Analyze and evaluate the impact of public policy on economic growth from an ethical and global position. Be sure to be specific as to which ethical posture you are taking. See this website for information on ethical postures.
http://www.philosophybasics.com/branch_ethics.html
12 point, time new roman, not a paper, two paragraphs,
Edition: 1, Section: NEWS--NATIONAL, pg. 8
Business leaders are warning that the Government's decision to not class farms as high risk sectors could lead to complacency among farmers about safety.
The Government has revealed what it defined as "high risk sectors" as those which had seen 25 fatalities for every 100,000 workers since 2008.
It also included industries with 25 serious injuries per 1000 workers or where there was a risk of a catastrophic event causing multiple deaths.
Industries which are deemed "high risk" will have to have health and safety representatives even where there are fewer than 20 workers, while those which escape the definition will not.
The definition means most farms will not be defined as high-risk, soavoiding the requirement to have such a representative.
Information from Workplace Relations Minister Michael Woodhouse shows sheep, beef and grain farming has a fatality rate of 12 per 100,000 workers while dairy is 16 fatalities per 100,000.
The Business Leaders' Health and Safety Forum immediately branded the decision as disappointing, and would send the "wrong message" to the industry.
"It sends a signal that everything is okay in the farming sector - and that the industry can continue on with business as usual.
"That's just not true. Farming is a dangerous industry to work in and the industry needs to own that problem and change its practices," Francois Barton, the forum's executive director, said.
Barton said the definition excluded farms from only the requirements around representation, and they would still be required to comply with other requirements.
"However, telling farmers they work in a low-risk industry can only undermine the agricultural sector's motivation to change in response to the new law.
"We risk facing a situation where other high-risk industries, like forestry and construction, are taking ownership and making improvements and farming gets left behind.
As the Health and Safety Reform Bill entered the committee stage in Parliament yesterday, Woodhouse released a list of 57 industries of workplaces which will require health and safety representatives where there are fewer than 20 workers.
How farms would be treated under the new legislation has been a major point of contention, with reports of a threat of backlash among National's backbench MPs.
Worksafe New Zealand says there have been 108 fatalities in agriculture since the start of 2010, including 12 so far in 2015.
Quad bike deaths account for just under a quarter of the fatalities over this period.
Woodhouse acknowledged that the rules meant that the "majority" of farms would not require health and safety repres.
Analyze and evaluate the impact of public policy on economic growt.docx
1. Analyze and evaluate the impact of public policy on economic
growth from an ethical and global position. Be sure to be
specific as to which ethical posture you are taking. See this
website for information on ethical postures.
http://www.philosophybasics.com/branch_ethics.html
12 point, time new roman, not a paper, two paragraphs,
Edition: 1, Section: NEWS--NATIONAL, pg. 8
Business leaders are warning that the Government's decision to
not class farms as high risk sectors could lead to complacency
among farmers about safety.
The Government has revealed what it defined as "high risk
sectors" as those which had seen 25 fatalities for every 100,000
workers since 2008.
It also included industries with 25 serious injuries per 1000
workers or where there was a risk of a catastrophic event
causing multiple deaths.
Industries which are deemed "high risk" will have to have
health and safety representatives even where there are fewer
than 20 workers, while those which escape the definition will
not.
The definition means most farms will not be defined as high-
risk, soavoiding the requirement to have such a representative.
Information from Workplace Relations Minister Michael
Woodhouse shows sheep, beef and grain farming has a fatality
rate of 12 per 100,000 workers while dairy is 16 fatalities per
100,000.
The Business Leaders' Health and Safety Forum immediately
branded the decision as disappointing, and would send the
"wrong message" to the industry.
"It sends a signal that everything is okay in the farming sector -
and that the industry can continue on with business as usual.
2. "That's just not true. Farming is a dangerous industry to work in
and the industry needs to own that problem and change its
practices," Francois Barton, the forum's executive director, said.
Barton said the definition excluded farms from only the
requirements around representation, and they would still be
required to comply with other requirements.
"However, telling farmers they work in a low-risk industry can
only undermine the agricultural sector's motivation to change in
response to the new law.
"We risk facing a situation where other high-risk industries, like
forestry and construction, are taking ownership and making
improvements and farming gets left behind.
As the Health and Safety Reform Bill entered the committee
stage in Parliament yesterday, Woodhouse released a list of 57
industries of workplaces which will require health and safety
representatives where there are fewer than 20 workers.
How farms would be treated under the new legislation has been
a major point of contention, with reports of a threat of backlash
among National's backbench MPs.
Worksafe New Zealand says there have been 108 fatalities in
agriculture since the start of 2010, including 12 so far in 2015.
