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IJPMR 2009; 20 (2):48-51
Journal II
AZKIYATUN
Correlation Between Instrumental HandFunction and Activities of Daily Living
in Rheumatoid ArthritisAK Gupta, SL Yadav, U Singh, S Wadhwa, A Kumar, D Borah, RM Pandev
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Objective:
To find the correlation of instrumental hand functionand Activities of Daily Living (ADL) in rheumatoidarthritis patients
ABSTRACT
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50 patients of either sex
Objective evaluation ofhand function :use Hand dynamometerand electrogoniometer
assessed for theirfunctional limitationsusing IHAQ-DI
METHODS
Spearman rank collision To find out theassociation among the variables
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ABSTRACT
Results:Most of the disease specific parameters:
- Morning stiffness- Number of inflamed joints
- Duration of the disease- DeformitiesDeficits in grip strength, tip pinch, palmar pinch, and ROM
of hand a strong correlation with difficulty in ADL inpatient with RA
Instrumental hand functions (grip strength, pinch strengthand ROM of joints) were significantly impaired in patient withRA and they had good correlation with Indian HealthAssessment Questionnaire Disability Index (IHAQ-DI)
A strong correlation withthe instrumental hand
function
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ABSTRACT
Conclusion:Instrumental hand function assessment along with IHAQ-DI
is an effective tool in evaluation and modulation oftherapeutic interventions in patients with rheumatoidarthritis
The instrumental hand function assessment can also predictthe deficits in ADL
Key words:Rheumatoid Arthritis, Hand function, Activity of Daily Living
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INTRODUCTION
Rheumatoid arthritis (RA) is a chronic symmetricalinflammatory polyarthritis of small and large joints of theextremities
Involved joints show inflammation with swelling, tenderness,warmth, and decreased ROM
Joint and tendon destruction may lead to various deformitiesof the extremities
These patients show different degrees of difficulty in
performing ADLAs the disease has a considerable impact on the ADL, it was
tried to assess and establish the correlation of hand functionand ADL in RA patients using IHAQ-DI
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MATERIALAND METHODS
Fifty consecutive patients of either sex:- Fulfilling the inclusion criteria and- Agreeing to participate in the study
They were taken from those attending the outpatientdepartment of Physical Medicine and Rehabilitation, AllIndia Institute of Medical Sciences, New Delhi.
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The inclusion criteria were:
(1) age group: 20 50 years
(2) sex: both males and females(3) all old and newly diagnosed cases of RA at any stage of
disease(4) Symptoms present at the time of initial examination
(5) Patients ability to understand and perform theprescribed test for hand function and answer IHAQ-DIquestionnaire
(6) Willingness to participate
MATERIALAND METHODS
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The patients were made to sit comfortablyTheir hand function was objective evaluated using:
- Dynamometer for grip strength, pinch strength
- Goniometer for ROMof wrist and joints of handsAfter the testing of hand function, the patients were assessed
for their functional limitations using IHAQ-DIThe result obtained was analyzed statistically and interpreted
with a view to comparatively evaluate the instrumental findingand ADL assessment using the IHAQ- DI scale
Spearman rank collision was performed using SAS 8.0statistical package to find out the association among variables
statistically significant level p-value
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MEDIAN: Age: 36.50 years (range 23-50) Duration of disease: 4 years (range 0.25-30)
Pain score on VAS: 4 (range 0-8) IHAQ-DI: O.75 (range 0.08-2.08)
In this studyThere were 40 (80%) females and 10 (20%) males
At the time of study there was no active inf lammation in anyjoint in 26 patients
30 (60%) patients were having anemia.
RESULT
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Morning stiffness of more than 30 minutes: was present only in 38% patients:no significant correlation with IHAQ-DIhad correlation of deficit of ROM of right hand.
