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Nilsdotter, Anna
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Brorsson, S., Nilsdotter, A., Thorstensson, C. & Bremander, A. (2014). Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group. BMC Musculoskeletal Disorders, 15(1), Article ID 154.
Open this publication in new window or tab >>Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group
2014 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 15, no 1, article id 154Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group.

METHODS: Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC.

RESULTS: The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and-for the EDC-also when writing with a pen and using a key (p < 0.02). The exercise "rolling dough with flat hands" required the lowest %MVIC and may be less effective in improving muscle strength.

CONCLUSIONS: Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength. © 2014 Brorsson et al.; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London, England: BioMed Central, 2014
Keywords
Muscle activation, Muscle extension force, Flexion force, Female, Daily activities
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-26417 (URN)10.1186/1471-2474-15-154 (DOI)000337326200001 ()24886491 (PubMedID)2-s2.0-84903584119 (Scopus ID)
Available from: 2014-09-10 Created: 2014-09-10 Last updated: 2018-10-22Bibliographically approved
Brorsson, S., Thorstensson, C., Nilsdotter, A. & Bremander, A. (2014). Two different sets of handexercises improved grip strength after after eight weeks in patients with arthritis. Paper presented at EULAR (The European League Against Rheumatism) Annual European Congress of Rheumatology, Paris, France, 11-14 June, 2014. Annals of the Rheumatic Diseases, 73(Suppl. 2), 1210-1210
Open this publication in new window or tab >>Two different sets of handexercises improved grip strength after after eight weeks in patients with arthritis
2014 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, p. 1210-1210Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background Hand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand exercises are recommended. A number of hand exercises are often used in the clinic but there is little information about “the effects of a minimal set of hand exercises” and if the choice of exercises is important to improve strength and function in the hand.

Objectives To study the effect on grip- and finger extension strength and patient reported hand function from two different sets of handexercises performed over 8 weeks using a randomized study design.

Methods Female patients with arthritis (RA and HOA, n=121) were randomly assigned to two different sets of handexercises (HE) for 8 weeks. The four hand exercises applied in the program were exercises commonly used in traditional hand training programs. The exercises were split into two groups depending on if the muscle activation (measured with EMG) were greater in forearm flexor (HE I, n=62) or in extensor muscles (HE II, n=59) (REF). HE I: isolated finger opposition (digits II-V) and rolling the putty with a flat hand, HE II: squeezing the putty and finger extension with putty resistance. The two HE were performed daily and each set was repeated 15 times, training time per day was maximum 5 minutes 7 days/week.

Grip strength was measured with Grippit and finger extension strength with EX-it both validated instruments (unit: N). Pain was measured with a Visual Analogue Scale (VAS), 0-10 (best to worst). Hand functions were evaluated with the patient reported questionnaire Quick Disability Arm Shoulder and Hand (QuickDASH), 0-100 (best to worst).

Results Mean grip strength (p=0.01) and mean finger extension force (p=0.004) increased after the training period in the group using HE I. In HE II the mean finger extension force increased (p=0.044), table 1. Hand function was stable over the training period.

Table 1.

Descriptive data of finger extension (EXIT) force and grip strength in the right hand, hand function (QuickDASH) and VAS pain presented as mean ± SD (min–max)

Conclusions Five daily minutes with two hand exercises resulted increased grip strength and finger extension force after eight weeks. We suggest that hand exercises should be combined and selected to improve both flexor and extensor muscle strength of the forearm.

