why are outcomes used in OT
- Evaluate change over time (treatment effectiveness, maturation, decline in status)
- Discriminate between or among different groups (diagnosis, classification)
- Predict future status (diagnosis or outcome)
international classification of function (ICF) model
health condition
body function and structure (impairment), activities (limitation), participation (restriction)
environmental and personal factors
what constructs DASH measures
30 item self report questionnaire that assesses musculo disorders of upper limbs
Quick DASH - 11 items
impairment - 5 questions
activity - 19 questions
participation - 3 questions
interpret DASH scores
a higher score indicate a greater level of disability and severity, whereas, lower scores indicate a lower level of disability. The score on both test ranges from 0 (no disability) to 100 (most severe disability)
applicability
able to read and interpret, time to administer, administration burden, cultural applicability
reliability
consistency, repeatability, stability
Internal consistency
Instrumental reliability: test retest
Inter rater reliability
Standard error measure
validity
measures what it is intended to measure
Construct validity: ceiling or floor effect; how well does the test measure the theoretical concept
Content validity: if test represents the content properly
what does responsiveness of a patient-centered questionnaire mean
Ability of an instrument to measure clinically important change over time; essential when evaluating the relative benefits of different interventions
Known amount of error of an instrument
Calculated by the Standard Response Mean (SRM) and Effect Size (ES)
SRM: mean change divided by standard deviation of change scores
ES: mean change divided by standard deviation of baseline score
meaning of 1/2 life of a medication
The time it takes to get one-half of the drug distributed in this initial compartment is the alpha half-life.
- It takes 5 half-lives to reach steady state when you initiate a drug
The time it takes to get one-half of the drug eliminated from the body is the beta half-life.
- It takes 5 half-lives to eliminate all of the drug when you stop it
tolerance
happens when a person no longer responds to a drug in the way they did at first. So it takes a higher dose of the drug to achieve the same effect as when the person first used it. This is why people with substance use disorders use more and more of a drug to get the “high” they seek.
addiction
can result from taking drugs or alcohol repeatedly. If a person keeps using a drug and can’t stop, despite negative consequences from using the drug, they have an addiction
side effects of steroid (prednisone)
- ***Breakdown of bone, ligaments, muscle, and skin
- Adrenocortical suppression, **patients must wean off the drug
- Cushing’s syndrome, round puffy face, redistribution of fat, hypertension, osteoporosis, hirsutism (excessive hair growth), glucose intolerance
- Increased susceptibility for infections, peptic ulcer, mood swings, glaucoma
- Anxiety, sleeplessness
- Breakdown of connective tissue, bone, and muscle
side effects of anti-inflammatory drugs (NSAIDS)
- CNS: headaches, tinnitus, and dizziness
- Cardiovascular: fluid retention, hypertension, edema
- GI: abdominal pain, dysplasia, nausea, vomiting, and ulcers or bleeding
- Hematologic: rare platelets, anemia
- Hepatic: abnormal liver function tests and liver failure
- Pulmonary: asthma
- Skin: rashes, pruritus
- Renal- renal insufficiency or failure
clinical manifestations of trigger finger
- Tenosynovitis of the flexor tendon sheath. - Thickening occurs and a nodule forms.
- The nodules become stuck between the A1 and A2 pulleys
- The digit becomes stuck in flexion
- **Most common in the long and ring finger, thumb on dominant hand
causes of trigger finger
- Repetitive gripping
- Pressure over palm
- Tendinitis
- Individual’s tendency to collect fluid around their tendons
- Cause is likely multifactorial
More common in women aged 5th and 6th decade of life
**Diabetic individual at risk
conservative treatment for trigger finger
- Orthosis wear
- MP joint block, full digit extension
- Ice massage, make activity changes, NSAIDS, massage
- Injection: corticosteroid into tendon sheath (improve in individuals with shorter term trigger finger 6mo or less, diabetics, and those with more than one digit triggering)
surgical options for trigger finger
A1 pulley is released
pathophysiology of dupuytren’s contracture
- Disease of the palmar fascia (abnormal thickening)
- Small lumps/nodules develop in the hand
- Tissue tightens and fingers begin to be pulled towards the palm
- Individuals can develop Lederhosen disease or Peyronie’s disease
*Ring finger and small finger most common
Genetic Predisposition: Northern European descent, men over 60
Common after trauma (pseudo dupuytren’s; traumatic palmar fascitis)
Association: diabetes, smoking, alcohol, epilepsy, liver disease
conservative management for dypuytren’s
- Discuss adaptive techniques
- Biomechanical interventions that do not reserve the process
- Most will gradually have an increased flexion contracture
- Heat, stressing, massage
- Orthosis will not reverse the process
surgeries for dypuytren’s
- When contracture is greater than 30 degrees
1. Percutaneous Needle Aponeurotomy
2. Enzyme Injection (Xiaflex)
3. Fasciectomy
4. Dermofasciectomy
5. Amputation
Percutaneous Needle Aponeurotomy
Go in with a needle to try to break up the tissue
Eventually the cord breaks
Risks: nerve or tendon injury, infection (low risks), tendon rupture
Therapy: Fabricate a nocturnal extension orthosis, Exercises for mobility, Avoid heavy gripping post-op week 1, Return to driving and sport usually within 1-2 weeks
Enzyme Injection (Xiaflex)
- Enzyme is left to digest the cord overnight
- Next day the cord is manually released
Risks: skin rupture, tendon rupture, edema, hematoma, pain, fever and pruritus (itch).
Therapy: Hand Orthosis Fabrication For Nocturnal Wear, AROM exercises, Edema Control, Scar management, Return To Previous Level Of Activity As Wound heals.
Fasciectomy
Open procedure that removes the disease tissue of the cord
Zig zag incision to limit scar and skin contracture
Dermofasciectomy
Skin graft closes the wound
Immobilized for 7-10 days for the graft to take
Advantage: import fresh skin in individuals with poor skin quality
