hand-arm vibration syndrome experience functional, social, emotional, and psychological disability [17]. Dual-task interference may impact the daily lives of people with Parkinson's disease, especially those with more severe disease or who report arm and hand problems [20]. A holistic approach addressing both physical and mental aspects is crucial for long-term functional outcomes after hand injury [25]. Patients with a weak sense of coherence face several conditions in life that challenge their everyday lives, and a hand-related disorder makes their everyday lives even more challenging [27]. The nature of life impact following ankle fractures can extend beyond short-term pain and discomfort into many areas of life [28].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity phases such as desk work or driving. However, early identification of sarcopenia is essential to prevent negative consequences such as disability and death among hospitalized elderly patients [10], and early retirement is associated with worse disability, quality of life, and functional outcome after replantation or revascularisation of the upper extremity [1]. Evaluation of upper limb functional capacity and self-reported disability is warranted to provide advice regarding exercises or adjustments at work for patients with osteoarthritis of the hands [3].

Full activity (months): Specific month ranges for manual work or sport are not detailed in the evidence base. Results after 9-month follow-up for Dupuytren's contracture treated with percutaneous fasciotomy with Xiaflex (collagenase) include details on hand therapy [74]. Participants with scleroderma experienced clinically significant improvements in body function/structure measurements of hand function and in their ability to participate in activities following paraffin and exercise treatment [7]. Better early functional outcomes after operation for distal radial fracture do not seem to shorten sick leave duration [79].

Complete recovery / outcome plateau (months): The evidence does not define specific month ranges for the stabilization of pain, strength, or final functional outcomes. Long-term results of prosthetic treatment for child amputees followed into adult life are excellent, with most making normal social adjustments and more than half having families [72]. Bilateral above-the-knee amputees from the Vietnam War led relatively normal, productive lives within the context of their physical limitations [8]. Amputation level is linked to physical function but not to quality of life or pain measures after amputation for musculoskeletal tumours [5].

Rehabilitation protocol: A holistic approach addressing both physical and mental aspects is crucial for long-term functional outcomes after hand injury [25]. Safety and social issues of hand function and quality of life had an evident association with functional recovery after surgery and hand therapy in patients with Dupuytren's disease [9]. Splint use for partial thumb amputation demonstrated clinically significant changes over time with minimal changes in impairment, indicating enhanced function and improved patient perception of disability [13]. Disability outcome measures can expand clinician views toward individualized, activity-of-daily-living–oriented treatment regimens for hand trauma [2].

Functional milestones: Psychological factors appear to affect patient-reported health status (disability) more than they affect performance-based measures of function [6]. Dupuytren's disease is associated with known functional impairments, limitations on self-care, and major impacts on the psychosocial area [4]. Disease activity was associated with hand function impairment in rheumatoid arthritis patients with variable follow-up [31]. The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life [28]. Patients with a weak sense of coherence faced several conditions in life that challenged their everyday lives, and their hand-related disorder made their everyday lives even more challenging [27].

Other Considerations: Early retirement is associated with worse disability, quality of life, and functional outcome after replantation or revascularisation of the upper extremity [1]. Evaluation of upper limb functional capacity and self-reported disability is warranted to provide advice regarding exercises or adjustments at work for patients with osteoarthritis of the hands [3]. Early identification of sarcopenia is essential to prevent negative consequences such as disability and death among hospitalized elderly patients [10].