Duration of RA:
strongly correlated with diminished ROM of bilateralhand and presence of deformities
but not with any other parameters of instrumental handfunction or IHAQ-DI
Inflamed joint count: Strong correlation with deficit of ROM of both sides
Pain score on VAS:No correlation with IHAQ-DI and instrumental hand
function
RESULT
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RESULT
Hand deformities:present in 70% patientsstrongly correlated with deficit of right side tip pinch,
deficit of bilateral hand ROM and with IHAQ-DIRestriction of ROM of bilateral hands:present in 62% patientsstrongly correlated with IHAQ-DI
Grip strength deficits of both sides:
strongly correlated with IHAQ-DIMost of the patients were having deficits of grip strength
affecting the right side more frequently.
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RESULT
Tip pinch and palmar pinch strengths:lower in most of the patients (88%)left hand was more severely involved than the right hand
Bilateral tip and palmar pinch strength deficits:strongly correlated with IHAQ-DI
In most of the patients key pinch was impaired but nosignificant correlation was found with IHAQ-DI.
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AKS: apakah kamu bisa Tanpa
kesulitan
Dengan
sedikit
kesulitan
Dengan
banyak
kesulitan
Tidak bisa
mengerjakan
Jumlah
pasien (%)
Jumlah
pasien (%)
Jumlah
pasien (%)
Jumlah
pasien (%)
Memakai baju sendiri termasuk
sari/salwar/dhoti/ piyama dan mengancingkan
baju?
24 (48) 21 (42) 4 (8) 1 (2)
Naik turun dari tempat tidur? 28 (56) 20 (40) 1 (2) 1 (2)
Mengangkat secangkir atau segelas penuh ke
mulut?
25 (50) 22 (44) 2 (4) 1 (2)
Berjalan di luar ruang pada tanah datar 23 (46) 19 (38) 7 (14) 1 (2)
Membasuh dan mengeringkan seluruh tubuh? 16 (32) 28 (56) 5 (10) 1 (2)
Jongkok di toilet atau duduk bersila di lantai 14 (28) 14 (28) 7 (14) 15 (30)
Membungkuk untuk mengambil pakaian dari
lantai
25 (50) 18 (36) 5 (10) 2 (4)
Mengetuk - ngetuk 27 (54) 17 (34) 6 (12) 0 (0)
Keluar masuk auto rickshaw/manual
rickshaw/mobil?
15 (30) 24 (48) 9 (18) 2 (4)
Berjalan 3 kilometer? 7 (14) 23 (46) 9 (18) 11 (22)
Belanja di pasar sayuran 8 (16) 27 (54) 7 (14) 8 (16)
Naik tangga 15 (30) 21 (42) 10 (20) 4 (8)
Table 1. Indian Health Assessment QuestionnaireRESULT
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RESULT
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Outcome assessment in patients with RA includesmeasurement of physical function
Physical disability is an important outcome of rheumatoidarthritis
Morning stiffness (lasting more than 30 minutes) was presentonly in 19 (38%) patients as the patients were in differentstages of the disease and treatment- There was no significant correlation between morning
stiffness and IHAQ-DI- Morning stiffness strongly correlated with deficits of ROM ofright hand
DISCUSSION
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Curkovic found that there was general trend of the risinggrip strength since morning to evening without statisticalrelevance and grip strength negatively correlated with thegrade of morning stiffness
but in this study no association could be found between
morning stiffness and grip strength
DISCUSSION
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DISCUSSION
Duration of RA: strongly correlated with decrease of ROM of bilateral hand
and deformitiesno correlation with any other parameter of instrumental
hand function and IHAQ-DIIn contrast, Bodur found that disease duration strongly
correlated with special hand disability index of StanfordHAQ
Inflamed joint count:
strongly correlated with deficits of ROM of both sidesno correlation with IHAQ-DI
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DISCUSSION
In this study most of the patients were having decreasedgrip strength with right side affected more severely
Both sides of grip strength deficits strongly correlated withIHAQ-DI
Hakkinen also found that grip strength wasassociated withthe total HAQ disability index
Tip pinch strength:lower in most of the patients (88%) and left hand was
more severely involved than the right hand probably
becaue of neglect of the non-dominant sidedeficits of bilateral hands strongly correlated with IHAQ-
