gms | German Medical Science

Clinical issue/s: Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability.

Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments.

However, the degree to which this is the case has been incompletely explored.

Questions/purposes: The purpose of this study was to determine if disability (as measured by the Disabilities of the Arm, Shoulder and Hand [DASH] and the Michigan Hand Questionnaire [MHQ]) and pain intensity correlate with impairment (as measured by the American Medical Association [AMA] impairment guide). Secondary study questions addressed the effect of pain intensity and symptom of depression on predicting disability.

Innovative, analytical or new approach: Impairment and disability were evaluated in a sample of 107 hand-injured patients a mean of 11 months after injury. Impairment rating was performed prospectively.

From the patients who came for therapy, they were invited to fill out the questionnaire and evaluated for impairment rating. Response variables of DASH, MHQ, and visual analog scale pain intensity values were collected at the same setting. Other explanatory variables included demographic, injury-related, and psychological factors (symptoms of depression measured with the Beck Depression Inventory). Initial bivariate and multivariate analyses were performed to determine correlations of disability and pain to impairment rating and other exploratory variables.

Contribution to advancing HT practice: Decreasing impairment can be helpful in decreasing disability but not fully. Knowing the factors that can affect this relation can help us to use them in the therapeutic strategy.