Key Evidence

  • [L3] Also, those who had to retire early had a worse disability, quality of life and functional outcome. (10.1186/1471-2474-15-73)
  • [L3] The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living–oriented, treatment regimens. (10.1016/j.jhsa.2006.05.017)
  • [L3] A careful evaluation of upper limb functional capacity and self-reported disability is warranted to provide advice regarding exercises or adjustments at work. (10.1016/j.jht.2017.01.003)
  • [L1] The results illustrate the existence of known functional impairments, limitations on self-care, and major impacts on the psychosocial area. (10.1016/j.jht.2024.12.007)
  • [L4] This unprecedented national survey confirms amputation level is linked to physical function, but not QOL or pain measures. (10.1302/0301-620x.97b9.35192)
  • [L2] Psychological factors appear to affect disability (patient-reported health status) more than they affect performance-based measures of function. (10.1016/j.jhsa.2008.07.006)
  • [L4] All participants experienced clinically significant improvements in both body function/structure measurements of hand function and in their ability to participate in activities. (10.1016/j.jht.2008.06.009)
  • [L4] The patients in the present study have led relatively normal, productive lives within the context of their physical limitations. (10.2106/00004623-199910000-00003)
  • [L4] Safety and social issues of hand function and quality of life had an evident association with functional recovery. (10.1016/j.jht.2014.11.006)
  • [L4] Early identification is essential to prevent negative consequences such as disability and death. (10.1186/s12891-015-0570-x)
  • [L2] Psychological factors are the strongest determinants of the HRQOL and disability. (10.1016/j.jhsa.2009.11.016)
  • [L4] While general outcomes were good, thumb ray dysfunction in sensibility and mobility remained the main functional disability. (10.1177/1753193412468577)
  • [L4] Splint use in this case demonstrated clinically significant changes over time with minimal changes in impairment indicating enhanced function and improved patient perception of disability. (10.1016/j.jht.2008.08.004)
  • [Case_report] Function improved for this participant by nearly two standard deviations, while quality of life was maintained. 3D-printing is a viable, adaptable, and cost-effective alternative that aided the participant's function. (10.1016/j.jht.2024.12.004)
  • [L3] Patients were not able to take advantage of their maximum active abduction during the range of motion in activities of daily living. (10.1016/j.jse.2009.10.012)
  • [L4] Adults with untreated triphalangeal thumbs had adequate thumb movement but diminished strength for specific functions. (10.1016/j.jhsa.2010.03.033)
  • [L4] HAVS patients experience functional, social, emotional, and psychological disability. (10.1016/j.jht.2016.10.010)
  • [L3] The MACS classification is useful to evaluate how well children can handle objects in daily activities. (10.1016/j.jhsa.2008.02.032)
  • [L3] Pain and function are the domains of the MHQ that are best able to discriminate between patients who are satisfied and those who are not. (10.1016/j.jhsa.2008.11.001)
  • [L4] Dual-task interference may impact the daily lives of people with PD, especially those with more severe disease or who report arm and hand problems. (10.1016/j.jht.2024.04.002)
  • [L2] The use of invalidated or unreliable patient-reported outcome measures may improperly estimate patient pain and functional status, which could affect treatment options, patient satisfaction, reimbursement, and/or quality of life. (10.5435/jaaos-d-16-00303)
  • [L4] The use of the prosthetic improves function, which in turn, can have improved psychological benefits, and helps determine if the patient will want or use a permanent prosthetic before investing in a costly item. (10.1016/j.jht.2010.04.003)
  • [L1] The ICF can help promote further development of adequate outcome measures including activity limitation and participation restrictions by targeting patient centred goals and respecting patients' needs. (10.1186/1471-2474-9-139)
  • [L4] The ICF HandA provides a consensus on outcome measures and instruments to systematically assess function in patients with hand injuries and disorders. (10.1177/1753193417706248)
  • [L4] A holistic approach addressing both physical and mental aspects is crucial for long-term functional outcomes. (10.1016/j.jht.2023.10.002)
  • [L4] Participants had several conditions in life that challenged their everyday lives, and the hand-related disorder made their everyday lives even more challenging. (10.1016/j.jht.2023.12.016)
  • [L4] The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. (10.1186/1471-2474-13-224)
  • [L3] Reporting active extension deficit or using patient-reported outcome measures may minimize this impact. (10.1177/1753193414529074)
  • [L4] The mean DASH score was moderately elevated at 15, indicating that many of these patients have sequelae. (10.1177/1753193410381820)
  • [L3] Disease activity was associated with hand function impairment in RA patients with variable follow-up. (10.1186/s12891-016-1246-x)
  • [L4] Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions. (10.1016/j.jht.2020.04.002)
  • [L4] Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. (10.1016/j.jht.2019.06.001)
  • [L1] Therapeutic activities that mimic ADL improve the functions of the hand more effectively than standard rehabilitation activities. (10.1016/j.jhsa.2007.08.008)
  • [L3] The results indicate that the QuickDASH can be used instead of the DASH to measure disability/symptom severity with similar precision in a variety of arm disorders. (10.1186/1471-2474-7-44)
  • [L3] Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings. (10.1016/j.jht.2017.06.003)
  • [L4] To determine accurately the effectiveness of Dupuytren disease interventions from the patients' perspective, it is important to determine their impacts on both activity limitations and quality of life. (10.1016/j.jhsa.2013.03.036)
  • [L4] Our findings support that we have presented a tool which can be used in future study within this population to better understand the hand kinetics associated with the highly problematic task of jar-opening and joint protection strategies intended to reduce hand loads. (10.1016/j.jht.2021.04.012)
  • [L3] The QoL questionnaire is a more appropriate instrument than the DASH for use with clients with SFT, unless the clients are in the severe (grade 3) category. (10.1016/j.jht.2015.04.005)
