Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia.
01 Jul 2009-American Journal of Occupational Therapy (American Occupational Therapy Association)-Vol. 63, Iss: 4, pp 506-510
TL;DR: The B&B Test is a reliable measure of upper-extremity function in fibromyalgia patients and is able to reveal a reduction in upper- extension function in these patients compared with both healthy control participants and normative scores.
Abstract: Objective The aim of this study was to determine the reliability of the Box and Block (B&B) Test of Manual Dexterity for upper-extremity function in patients with fibromyalgia and to compare their results with those of healthy control participants. Method We assessed reliability of the B&B Test within and between testers using the intraclass correlation coefficient (ICC). We compared fibromyalgia patient (n = 30) and control group (n = 30) scores using analysis of variance and population-based normative data. Results The B&B Test was reliable with ICCs of .90 to .85. Fibromyalgia patients' B&B Test scores were significantly lower (more impaired) than those of the control group and standardized norms. Conclusions The B&B Test is a reliable measure of upper-extremity function in fibromyalgia patients and is able to reveal a reduction in upper-extremity function in these patients compared with both healthy control participants and normative scores.
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TL;DR: This case study report demonstrates the use of motion analysis with a modification of the Box and Blocks test for cyclical motion within a motion capture laboratory to quantify quality of motion and compensatory movements of prosthetic users.
Abstract: This case study report demonstrates the use of motion analysis with a modification of the Box and Blocks test. The goal was to quantify observed improvements in compensatory movements and simultaneous control in a subject using different prostheses before and after targeted muscle reinnervation (TMR) surgery. This is a single case study with data collection using a body-powered prosthesis pre-TMR surgery and 6 mo postfitting with a TMR myoelectric prosthesis. The Box and Blocks test was modified for cyclical motion within a motion capture laboratory. With the TMR myoelectric prosthesis, the subject was able to simultaneously activate the hand and elbow. Task performance was slower, but there was improved elbow flexion and less trunk compensatory motion than with the body-powered prosthesis. There are several limitations to the case study because there is no direct comparison of myoelectric performance before and after TMR surgery; however, the current report presents a potential method to quantify quality of motion and compensatory movements of prosthetic users. With further study, this test procedure has the potential to be a useful outcome measure for future standardized assessments of upper-limb prosthetic function.
60 citations
Cites methods from "Reliability of the box and block te..."
...The test measures quantity of blocks moved in 1 minute, regardless of quality of movement, and is a widely used outcome measure of upper-limb function [6–8] that is commonly available in rehabilitation centers....
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TL;DR: The targeted BBT allows analysis of repetitive movements, and may more closely model common real-world object manipulation scenarios in which a user is required to control a movement from pick-up to release.
Abstract: Background
The Box and Block Test (BBT) is a functional outcome measure that is commonly used across multiple clinical populations due to its benefits of ease and speed of implementation; reliable, objective measurement; and repetition of motion. In this study, we introduce a novel outcome measure called the targeted BBT that allows for the study of initiation, grasping, and transport of objects, and also of object release. These modifications to the existing test may increase the ecological validity of the measure while still retaining the previously stated benefits of the standard BBT.
Methods
19 able-bodied subjects performed the targeted BBT and two other standard tests. Using an integrated movement analysis framework based on motion capture and ground force data, quantitative information about how subjects completed these tests were captured. Kinematic parameters at the wrist, elbow, shoulder, thorax, and head, as well as measures of postural control, were calculated and statistically compared across the three tests.
Results
In general, the targeted BBT required significantly higher RoM at the elbow, shoulder, thorax and head when compared to standard tests. Peak angles at these joints were also higher during performance of the targeted BBT. Peak angles and RoM values for the targeted BBT were close to those found in studies of movements of able-bodied individuals performing activities of daily living.
Conclusion
The targeted BBT allows analysis of repetitive movements, and may more closely model common real-world object manipulation scenarios in which a user is required to control a movement from pick-up to release.
59 citations
TL;DR: Taking together, musical sonification may be a promising therapy for motor impairments after stroke, but further research is required since estimated effect sizes point to moderate treatment outcomes.