Place, publisher, year, edition, pages
London: BMJ Books, 2014
National Category
Physiotherapy
Identifiers
urn:nbn:se:hh:diva-25237 (URN)10.1136/annrheumdis-2014-eular.4883 (DOI)000346919806471 ()
Conference
EULAR (The European League Against Rheumatism) Annual European Congress of Rheumatology, Paris, France, 11-14 June, 2014
Available from: 2014-04-30 Created: 2014-04-30 Last updated: 2018-03-22Bibliographically approved
Brorsson, S., Nilsdotter, A., Thorstensson, C. & Bremander, A. (2012). Hand flexor and extensor muscle activity in daily activities and hand exercises in women with rheumatoid arthritis or hand osteoarthritis. Paper presented at European League against Rheumatism (EULAR) 2012, Berlin, Germany, 6-9 June, 2012. Annals of the Rheumatic Diseases, 71(Suppl. 3), 754-754
Open this publication in new window or tab >>Hand flexor and extensor muscle activity in daily activities and hand exercises in women with rheumatoid arthritis or hand osteoarthritis
2012 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no Suppl. 3, p. 754-754Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: Impaired hand grip function is common and occurs early in the course of disease in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA), affecting daily life activities and quality of life.

Objectives: To evaluate muscle force and muscle activity in forearm flexors and extensors during daily activities and clinically well-known hand exercises in women with RA and HOA compared with healthy controls

Methods: The RA group was consecutively included from a specialist clinic and had a disease duration of at least one year.  Women with HOA were allocated from out-patients primary health care clinics in the same area and clinically diagnosed with symptomatic HOA. The age matched control group had no history of hand/arm injuries, inflammatory or muscle disease. Full active finger extension ability was required for all subjects. Hand force (Newton) was measured with EX-it (extension) and Grippit (flexion), both validated instruments. Muscle activity was measured in m. extensor digitorum communis (EDC) and m. flexor carpi radialis (FCR) with surface EMG (S-EMG) on the dominant hand while performing four daily activities (ADL) and four hand exercises and described as percent of maximal voluntary isometric contraction (% MVIC) based on data from EX-it and Grippit. Pain was measured with Visual Analogue Scale (VAS) 0-10 (best to worst). Differences between groups were analyzed and controlled for age.

Results: Fifty-six women were included; 20 with RA (age mean (SD) 59.2 (10.7) years, VAS pain 2.2 (1.6)), 16 with HOA (age 67.5 (9.3) years, VAS pain 4.1 (1.9)) and 20 healthy controls (age 56.0 (9.7) years). Women with RA and HOA showed decreased extension and flexion force compared with healthy women (p<0.03).There was a tendency towards higher % MVIC in all tests for women with RA or HOA compared with healthy women, with a statistically significant difference between HOA and healthy women for EDC (p<0.05).

ADL activities “writing with a pen”, and “cutting with scissors” showed the highest % MVIC in both EDC and FCR in all groups. The exercises “isolated opposition”, and “rolling the dough with flat hands”, had high % MVIC in EDC, while “squeezing the dough” and “isolated opposition” had high % MVIC in FCR.

Conclusions: Women with RA and HOA tend to use a higher % MVIC than healthy women in many daily activities and in hand exercises. Strengthening exercises should include both extensor and flexor specific training.

Disclosure of Interest: None Declared

Place, publisher, year, edition, pages
London, United Kingdom: BMJ Publishing Group Ltd, 2012
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-20009 (URN)10.1136/annrheumdis-2012-eular.2946 (DOI)000208898504071 ()
Conference
European League against Rheumatism (EULAR) 2012, Berlin, Germany, 6-9 June, 2012
Available from: 2012-11-20 Created: 2012-11-20 Last updated: 2018-07-09Bibliographically approved
Benoni, A. C., Bremander, A. & Nilsdotter, A. (2012). Patient-reported outcome after rheumatoid arthritis-related surgery in the lower extremities: A report from the Swedish National Register of Rheuma Surgery (RAKIR). Acta Orthopaedica, 83(2), 179-84
Open this publication in new window or tab >>Patient-reported outcome after rheumatoid arthritis-related surgery in the lower extremities: A report from the Swedish National Register of Rheuma Surgery (RAKIR)
2012 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 83, no 2, p. 179-84Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Although decreasing with the development of effective pharmacological regimes, joint surgery has improved the function and quality of life of patients with rheumatoid arthritis (RA). Few studies have assessed patient-reported outcomes after RA surgery to the lower extremities. Here we report patient-relevant outcome after RA-related surgery based on the first data from the Swedish National Register of Rheuma Surgery (RAKIR).