  • [L3] The slopes of the force-generation and force-decay phases of the Force-Time curve did not validly measure the sincerity of effort in participants with upper extremity injury, perhaps because they were protective of their injured hand and exerted only submaximal effort even at their best grip attempt. (10.1016/j.jht.2010.07.005)
  • [L1] Children receiving BoNT-A injections demonstrated clinically meaningful short-term improvements in upper extremity function. (10.1016/j.jhsa.2012.12.019)
  • [L1] Taping can be an effective option for repositioning the thumb and improves upper extremity function by controlling the thumb in palm mechanically and enabling sensorial input by maintaining the correct hand position. (10.1016/j.jht.2014.09.007)
  • [L5] Dexterity is a subset of hand function defined as the coordination of voluntary movement to accomplish an actual or simulated functional task accurately, quickly, resourcefully, and adapting to the environment or change. (10.1016/j.jht.2019.11.001)
  • [L4] Incorporating a biopsychosocial approach into rehabilitation could lead to better functional outcomes. (10.1177/17531934221131883)
  • [L5] Simultaneous activation of the FDP and the intrinsic muscles results in an apparently more functional hand closing compared with FDP activation alone because of altered kinematics and larger fingertip-to-palm distances. (10.1016/j.jhsa.2013.08.099)
  • [L4] This study demonstrates that hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health related quality of life. (10.1016/j.jht.2025.01.007)
  • [L1] Physical therapies were the most robustly assessed but studies were underpowered, providing insufficient evidence of efficacy. (10.1186/s12891-016-1200-y)
  • [L5] Initial nonsurgical treatment is warranted but may have poorer results in patients with more severe or chronic contractures; surgery should be considered for limited improvement after 3 to 6 months of conservative management. (10.5435/jaaos-d-18-00310)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L4] The targeted surgical intervention and undefined therapy intervention seemed to have little influence on activity and participation, although wrist/finger biomechanics and active range of motion improved. (10.1197/j.jht.2008.01.001)
  • [L5] The authors present fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function and early postoperative activity-based training in patients with cervical spinal cord injuries. (10.1177/1753193419827814)
  • [L5] Current movement science supports the tight interaction of posture and upper extremity function through developmental time and in real time, such that one system cannot be considered separate from the other. (10.1016/j.jht.2015.01.008)
  • [L4] Biomechanical analysis showed a huge amount of force and pressure, several times larger than that of ring avulsion injury, results when a steer pulls on the thumb. (10.1177/03635465030310051601)
  • [L3] Touch screen technology has become increasingly relevant to hand function in modern society. (10.1016/j.jhsa.2014.12.028)
  • [L4] The results provide reference values and suggest factors to be considered when evaluating hand function and therapeutic outcomes in both clinical and research settings. (10.1016/j.jht.2017.05.012)
  • [L4] Those who continued conservative treatment showed pain relief and reduced calcification for up to 6 months, suggesting conservative treatment could be tried for at least 6 months before considering surgical options. (10.1186/s13018-018-0997-5)
  • [L4] Classification of angular measurement according to the tested systems does not reflect the patient's perspective; it limits the precision of the measurement and adds little value to the measurement itself. (10.1016/j.jhsa.2018.06.010)
  • [L4] Knowing these frequently used grasp types is essential for assessing grasp rehabilitation processes and developing hand prostheses. (10.1016/j.jht.2014.04.002)
  • [L4] All patients moved up 1 to 3 levels in the Zancolli classification and showed a marked improvement in upper-extremity function. (10.1054/jhsb.1998.0002)
  • [L4] This study demonstrates that high test-retest reliability of tip, key, and palmar pinch force sense in healthy adults can be achieved using standardized positioning and the proposed approach. (10.1186/s12891-020-3187-7)
  • [L5] Assessment and treatment of psychosocial factors may improve surgical outcomes, correct pain-related misconceptions, decrease reported pain and disability, increase quality of life, and limit unnecessary interventions, particularly for patients with nonspecific or medically unexplained pain. (10.1016/j.jhsa.2008.05.007)
  • [L3] One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management. (10.1016/j.jht.2025.02.013)
  • [L3] A moderate correlation exists between financial distress and disability in patients with nonacute orthopaedic conditions, particularly in patients with low socioeconomic status. (10.5435/jaaos-d-18-00252)
  • [L4] Permanent results with a functional upper extremity and very satisfactory pain relief can be anticipated. (10.1177/1753193411413852)
  • [L4] The results show a non-pharmacological treatment gap in OA care, with most patients reporting no pain or mild pain and having not received non-pharmacological treatment prior to surgical consultation. (10.1186/s12891-019-2567-3)
  • [L4] Surgery significantly improved the ease of care for non-communicative patients with severe upper limb spasticity, with implications for carers and associated health costs. (10.1177/1753193419866595)
  • [L4] However, amputation should not be ignored as a treatment option for long-standing therapy-resistant CRPS-I. (10.2106/jbjs.m.00788)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L2] Higher baseline functional impairment was not associated with better adherence. (10.1016/j.jht.2021.04.024)
  • [L2] Results after 9 month follow-up, hand therapy after treatment will be presented in detail and discussed. (10.1016/j.jht.2010.09.006)
  • [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. (10.1016/j.jhsa.2023.03.027)
  • [L4] However, digital pain extent was not associated with any psychological measure nor with pain-related disability. (10.1186/s12891-022-05700-3)
  • [L3] Moderate-severe HV deformity and HV-related pain impaired physical function independent of KOA. (10.1186/s12891-018-2100-0)
  • [L4] Despite the recurrence, the mean postoperative deformity was significantly better than preoperatively and the majority of patients' families subjectively reported good function. (10.1177/1753193409354523)
  • [L3] Although several studies have shown better early functional outcomes after operation, this does not seem to shorten sick leave. (10.1177/17531934231194673)