Quad bike deaths account for just under a quarter of the
fatalities over this period.
Woodhouse acknowledged that the rules meant that the
"majority" of farms would not require health and safety
representatives, but employers will still be required to involve
their staff in workplace safety decisions.
Labour leader Andrew Little said that one of New Zealand's
most dangerous industries had been excluded from
representation as a result of political dealmaking.
"I think it is totally wrong for an industry that has had more
fatalities than most and for a group, namely farmers, who say
they know how to do it but clearly don't," Little said.
"What you need is good law, good enforcement, and that's now
been denied to an industry that's killing far too many of their
own." Primary Industries Minister Nathan Guy said he was
4. Mathew et al. utilize a case series to assess
the hazards of assistive technology (AT) in the
causation of secondary injuries to farmers with
existing handicaps and disabilities. It is well-
known how innovative and technically skilled
farmers are, but it is still remarkable to consider
the ingenuity in self-design of AT applied to
maintain the ability to farm. This study applies
qualitative methods to assess designs and work
practices in situations that have not had system-
atic assessments of associated hazards.
Two of the papers assess how the
North American Guidelines for Children’s
Agricultural Tasks (NAGCAT) can be applied to
situations where they are not routinely utilized.
Asti et al. have identified that the NAGCAT are
often not applied to work practices around large
animals and that further refinement of the guide-
lines are recommended in order to improve their
effectiveness in these situations. Gundacker and
Gundacker make a case that the NAGCAT are
appropriate to many common agricultural tasks
in the Jalisco region (an important agricultural
region in Mexico), but cultural modification
including translation into Spanish and addition
of work practices applicable for exposures
unique to that area are necessary.
Marcum et al. identify factors associated with
hours farming in a study of Kentucky and South
Carolina farmers over 50 years of age. It is
informative to see that chronic illnesses in their
study population seemed to have only a minor
impact. I would have expected that this would
5. be a factor associated with early retirement from
farming. Adesiyun et al. report on two epi-
demiological surveys of infectious disease that
can be acquired in farm populations, specifi-
cally brucellosis, toxoplasmosis, leptospirosis,
and hantavirus. There did not appear to be any
identifiable risk factors unique to agricultural
workers, but the surveys did show that evi-
dence of infection was observed in agricultural
workers. Further assessment of risk factors and
heightened awareness on the part of health care
workers in Trinidad and Tobago for these ill-
nesses in agricultural workers is recommended
by the authors.
Lee and Hair report on the 2011 Agricultural
Safety and Health Council of America
(ASHCA) national workshop. The report
highlights ongoing efforts by agricultural pro-
ducers to begin the process of taking the lead in
developing agriculture as a safe and desirable
industry/vocation to work in.
I would also like to encourage the read-
ership of the Journal of Agromedicine, as
well as agricultural commodity organizations
and agricultural-associated industries, to do
what they can to promote ongoing support for
161
162 EDITOR’S COMMENTS
agricultural safety and health initiatives by the
6. US federal government. There is a risk that fund-
ing for agricultural safety and health research,
education and outreach programs will be elim-
inated entirely or severely decreased from the
2012 budget. Initially, funding for the National
Institute for Occupational Safety and Health
(NIOSH) Agriculture, Forestry, and Fishing pro-
gram – which includes the present eight NIOSH
Centers for Agricultural Disease and Injury
Research, Education, and Prevention distributed
strategically across the nation – was to be elim-
inated from the 2011 budget. This funding cut
also proposed eliminating the entire budget for
the NIOSH Education and Research Centers,
which are critical in training agricultural and
occupational health and safety professionals. It
was reinstated, but it is uncertain whether it will
survive the 2012 budget negotiations. There is
very little state financial support of such pro-
grams, and the state budgets projected for the
future will not allow making up the loss of
federal funds. As a result, there would be elim-
ination or severe curtailment of the programs
intended to reduce and ultimately eliminate
unnecessary death and disability resulting from
agricultural production work practices.
The agricultural safety and health initiatives,
as well as training for safety and health
professionals critical in providing ongoing
research, education, and outreach, are necessary
to continue the work that has led to a decrease
in serious injuries and fatalities in the agricul-
tural sector. While there have been laudable
positive effects from these efforts, agriculture
7. continues to be a very hazardous occupation
with much more to accomplish. It would be
a shame to halt the progress and watch mor-
tality and morbidity rates in adults and chil-
dren working in agriculture start an upward
trend. There is not an adequate safety net for
those who are directly involved in producing
our nation’s food, and who are an essential
component of a critical industry necessary for
our basic survival. In this time of diminishing
access to health care services in rural areas, cut-
ting funding for preventive services sends the
entirely wrong message for those engaged in
hazardous activities so that we can have food
on our plates. I applaud ASHCA for taking
proactive steps to improve their own indus-
try, but their efforts should complement NIOSH
programs, not replace these critical programs.
