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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

IHAQ-DI4/12/2011 21


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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

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