See Also

References

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[4] Patients’ perspectives on Dupuytren’s disease: A scoping review and categorization using the WHO International Classification of Functioning, Disability and Health Framework (ICF). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.12.007

[5] Physical functioning, pain and quality of life after amputation for musculoskeletal tumours. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b9.35192

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[7] The Effect of Paraffin and Exercise on Hand Function in Persons with Scleroderma: A Series of Single Case Studies. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2008.06.009

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[20] Effects of dual-task interference on dexterity performance in people with mild to moderately severe Parkinson’s disease: An observational analysis. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.04.002

[21] Measures for Pain and Function Assessments for Patients With Osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-16-00303

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[26] Chapter 55 Pediatric Upper Extremity Disorders. 2020.

[27] Management of everyday life after a hand operation—A qualitative study of patients with a weak sense of coherence. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.12.016

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[30] DASH and sollerman test scores after hand injury from powered wood splitters. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410381820

[31] Patient and physician perspectives of hand function in a cohort of rheumatoid arthritis patients: the impact of disease activity. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1246-x

[32] Evaluation of individual finger forces during activities of daily living in healthy individuals and those with hand arthritis. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2020.04.002

[33] Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2019.06.001

[34] Comparison of Therapeutic Activities With Therapeutic Exercises in the Rehabilitation of Young Adult Patients With Hand Injuries. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.08.008

[35] The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskeletal Disorders. 2006. DOI: 10.1186/1471-2474-7-44

[36] Kinematic evaluation for impairment of skilled hand function in chemotherapy-induced peripheral neuropathy. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.06.003

[37] The Impact of Dupuytren Disease on Patient Activity and Quality of Life. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.036

[38] Reliability and validity of a novel instrument for the quantification of hand forces during a jar opening task. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2021.04.012

[39] Stenosing flexor tenosynovitis: Validity of standard assessment tools of daily functioning and quality of life. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2015.04.005

[40] Using the Force–Time Curve to Determine Sincerity of Effort in People with Upper Extremity Injuries. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2010.07.005

[41] Upper Extremity Spasticity in Children With Cerebral Palsy: A Randomized, Double-Blind, Placebo-Controlled Study of the Short-Term Outcomes of Treatment With Botulinum A Toxin. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.12.019

[42] Effects of taping the hand in children with cerebral palsy. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.09.007

[43] Defining dexterity—Untangling the discourse in clinical practice. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2019.11.001

[44] Prediction of disability in trigger finger: a cross-sectional and longitudinal study. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221131883

[45] Intrinsic Hand Muscle Function, Part 1: Creating a Functional Grasp. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.099

[46] The effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.01.007

[47] Systematic review of non-surgical treatments for early Dupuytren’s disease. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1200-y

[48] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[49] Etiology, Evaluation, and Management Options for the Stiff Digit. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00310

[50] Demographic Biases of Scoring Instruments for the Results of Total Knee Arthroplasty. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00009

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[53] Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419827814

[54] Upper extremity function: What's posture got to do with it?. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2015.01.008

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[56] Hand Function With Touch Screen Technology in Children With Normal Hand Formation, Congenital Differences, and Neuromuscular Disease. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.028

[57] Reference values of intrinsic muscle strength of the hand of adolescents and young adults. Journal of Hand Therapy. 2018. DOI: 10.1016/j.jht.2017.05.012

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[62] Test–retest reliability of tip, key, and palmar pinch force sense in healthy adults. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-3187-7

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[64] Value of Psychological Evaluation of the Hand Surgical Patient. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.05.007

[65] Nonoperative treatment of the Boutonniere deformity: Is there a difference in outcomes?. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.013

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[68] Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2567-3

[69] Upper limb surgery for severe spasticity after acquired brain injury improves ease of care. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419866595

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