Abstract: Gross-motor impairments are common after stroke, but efficient and motivating therapies for these impairments are scarce. We present an innovative musical sonification therapy especially designed to retrain patients' gross-motor functions. Sonification should motivate patients and provides additional sensory input informing about relative limb position. Twenty-five stroke patients were included in a clinical pre-post study and took part in the sonification training. The patients' upper extremity functions, their psychological states and their arm movement smoothness were assessed pre and post training. Patients were randomly assigned to either of two groups. Both groups received an average of ten days (M = 9.88; SD = 2.03; 30min/day) of musical sonification therapy (music group, MG) or a sham sonification movement training (control group, CG), respectively. The only difference between the two protocols was that in the CG no sound was played back during training. In the beginning, patients explored the acoustic effects of their arm movements in space. At the end of the training, the patients played simple melodies by coordinated arm movements. The 15 patients in the MG showed significantly reduced joint pain (F = 19.96, p < 0.001) in the Fugl-Meyer Assessment after training. They also reported a trend to have improved hand function in the Stroke Impact Scale as compared to the control group. Movement smoothness at day one, day five and the last day of the intervention was compared in MG patients and found to be significantly better after the therapy. Taken together, musical sonification may be a promising therapy for motor impairments after stroke but further research is required since estimated effect sizes point to moderate treatment outcomes.
53 citations
Cites methods from "Reliability of the box and block te..."
...(c) The box and block test (BBT) assesses unilateral gross manual dexterity (27, 28)....
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TL;DR: The consistency in nondisabled data suggests that normative kinematic trajectories can be defined for this task, and this motion capture procedure may add to the understanding of movement in upper-limb impairment and may be useful for measuring the effect of interventions to improve upper- Limb function.
Abstract: Motion analysis is an important tool for examining upper-limb function. Based on previous work demonstrating a modified Box and Blocks (BB) test with motion capture to assess prosthetic performance, we collected data in 16 nondisabled participants to establish normative kinematics for this test. Four motions of the modified BB test were analyzed to establish kinematic data for upper-limb and trunk motion. The test was repeated for right and left arms in standing and seated positions. Data were compared using a nonparametric Friedman test. No differences were found between right- and left-hand performance other than for task completion time. Small but significant differences were found for standing and seated performance, with slightly greater ranges in standing for axial trunk rotation, medial-lateral sternum displacement, and anterior-posterior hand displacement. The kinematic trajectories, however, were very consistent. The consistency in our nondisabled data suggests that normative kinematic trajectories can be defined for this task. This motion capture procedure may add to the understanding of movement in upper-limb impairment and may be useful for measuring the effect of interventions to improve upper-limb function.
39 citations
Cites background from "Reliability of the box and block te..."
...The BB test has strong clinical utility in the assessment of neurologic impairment [13], musculoskeletal impairment [14], and in the elderly [15]....
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TL;DR: A novel musical sonification therapy especially designed to retrain gross‐motor functions after stroke is presented and may be a promising therapy for impairments after stroke.
Abstract: Gross-motor impairments are common after stroke, but efficacious and motivating therapies for these impairments are scarce. We present a novel musical sonification therapy especially designed to retrain gross-motor functions. Four stroke patients were included in a clinical pre-post feasibility study and were trained with our sonification training. Patients' upper-extremity functions and their psychological states were assessed before and after training. The four patients were subdivided into two groups, with both groups receiving 9 days of musical sonification therapy (music group, MG) or a sham sonification training (control group, CG). The only difference between these training protocols was that, in the CG, no sound was played back. During the training the patients initially explored the acoustic effects of their arm movements, and at the end of the training the patients played simple melodies by moving their arms. The two patients in the MG improved in nearly all motor function tests after the training. They also reported in the stroke impact scale, which assesses well-being, memory, thinking, and social participation, to be less impaired by the stroke. The two patients in the CG did benefit less from the movement training. Taken together, musical sonification may be a promising therapy for impairments after stroke.