DIright tip pinch strength was more strongly correlated with
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In right hand, key pinch was impaired in almost 100%patients and right hand was also more severely impaired
But there was no significant correlation between IHAQDIand key pinch deficit in both hands
Palmar pinch strength was also lower in most of the patients(88%) and left hand was more severely involved. Both sidespalmar pinch strength deficits strongly correlated withIHAQ-DI
Bodur6 noted that disease duration, grip strength, pinch
measurements, clinical and laboratory activity parametersstrongly correlated with hand disability
DISCUSSION
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They concluded that grip strength and pinchmeasurements seemed to be the most related variables
with hand disability and articular damage
So, grip strength and pinch measurement should beincluded in the evaluation and follow-up of the patientswith RA in hand rehabilitation units
DISCUSSION
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DISCUSSION
In this study, there was no restriction of ROM in 38%patients
ROM was more severely affected in the left hand probablybecause of the neglect due to non-dominant side
Decrease in ROM of bilateral hands strongly correlated withIHAQ-DI
Dellhag10 found that flexion and extension deficits in digitsII through V were the strongest predictors of actual hand
function Hakkinen concluded that in patients with rheumatoid
arthritis, pain and ROM of joints had the greatest impact onindividual sub dimensions of the HAQ.
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Instrumental and functi ns (gri strengt , inc strengtand range fmotionof joints) ere significantly impaired inpatient it Aand t ey adgood correlation it IHAQ-
I
e instrumental and functions assessment along itIHAQ- I are effective tools in evaluation andmodulationoft erapeutic interventions inpatients it A
The instrumental hand functions assessment can alsopredictthe deficits inADL
CONCLUSION
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THANK YOUFOR YOUR ATTENTION
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Diagnosis
RAAmerican Rheumatologic Association (ARA) Criteria 1988 :
yHarus memenuhi 4 dari 7 kriteria
yKriteria 1-4 harus ada minimal 6 mgg
1. Morning stiffness di sendi & sekitarnya, minimal 1 jam
2. Arthritis 3 sendi (soft tissue swelling or fluid) : PIP, MCP, wrist, elbow, knee,
ankle, MTP joint
3. Arthritis hand joint (min 1 sendi bengkak pada wrist, MCP&/PIP)
4. Symmetric arthritis
5. Rheumatoid nodule (subcutaneous nodules diatas extensor surface, bonyprominent or in juxta articular region)
6. Serum RF (+)
7. Perubahan radiologi (hand & wrist) : erosi, dekalsifikasi tlg, penyempitan celah
sendi simetris)
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Hand dynamometer
Electrogoniometer
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Gejala & keluhan ygmenyertai (nyeri,
keterbatasan geraksendi, deformitas
sendi dsb)
Gangguanfungsi
Disabilitas
Kehilangankemampuan
fungsi &kemandirian
Maka diperlukan tindakan atau terapiKedokteran fisik & rehabilitasi medik
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The important determinants in classifying arthritis are whether thedisorder is inflammatory or noninflammatory, symmetric or asymmetric,or accompanied by systemic and extraarticular manifestations.
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Masalahakibatrematik
Nyeri
Keterbatasan
gerak sendi
Atrofi sertapenurunanketahanan
(endurance) sertakekuatan (strength)otot
Deformitas
Instabilitassendi
Gangguanpembebanan
sendi
Gangguandensitas tulang
Penggunaanenergi tidak
efisien
Penurunan fungsi& kenyamanan
(well-being)
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Tujuan terapi
Kedokteranfisik danrehabilitasi
medik :
Pencegahan, agar masalah tidak sampaiterjadi
Menghilangkan masalah, agar tidak terjadikecacatan
Mengurangi masalah, agar kecacatan yangterjadi dapat diperkecil
Memaksimalkan fungsi yang ada
Memberikan kualitas hidup yang baik
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RA OA AS Gout
Morning
stiffness
>1-2 jam