Ongoing reinforcement of preventive strategies,
and improvement in behavioral and engineering
strategies to improve the agricultural work place
and work practices, continues to be needed.
Steven R. Kirkhorn, MD, MPH, FACOEM
Editor-in-Chief, Journal of Agromedicine
Copyright of Journal of Agromedicine is the property of Taylor
& Francis Ltd and its content may not be copied
or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission.
However, users may print, download, or email articles for
individual use.
8. Journal of Back and Musculoskeletal Rehabilitation 26 (2013)
467–473 467
DOI 10.3233/BMR-130408
IOS Press
Michigan Hand Outcomes Questionnaire in
rheumatoid arthritis patients: Relationship
with disease activity, quality of life, and
handgrip strength
Dilek Durmus∗ , Bora Uzuner, Yunus Durmaz, Ayhan Bilgici
and Omer Kuru
Department of Physical Medicine and Rehabilitation, Medical
Faculty, Ondokuz Mayis University, Samsun, Turkey
Abstract.
BACKGROUND AND OBJECTIVES: The aim of this study was
to investigate the clinical relevance of Michigan Hand
Outcomes Questionnaire (MHQ) in patients with rheumatoid
arthritis (RA) and to evaluate the relationship between MHQ
and
disease activity, quality of life (QL), and handgrip strength
separately.
MATERIAL AND METHOD: Eighty RA were included in the
study. Disease activity is evaluated with Disease Activity
Score 28 (DAS28), pain is evaluated with Visual Analog Scale
(VAS). The Disabilities of Arm, Shoulder and Hand (DASH),
MHQ, Short-Form 36 (SF-36), and Health Assessment
Questionnaire (HAQ), Arthritis Impact Measurement Scales-
hand and
finger function scale-2 (AIMS-2) were completed by all
patients. Hand muscle strength (HMS) was measured with a
9. hand-held
dynamometer.
RESULTS: The MHQ moderately correlated with DAS28. When
the patients were grouped according to three disease activity
measurements, DASH scores were significantly higher with
higher disease activity and MHQ scores were significantly
lower with
higher disease activity. A high correlation was found between
MHQ total and HAQ, AIMS-2. The SF-36 scores were
correlated
with MHQ scores.
CONCLUSIONS: The MHQ scores correlate with disease
activity indices, functional disability, QL and DASH. The
clinical
relevance of MHQ, like DASH, is high and both questionnaires
can be used effectively.
Keywords: Rheumatoid Arthritis, MHQ, DASH, SF-36, HAQ,
disease activity
1. Introduction
Rheumatoid arthritis (RA) is a chronic, generally
progressive auto-immune disease that causes func-
tional disability, pain, and joint destruction. Hand de-
formity and dysfunction are common in patients with
RA and is a major factor on quality of life (QL). It
is estimated that the hands and wrists are affected in
∗ Address for correspondence: Dilek Durmus, Department of
Physical Medicine and Rehabilitation, Medical Faculty,
Ondokuz
Mayis University, Samsun, Turkey. Tel.: +90 362 312 19 19
3091;
Fax: +90 362 4576041; E-mail: [email protected]
80% to 90% of the patients with RA. Up to 30% of pa-
11. tion in daily life activities. Although the HAQ in-
cludes items dealing with upper limb activities, it was
not originally designed to assess the upper extrem-
ity [2,8,9]. But the AIMS-2 includes items dealing with
hand-specific functions. Various questionnaires have
been used for evaluation of RA, Carpal Tunnel Syn-
drome (CTS) and hand-specific disorders. One of them
is ‘Disabilities of Arm Shoulder and Hand (DASH)
Questionnaire’. The DASH is a standardized patient-
based outcome measure that assesses impairments and
activity limitations of the upper extremity [2]. Michi-
gan Hand Outcomes Questionnaire (MHQ) has been
developed to measure physical function and symptoms
in patients with hand-specific disorders [10]. It has
some certain advantages over the other tools. It as-
sesses both hands separately, and includes a subgroup
about patient satisfaction. The six subgroups of MHQ
are; aesthetics, pain control, work performance, over-
all hand function, satisfaction with hand functions and
activity of living. It takes 15 minutes to complete and
it has been shown reliable and valid in CTS, RA, and
many other types of hand disorders [2,10–14].