38 citations
References
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University of Kansas1, Wellesley College2, University of Illinois at Urbana–Champaign3, Oregon Health & Science University4, Boston University5, McMaster University6, University of Connecticut7, University of North Dakota8, Toronto Western Hospital9, University of Texas Health Science Center at San Antonio10
TL;DR: Criteria for the classification of fibromyalgia are widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites, and no exclusions are made for the presence of concomitant radiographic or laboratory abnormalities.
Abstract: To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
9,289 citations
"Reliability of the box and block te..." refers methods in this paper
...Patients attending the program had the diagnosis of FMS confirmed by a physician using the American College of Rheumatology 1990 criteria (Wolfe et al., 1990) before enrollment in the program....
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5,783 citations
"Reliability of the box and block te..." refers methods in this paper
...We calculated ICCs within examiner (ICC[2]) and between examiners (ICC[1]) for the 30 patients with FMS and the 30 control participants (Fleiss, 1981)....
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TL;DR: The purpose of this study was to develop normative data for adults to enable clinicians to objectively compare a patient's score to a normal population parameter.
Abstract: The Box and Block Test, a test of manual dexterity, has been used by occupational therapists and others to evaluate physically handicapped individuals. Because the test lacked normative data for adults, the results of the test have been interpreted subjectively. The purpose of this study was to develop normative data for adults. Test subjects were 628 Normal adults (310 males and 318 females) from the seven-county Milwaukee area. Data on males and females 20 to 94 years old were divided into 12 age groups. Means, standard deviations, standard error, and low and high scores are reported for each five-year age group. These data will enable clinicians to objectively compare a patient's score to a normal population parameter.
1,597 citations
"Reliability of the box and block te..." refers methods or result in this paper
...Finally, we compared both groups’ scores to normative data collected by Mathiowetz et al. (1985), using each participant’s average score....
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...Normative data for the B&B Test have been documented for adults on the basis of 628 people without disabilities between ages 20 and 70+ years (Mathiowetz et al., 1985)....
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...The B&B Test as described by Mathiowetz et al. (1985) was shown in our study to be reliable in both healthy control participants and FMS patients whether repeated by the same examiner or a different examiner, thus supporting its use in patients with FMS....
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...When compared with the normative values provided by Mathiowetz et al. (1985), the FMS patients’ average score was 3 standard deviations below and the control group’s average score was 1.9 standard deviations below the age-matched mean....
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TL;DR: The results show that the test-retest reliability is high and the validity of theBBT is shown by significant correlations between the BBT, an upper limb performance measurement and a functional independence measurement, which will help rehabilitation clinicians to differentiate better between real difficulties and those that may be attributed to normal aging.
419 citations
"Reliability of the box and block te..." refers background in this paper
...The authors of a study establishing reliability and validity of the B&B Test with elderly people underscored the importance of “measuring the reliability of an instrument with the targeted clientele” (Desrosiers et al., 1994, p. 754)....
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...Further validation of the test targeted more specific clients, including elderly adults (Desrosiers et al., 1994), patients with multiple sclerosis (Paltamaa et al., 2005), and patients with Charcot–Marie–Tooth disease (Svensson & Häger-Ross 2006)....
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TL;DR: Electromyographic measurements and interviews concerning muscular pain and disability were performed prospectively every 10th week on 30 healthy new female employees of a chocolate manufacturing plant to predict future patient status with trapezius myalgia.
Abstract: Electromyographic (EMG) measurements and interviews concerning muscular pain and disability were performed prospectively every 10th week on 30 healthy new female employees of a chocolate manufacturing plant. The static muscle activity and rate of short unconscious interruptions in EMG activity (EMG gaps) of the trapezius muscle during repetitive work tasks were evaluated as possible risk factors for patient status with trapezius myalgia. At the start of employment, the static and median contraction levels were significantly higher in future patients than in the rest of the subjects (nonpatients). In subsequent recordings these values were reduced to the level of the nonpatients. Throughout the study, the future patients had a lower frequency of EMG gaps than the nonpatients. A regression analysis showed a significant value for a low rate of EMG gaps to predict future patient status.
347 citations