Date Presented 03/26/20
The purpose of this study was to quantify active ROM required for individuals with rheumatoid arthritis using built-up spoons with electrogoniometry. Statistical analysis provided quantitative evidence supporting our hypothesis that using a built-up handle requires less active ROM for grasp. Clinical implications suggest that built-up handles may be used for other conditions with limited hand and wrist ROM, not just RA, increasing participation and independence in daily activities.
Primary Author and Speaker: Susan McDonald
Additional Authors and Speakers: David Levine, Hensley Barnes, Anna Cornett, Kathleen Craig, Sally Langager
Contributing Authors: Lauren Yeager, Michael Britt
PURPOSE: The purpose of this study was to quantify the active range of motion required for individuals with rheumatoid arthritis (RA) to grip standard and built-up handle spoons. Our hypothesis was that less ROM would be required to grip built-up spoons compared to a standard one. A previous study conducted by McDonald, Levine, Richards, and Aguilar (2016) showed the ROM required to grasp the spoons in persons with normal hand function decreased with increasing spoon diameter. This study attempted to bridge the gap by providing evidence that the ROM required to grip built-up spoon handles in individuals with RA decreases with increasing spoon diameter. A primary concern of people with RA is their loss of independence (Lutze & Archenholtz, 2007). By quantifying this data and providing the evidence showing that people with RA can use less ROM when utilizing adaptive silverware, more studies regarding its benefit will hopefully be conducted, prompting a small solution to the pain and loss of independence facing individuals with RA.
DESIGN: Thirty-eight individuals (seventy-six hands) with RA between the ages of 38-76 were recruited from a Rheumatology physicians practice. Inclusion criteria were: diagnosis of RA, 18 years or older, and no comorbidities that could further impair ROM of the hands and fingers. Individuals were provided with an informed consent document prior to inclusion in the study. This study was approved by the Institutional Review Board (IRB).
METHOD: Range of motion in all joints of the fingers was measured using the Biometrics F35 Single Axis Electrogoniometer (Biometrics Ltd, Ladysmith, VA, USA). The electrogoniometer was recalibrated before each patient to ensure the accuracy of the measurements. Patients placed their arms in a standardized position. They gripped spoons of increasing diameters: beginning with a standard handle spoon, built-up handle of 1.00 inches (2.54 cm), and built-up handle of 1.50 inches (3.81 cm). Measurements of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints were taken for digits 2-5 (index, middle, ring, and little fingers). The joints measured for digit 1 (thumb) were the MCP and interphalangeal (IP) joints. The means and standard deviations of all ROM measures were compared using factorial ANOVAs relating the spoons, fingers, and joints to determine how ROM differed based on these variables. Post-hoc analyses were then performed to determine the differences within each factor.
RESULTS: A 2 x 3 repeated measures ANOVA (dominant/non-dominant, spoon handle diameter) was performed for each finger joint. Main effects showed significant differences in ROM between handle sizes for all joints (p<.01, p<.01, η
p
2=0.138 -0.934), with the greatest effect size seen in the PIP and DIP joints. Further pairwise comparisons showed significant differences between all handle sizes with the exception of between the normal and 1 inch handles for the 1st, 3rd, 4th, and 5th finger MCP joints.
CONCLUSION: This study provides quantitative evidence supporting our hypothesis that using a built-up handle spoon requires less AROM for grasp. The clinical implications of this study suggests that patients with RA and other conditions that restrict joint ROM in the hands may not only benefit from the use of adapted, built-up utensils, but other adapted handles in order to increase participation and independence in daily activities. Anecdotally, patients in our study reported increased comfort when grasping adaptive silverware versus standard silverware
IMPACT STATEMENT: Built-up handles may be used for other conditions with limited hand and wrist ROM, not just RA and may increase participation and independence in daily activities.
References
McDonald, S., Levine, D., Richards, J., & Aguilar, L. (2016). Effectiveness of adaptive silverware on range of motion of the hand. PeerJ, 4(2), e1667. doi:10.7717/peerj.1667
Lutze, U., & Archenholtz, B. (2007). The impact of arthritis on daily life with the patient perspective in focus. Scandinavian Journal of Caring Sciences, 21(1), 64-70. doi: 10.1111/j.1471-6712.2007.00443.x
