Electronic Thesis and Dissertation Repository

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Dr. Joy C MacDermid

Abstract

Abstract

Objectives: The primary objective of this study was to determine the effect of age and gender on hand dexterity after distal radius fracture (DRF). The second aim of this study was to evaluate the recovery of hand dexterity in 1-year follow-up of DRF. The third purpose of this study was to determine the extent to which loss of range of motion (ROM) and grip strength predicts hand dexterity 6-months after injury

Methods: A prospective cohort study of 242 patients with DRF examined the recovery of hand dexterity across 3 time-points (3, 6 and 12 months). Dexterity testing was performed using the small, medium and large objects subtests of the NK Dexterity testing; in both hands. The mean of two trials was computed. A generalized lineal model (GLM) multivariate analysis was performed to determine the effect of age and gender on hand dexterity. Repeated measures (GLM) was performed to test recovery over time controlling for age and gender. A second prospective study of 391 patients examined if physical impairments predict hand dexterity at 3 months and 6 months after the DRF. A stepwise multiple regression was performed. Scatter plots were analyzed and the probability level was set at α=0.05, CI 95%

Results: Age was a statistically significant predictor for hand dexterity for all size of objects R2=0.227, p2=0.038, p=0.003, R2=0.044, p=0.01) but no significant effects were found on small objects (R2=0.000, p=0.860). Males had better hand dexterity scores on large and medium objects in the 3 to 6-month period. From 6-months to 12-months showed that males on medium objects were worsened while females had a slightly worst dexterity scores on that period. The manipulation of small objects indicated that females were performing much better in all three evaluation time points. Age, sex and radial-ulnar deviation arc of motion were significant predictors of large hand dexterity explaining the 23.2% of the variation in scores while, age and flexion-extension were significant predictors for the manipulation of small objects explaining the 10.9% of the variable at 3-months after fracture (n=391). At 6-months post injury, grip strength, ROM flexion-extension and age were found to be significant predictors explaining 34% of the variation in large hand dexterity. For the small objects, age, grip strength, sex and radial-ulnar deviation were significant predictors explaining 25.3% of the variation (n=319).

Conclusion: This study indicates that dexterity improves rapidly in between 3 and 6 months, and slowly worsened until 1-year following DRF; and it does not recover to the state of the uninjured hand even by 1 year. This would support the need for greater attention to hand dexterity during rehabilitation. Also, this study confirms that demographics and wrist impairments determine dexterity following DRF. At the 3-month follow-up, hand dexterity is determined primarily by ROM radio-ulnar deviation and flexion-extension. At the 6-month follow-up hand dexterity is determined primarily by grip strength and flexion-extension ROM. Identifying predictors of hand dexterity following a DRF can assist clinicians understand the relationship between hand dexterity and physical impairments to improve hand function


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