PATIENTS AND METHODS: 258 RA patients (212 women) who had joint surgery performed at the Department of Orthopaedics, Spenshult Hospital between September 2007 and June 2009 were included. Mean age at surgery was 64 (20-86) years. The patients completed the SF-36 and HAQ questionnaires preoperatively and 6 months postoperatively, and 165 patients completed them after 12 months.

RESULTS: Improvement was seen as early as at 6 months. At 12 months, 165 patients (141 women)-including hip (n = 15), knee (n = 27), foot (n = 102), and ankle (n = 21) patients-reported statistically significant improvements from preoperatively to 12 months postoperatively in HAQ (mean change: -0.11) and SF-36 subscales physical function (11), role physical (12), bodily pain (13), social functioning (6.4), and role emotional (9.4). Hip and knee patients reported the greatest improvements.

INTERPRETATION: Orthopedic RA-related surgery of the lower extremities has a strong effect on pain and physical function. Improvement is evident as early as 6 months postoperatively and remains after 12 months. Copyright © 2011 Nordic Orthopaedic Federation.

Place, publisher, year, edition, pages
Basingstoke: Taylor & Francis, 2012
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hh:diva-20158 (URN)10.3109/17453674.2011.645193 (DOI)000303242700015 ()22206446 (PubMedID)2-s2.0-84860284009 (Scopus ID)
Available from: 2012-12-14 Created: 2012-12-14 Last updated: 2018-03-22Bibliographically approved
Brorsson, S., Nilsdotter, A., Pedersen, E., Bremander, A. & Thorstensson, C. (2012). Relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis. Journal of Rehabilitation Medicine, 44(7), 605-608
Open this publication in new window or tab >>Relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis
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2012 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 7, p. 605-608Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.

METHODS: Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.

RESULTS: Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).

CONCLUSION: Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis. © 2012 Foundation of Rehabilitation Information.

Place, publisher, year, edition, pages
Uppsala, Sweden: Stiftelsen Rehabiliteringsinformation, 2012
Keywords
Extension force, Flexion force, Hand function, Hand strength, Muscle ratio, Rheumatoid arthritis
National Category
Physiotherapy
Identifiers
urn:nbn:se:hh:diva-19701 (URN)10.2340/16501977-0986 (DOI)000305814900014 ()22674244 (PubMedID)2-s2.0-84865972165 (Scopus ID)
Funder
The Crafoord Foundation
Available from: 2012-09-21 Created: 2012-09-21 Last updated: 2018-03-22Bibliographically approved
Nilsdotter, A. & Bremander, A. (2011). Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis care & research, 63(Suppl 11), S200-207
Open this publication in new window or tab >>Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire
2011 (English)In: Arthritis care & research, ISSN 2151-4658, Vol. 63, no Suppl 11, p. S200-207Article in journal (Refereed) Published
Abstract [en]

Outcome measures included in this review are the Harris Hip Score, the Hip Disability and Osteoarthritis Outcome Score, the Oxford Hip Score, the Lequesne Index of Sever- ity for Osteoarthritis of the Hip, and the American Acad- emy of Orthopedic Surgeons Hip and Knee Questionnaire.

The outcome measures chosen are the most common ones in the literature concerning hip function and symp- toms. Most of them are patient-reported. The selected mea- sures meet the basic requirements for an outcome mea- surement, although there are shortcomings in a few of them.

Place, publisher, year, edition, pages
Hoboken, USA: John Wiley & Sons, 2011
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hh:diva-20155 (URN)10.1002/acr.20549 (DOI)22588745 (PubMedID)2-s2.0-80755167781 (Scopus ID)
Available from: 2012-12-14 Created: 2012-12-14 Last updated: 2018-03-22Bibliographically approved
Brorsson, S., Hilliges, M., Sollerman, C. & Nilsdotter, A. (2009). A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis. Journal of Rehabilitation Medicine, 41(5), 338-342
Open this publication in new window or tab >>A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis
2009 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 5, p. 338-342Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To evaluate the effects of hand exercise in patients with rheumatoid arthritis, and to compare the results with healthy controls.