The objective of this study is to determine the clin-
ical relevance of MHQ in RA patients and to evalu-
ate the relationship between MHQ and disease activ-
ity, QL, handgrip strength, and DASH scores in these
patients.
2. Materials and methods
The study was conducted at the Department of Phys-
ical Medicine and Rehabilitation and Rheumatology in
Medical Faculty of “Ondokuz Mayis University”. The
patients were informed about the purpose of the study
and gave their consent local ethics committee approved
12. the study protocol. Eighty patients with RA, who had
been diagnosed as RA according to American College
of Rheumatology (ACR) [15] criteria, were enrolled
in the study. The diagnosis of RA was made by the
physical therapy specialists, based on the character-
istic symptoms, physical examination and laboratory
measurements. All patients were assessed by the same
physician.
Patients with thyroid disease, neurologic disease, di-
abetes mellitus, CTS, hand osteoarthritis, radiculopa-
thy of cervical spine, pregnancy, inability to com-
plete questionnaire due to cognitive impairment, hand
surgery within previous 3 months and, unable to read
or write were excluded from the study.
2.1. Disease activity
Disease activity was evaluated by Disease Activ-
ity Score 28 (DAS28). The DAS28 considers 28 ten-
der and swollen joint counts, general health (GH: pa-
tient assessment of disease activity using 10-cm vi-
sual analog scale; 0 = best, 10 = worst) and an acute
phase reactant [16]. We used erythrocyte sedimenta-
tion rate (ESR) to calculate DAS28. A simple summa-
tion is taken for the number of swollen joints, num-
ber of tender joints, patient’s global disease activity
(VAS in cm). An additional value for C-reactive pro-
tein (CRP) (mg/dl) is included. DAS-28 scores that are
greater than 5.1 imply high disease activity and scores
below 3.2 low disease activity.
2.2. Measurement of pain severity
Patients were asked to point about intensity of the
13. pain at resting and during activity on a 10-cm visual
analogue scale (VAS) indicating ‘0’ is no pain and ‘10’
is very severe pain.
2.3. Disability
Disability was measured using the Turkish validated
HAQ [17]. The HAQ is an easily administered self-
questionnaire comprising eight categories of function-
ing: dressing, rising, eating, walking, hygiene, reach,
grip, and usual activities [8,9].
2.4. Quality of life
Quality of life was assessed with Short Form 36
(SF-36). The SF-36 is a widely applied generic in-
strument for measuring health status and consists of
eight dimensions: physical functioning, social func-
tioning, physical role, emotional role, mental health,
vitality, bodily pain and general health perceptions.
D. Durmus et al. / Michigan Hand Outcomes Questionnaire in
RA patients 469
Scores range from 0 (worst) to 100 (best) with higher
scores indicating better health status [18]. The validity
and reliability study of the Turkish version of SF-36
was completed on patients with a chronic disease and
the test-retest reliability and internal consistency were
0.94 and 0.92, respectively [19].
2.5. Hand and finger functioning scale of the arthritis
impact measurement scales-2
14. The arthritis impact measurement scales-2 (AIMS-
2) is a questionnaire specifically designed to assess
health status in subjects with RA [20]. It consists of 12
domains, of which for this study only the “hand and
finger function” domain was used. This domain con-
sists of 5 questions, with the final score ranging from 0
to 10, with higher scores indicating worse hand func-
tion [21].
2.6. Handgrip strength
Handgrip strength was measured using a hand-
held dynamometer (Jamar) following published pro-
cedures [22]. For performing the test, subjects were
seated on a high plinth without supporting the fore-
arms. The shoulder was kept in adduction and neutral
rotation; elbow flexed at 90◦ forearm in neutral posi-
tion. The grip bar was adjusted to fit comfortably in
the subjects’ hand with the middle phalanges under the
grip handle. Subjects were requested to squeeze as hard
as they could while exhaling. Each hand was tested,
alternating back and forth for three trials. The highest
force production (in kilograms) for each hand then was
totaled for the dependent variable.
2.7. Questionnaires
2.7.1. DASH
The DASH is a 30-item questionnaire used to mea-
sure disability for any disorder affecting the upper ex-
tremity by assessing severity of symptoms and diffi-
culty in completing specific tasks [23]. It’s validity, re-
liability, and responsiveness have been shown for a va-
riety of upper extremity conditions [24,25]. The ques-
tionnaire includes a 30-item disability/symptom scale:
15. function (21 items), symptom severity (six items), and
psychological factors (three items); and two optional
scales: work (four items) and sports/performing arts
(four items). The score, which does not distinguish be-
tween the right and left extremities, is transformed to a
scale of 0 to 100, where a higher score indicates more
severe disability [23].
