Upper Extremity

From an orthopedic department 109 of 118 consecutive patients with upper extremity disorders who fulfilled the eligibility criteria (scheduled for elective surgery, 18 years or older, symptom duration of at least 2 months, able to answer questionnaires) responded to the Swedish version of the DASH before surgery and at the follow-up evaluation. The follow-up was done at 6 to 21 (mean 12) months after surgery.
Of the 109 responders, 105 had responded to at least 10 of the 11 items used in the QuickDASH and were included in the analysis. The mean age of the 105 participants was 52 (range 18–83) years; 60 (57%) were women and 45 were men.

All patients with T2DM were asked whether they had numbness, pain (prickling or stabbing, shooting, burning or aching pain), and paresthesia (abnormal cold or heat sensation, allodynia and hyperalgesia) in the toes, feet, legs or upper-limb. Then, an experienced physician performed the neurologic examination which included vibration, light touch, and achilles tendon reflexes on both sides in the knee standing position (as being either presence or weakening or loss). Vibration perception threshold (VPT) was assessed at the metatarsophalangeal joint dig I using a neurothesiometer (Bio- Thesiometer; Bio-Medical Instrument Co., Newbury, OH, USA). First, the patients were informed how to know the vibration sensation is felt by gradually turning the amplitude from zero to maximum, then the test began again from zero and they were asked to say the moment that they first felt it. Measurements were made on the planter aspect of the big toe bilaterally, three times consecutively for each big toe. The median of three readings is accepted as the VPT value of that measurement (35 (link)). Sensitivity to touch was also tested using a 5.07/10-g Semmes-Weinstein monofilament (SWM) at four points on each foot: three on the plantar and one on the dorsal side. The 10-g SWM was placed perpendicular to the skin and pressure was applied until the filament just buckled with a contact time of 2 s. Inability to perceive the sensation at any one site was considered abnormal (36 (link), 37 (link)). DPN was defined as VPT ≥25 V and/or inability to feel the monofilament (35 (link)), and then participants were divided into DPN group and no DPN group.
Ankle brachial index (ABI) was measured noninvasively by a continuous-wave Doppler ultrasound probe (Vista AVS, Summit Co., USA) with participants in the supine position after at least 5 min of rest. Leg-specific ABI was calculated by dividing the higher SBP in the posterior tibial or dorsalis pedis by the higher of the right or left brachial SBP (33 (link), 38 (link)). Patients were diagnosed as having PAD if an ABI value <0.9 on either limb (33 (link), 38 (link)).
DFU was defined as ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection (39 (link)).

Prior to clinician assessment and cohort assignment, all eligible and consenting patients were asked to complete the EQ-5D-5L [23 (link)], which assesses problems in 5-dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) that can be used to calculate a utility score, which ranges from 0 (health state equivalent to death) to 1 (perfect health). The EQ-5D-5L also includes a visual analog scale (VAS) that measures current health state, which ranges from 0 to 100 (best possible health). Patients were also asked to complete the SDS [24 (link)], which assesses disruption in 3 social functioning domains (work/school, social life, family life/home responsibilities) and includes a total score (sum of domain scores) which ranges from 0 (no disruption) to 30 (extreme disruption).
For severity of possible TD, clinicians and patients were asked to “rate the severity of visible, uncontrollable movements” for each of 4 body regions (head/face, neck/trunk, upper extremities, and/or lower extremities) using simple descriptors of “none”, “some”, or “a lot”. For impact of possible TD, patients who were aware of their abnormal involuntary movements (Cohort 2A) were asked to rate how much “over the past 4 weeks” did these movements “impact your ability” to perform each of 7 different activities/functions (usual activities, talking, eating, breathing, being productive, self-care, socializing), also using the descriptors of “none”, “some”, or “a lot”. For regression analyses, these descriptors were assigned values of 0, 1, and 2, respectively, with the summary score for severity ranging from 0 (“none” in all 4 regions) to 8 (“a lot” in all 4 regions) and the summary score for impact ranging from 0 (“none” in all 7 activities) to 14 (“a lot” in all 7 activities).