METHODS:

Forty women (20 patients with rheumatoid arthritis and 20 healthy controls) performed a hand exercise programme. The results were evaluated after 6 and 12 weeks with hand force measurements (with a finger extension force measurement device (EX-it) and finger flexion force measurement with Grippit). Hand function was evaluated with the Grip Ability Test (GAT) and with patient relevant questionnaires (Disability of the Arm, Shoulder, and Hand (DASH) and Short Form-36). Ultrasound measurements were performed on m. extensor digitorum communis for analysis of the muscle response to the exercise programme.

RESULTS:

The extension and flexion force improved in both groups after 6 weeks (p < 0.01). Hand function (GAT) also improved in both groups (p < 0.01). The rheumatoid arthritis group showed improvement in the results of the DASH questionnaire (p < 0.05). The cross-sectional area of the extensor digitorum communis increased significantly in both groups measured with ultrasound.

CONCLUSION:

A significant improvement in hand force and hand function in patients with rheumatoid arthritis was seen after 6 weeks of hand training; the improvement was even more pronounced after 12 weeks. Hand exercise is thus an effective intervention for rheumatoid arthritis patients, leading to better strength and function.

Place, publisher, year, edition, pages
Basingstoke: Taylor & Francis, 2009
Keywords
Hand exercise therapy, Rheumatoid arthritis, Extension force, Muscle architecture, Ultrasound, Hand strength, DASH, SF-36
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-2626 (URN)10.2340/16501977-0334 (DOI)000266097400007 ()19363566 (PubMedID)2-s2.0-64349122505 (Scopus ID)2082/3028 (Local ID)2082/3028 (Archive number)2082/3028 (OAI)
Available from: 2009-06-24 Created: 2009-06-24 Last updated: 2018-03-23Bibliographically approved
Brorsson, S., Hilliges, M., Sollerman, C. & Nilsdotter, A. (2008). 6 weeks of hand exercise significantly improved the hand-strength and -function in Rheumatoid Arthritis patients. Paper presented at 22nd Scandinavian Hand Society Meeting in Helsinki, Finland, 3-5 September.
Open this publication in new window or tab >>6 weeks of hand exercise significantly improved the hand-strength and -function in Rheumatoid Arthritis patients
2008 (English)Conference paper, Published paper (Refereed)
National Category
Engineering and Technology
Identifiers
urn:nbn:se:hh:diva-5979 (URN)
Conference
22nd Scandinavian Hand Society Meeting in Helsinki, Finland, 3-5 September
Available from: 2010-09-23 Created: 2010-09-23 Last updated: 2018-03-23Bibliographically approved
Brorsson, S., Nilsdotter, A., Sollerman, C., Baerveldt, A.-J. & Hilliges, M. (2008). A new force measurement device for evaluating finger extension function in the healthy and rheumatoid arthritis hand. Technology and Health Care, 16(4), 283-292
Open this publication in new window or tab >>A new force measurement device for evaluating finger extension function in the healthy and rheumatoid arthritis hand
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2008 (English)In: Technology and Health Care, ISSN 0928-7329, E-ISSN 1878-7401, Vol. 16, no 4, p. 283-292Article in journal (Refereed) Published
Abstract [en]

Although often neglected, finger extension force is of great importance for developing grip strength. This paper describes the design and evaluation of a new finger extension force measurement device (EX-it) based on the biomechanics of the hand. Measurement accuracy and test-retest reliability were analysed. The device allows measurements on single fingers as well as all the fingers (excluding the thumb) of both healthy and deformed hands. The coefficient of variation in the device was 1.8% of the applied load, and the test-retest reliability showed a coefficient of variation no more than 7.1% for healthy subjects. This study also provides reference values for finger extension force in healthy subjects and patients with rheumatoid arthritis (RA). Significant differences were found in extension strength between healthy subject and RA patients (men, p < 0.05 and women, p < 0.001). EX-it provides objective and reliable data on the extension force capacity of normal and dysfunctional hands and can be used to evaluate the outcome of therapeutic interventions after hand trauma or disease

