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R.M. Tapia-Haro1, A. Casas-Barragán1, S. Toledano-Moreno1, M.C. García-Ríos1, A.M. Castro-Sánchez2, M.E. Aguilar-Ferrándiz1
1University of Granada, Department of Physical Therapy, Granada, Spain, 2University of Almeria, Department of Nursing, Physical Therapy and Medicine, Almería, Spain
Background: Raynaud's phenomenon (RP) is a complex of symptoms produced by a peripheral vascular disorder that induces an excessive paroxysmal spasm in response to stimuli such as exposure to cold or emotional stressors. RP usually affects the cutaneous microvasculature of fingers and toes. It is characterised by changes in skin colour, different levels of pain and functional impotence. It is classified into two main types, primary and secondary Raynaud's and disability occurs in both forms. However, to the best our knowledge, there are no studies that have previously assessed the possible relationship between levels of vascular damage and the degree of disability in people suffering from RP.
Purpose: To evaluate the vascular involvement, hand functionality and disability in the upper extremities in participants with RP and controls. Secondly, we attempt to compare the relationships between vascular variables, functionality variables and disability in participants with Primary and Secondary RP.
Methods: A total of 30 subjects were included in this observational case-control study. Firstly participants were asked for their sociodemographic and clinical data. Oxygen Saturation of both hands was measured with a finger pulse oximeter (MEGOS Oxi- Pulse®, SONMEDICA S.A, [Barcelona, Spain]). We used a Hadeco Bi-Directional Vascular Doppler® (Japan) to record the blood flow in the radial and ulnar artery. The range of motion in index finger and thumb was assessed with a stainless steel finger goniometer (SAHEAN®. Finally upper limb disability was measured with the Spanish version of the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH).
Results: Significant differences were found between groups for blood flow in the radial artery (p≤0.001); the three modules of Q-DASH (p≤0.001); for passive index finger extension (p≤0.03); active thumb flexion (p≤0.036) and active thumb extension (non-dominant side: p=0.002). The multivariate regression analysis showed that extension of the index finger was significantly associated with the dependents variables Q-DASH and Sports-Arts module, predicting respectively almost 55% and 27% of the total variance on upper limb disability in RP patients. In the work module, the oxygen saturation and extension of the index finger were significantly associated with the dependent variable, predicting almost 42% of the total variance.
Conclusion(s): Upper limb disability in RP participants limits the practice of activities of daily living, especially those with secondary RP. In addition, disability associated with Raynaud's phenomenon seems to be more related to the loss of the range of motion in the hand rather than abnormalities or involvement at the vascular level.
Implications: The results of this study provide a new perspective on the relationship between vascular abnormalities and disability of the upper limbs in RP. The measures described and used to assess these factors should incorporate in the evaluation of this condition to achieve a more effective diagnosis. Therefore, these findings may stimulate future research projects to obtain valuable information that can help improve the diagnosis and treatment of this pathology
Funding, acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Keywords: Raynaud Disease, Upper Extremity, Disability Evaluation
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: University of Granada
Committee: Bioethics Committee of the ( Spain)
Ethics number: nº:27/CEIH/2015
All authors, affiliations and abstracts have been published as submitted.