Place, publisher, year, edition, pages
Amsterdam: IOS Press, 2008
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-5970 (URN)18776605 (PubMedID)2-s2.0-52449125684 (Scopus ID)
Available from: 2010-09-23 Created: 2010-09-23 Last updated: 2018-03-23Bibliographically approved
Brorsson, S., Nilsdotter, A., Hilliges, M., Sollerman, C. & Aurell, Y. (2008). Ultrasound evaluation in combination with finger extension force measurements of the forearm musculus extensor digitorum communis in healthy subjects. BMC Medical Imaging, 8, Article ID 6.
Open this publication in new window or tab >>Ultrasound evaluation in combination with finger extension force measurements of the forearm musculus extensor digitorum communis in healthy subjects
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2008 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 8, article id 6Article in journal (Refereed) Published
Abstract [en]

Background:

The aim of this study was to evaluate the usefulness of an ultrasound-based method of examining extensor muscle architecture, especially the parameters important for force development. This paper presents the combination of two non-invasive methods for studying the extensor muscle architecture using ultrasound simultaneously with finger extension force measurements.

Methods:

M. extensor digitorum communis (EDC) was examined in 40 healthy subjects, 20 women and 20 men, aged 35-73 years. Ultrasound measurements were made in a relaxed position of the hand as well as in full contraction. Muscle cross-sectional area (CSA), pennation angle and contraction patterns were measured with ultrasound, and muscle volume and fascicle length were also estimated. Finger extension force was measured using a newly developed finger force measurement device.

Results:

The following muscle parameters were determined: CSA, circumference, thickness, pennation angles and changes in shape of the muscle CSA. The mean EDC volume in men was 28.3 cm3 and in women 16.6 cm3. The mean CSA was 2.54 cm2 for men and 1.84 cm2 for women. The mean pennation angle for men was 6.5° and for women 5.5°. The mean muscle thickness for men was 1.2 cm and for women 0.76 cm. The mean fascicle length for men was 7.3 cm and for women 5.0 cm. Significant differences were found between men and women regarding EDC volume (p < 0.001), CSA (p < 0.001), pennation angle (p < 0.05), muscle thickness (p < 0.001), fascicle length (p < 0.001) and finger force (p < 0.001). Changes in the shape of muscle architecture during contraction were more pronounced in men than women (p < 0.01). The mean finger extension force for men was 96.7 N and for women 39.6 N. Muscle parameters related to the extension force differed between men and women. For men the muscle volume and muscle CSA were related to extension force, while for women muscle thickness was related to the extension force.

Conclusion:

Ultrasound is a useful tool for studying muscle architectures in EDC. Muscle parameters of importance for force development were identified. Knowledge concerning the correlation between muscle dynamics and force is of importance for the development of new hand training programmes and rehabilitation after surgery.

© 2008 Brorsson et al; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London: BioMed Central, 2008
Keywords
adult, aged, arm muscle, article, controlled study, echography, extensor muscle, female, finger, human, human experiment, male, muscle contraction, muscle force, muscle mass, muscle strength, non invasive procedure, normal human, postoperative care, rehabilitation care, thickness, forearm, histology, middle aged, nonparametric test, physiology, skeletal muscle
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-1941 (URN)10.1186/1471-2342-8-6 (DOI)18312699 (PubMedID)2-s2.0-41149116277 (Scopus ID)2082/2336 (Local ID)2082/2336 (Archive number)2082/2336 (OAI)
Available from: 2008-09-22 Created: 2008-09-22 Last updated: 2018-03-23Bibliographically approved

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