Table 1
Demographic data and the mean MHQ, DASH, DAS28, HAQ,
AIMS-2, VAS-pain, and SF-36 subscale scores
Mean ± Standard deviation
Age (years) 45.07 ± 14.15
Disease duration (years) 8.46 ± 5.68
ESR (mm/h) 27.67 ± 20.99
C-RP (mg/lt) 12.07 ± 11.26
VAS activity pain (cm) 4.20 ± 2.79
VAS rest pain(cm) 3.06 ± 2.60
DAS 28 3.74 ± 1.36
HAQ 0.81 ± 0.60
AIMS-2 3.44 ± 2.76
DASH total scores 36.43 ± 23.55
MHQ total scores 59.85 ± 13.77
Deformity (n)
Yes 22
No 58
SF-36 subgroups
Physical function 54.91 ± 28.76
Physical role limitation 35.31 ± 41.08
Pain 52.97 ± 25.40
General health 46.19 ± 21.82
Energy 52.94 ± 21.92
Social function 64.26 ± 24.33
16. Emotional role limitation 35.86 ± 41.73
Mental health 55.29 ± 20.76
Job (n)(%)
Housewife 56 (70.0)
Retired 10 (12.5)
Worker 14 (17.5)
Sex (n) (%)
Female 62 (77.5)
Male 18 (22.5)
ESR: Erythrocyte sedimentation rate, C-RP: C-reactive protein,
VAS: Visual analog scale, HAQ: Health Assessment Question-
naire, DAS 28: Disease Activity Score, DASH: Disabilities of
Arm,
Schoulder and Hand, MHQ: Michigan Hand Outcomes Question-
naire, SF-36: Short-form 36, AIMS-2: Arthritis Impact
Measure-
ment Scales.
2.7.2. MHQ
Consisting of 57 items, MHQ distinguishes between
the left and right hands over six domains including
overall hand function, activities of daily living, pain,
work performance, aesthetics, and patient satisfaction
with function [10]. Each domain is scored using the
unweighted method, by adding the responses (rang-
ing from 1 to 5) in each scale, and normalizing the
scores to a scale from 0 to 100 where a lower score
shows worsening severity of disability except for the
pain subgroup where higher score indicates worsening
severity of the pain. MHQ average final scores are cal-
culated by adding 6 subgroups findings and dividing
them by six after reversing the pain score. The overall
17. symptom severity score is calculated as the mean of the
scores [10,12,13].
470 D. Durmus et al. / Michigan Hand Outcomes Questionnaire
in RA patients
Table 2
Correlation of MHQ and DASH and disease activity scores
Factores DASH MHQ MHQ Activity MHQ overall MHQ MHQ
work MHQ Satisfaction MHQ
total total of living hand function pain performance with hand
function aesthetics
ESR (mm/h) r 0.281∗ −0.211 0.231∗ −0.172 0.136 −0.027
−0.273∗ −0.113
p 0.012 0.060 0.039 0.127 0.228 0.813 0.014 0.317
C−RP (mg/lt) r 0.188 −0.235∗ 0.211 −0.064 0.055 −0.109
−0.190 −0.014
p 0.095 0.036 0.061 0.573 0.625 0.337 0.091 0.904
VAS activity pain(cm) r 0.603∗ ∗ −0.564∗ ∗ 0.543∗ ∗
−0.440∗ ∗ 0.582∗ ∗ −0.474∗ ∗ −0.634∗ ∗ −0.298∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.007
VAS rest pain (cm) r 0.617∗ ∗ −0.566∗ ∗ 0.538∗ ∗ −0.457∗ ∗
0.505∗ ∗ −0.452∗ ∗ −0.599∗ ∗ −0.260∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.020
Patient’s global VAS r 0.592∗ ∗ −0.568∗ ∗ 0.495∗ ∗
−0.509∗ ∗ 0.485∗ ∗ −0.422∗ ∗ −0.661∗ ∗ −0.321∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.004
18. Swollen joint count r 0.380∗ −0.537∗ 0.466∗ ∗ −0.373∗
0.344∗ −0.270∗ −0.419∗ −0.361∗
p 0.01 0.0001 0.0001 0.001 0.002 0.016 0.0001 0.001
Tender joint count r 0.578∗ ∗ −0.610∗ ∗ 0.608∗ ∗ −0.578∗ ∗
0.576∗ ∗ −0.402∗ ∗ −0.653∗ ∗ −0.383∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.001
DAS 28 r 0.618∗ ∗ −0.615∗ ∗ 0.607∗ ∗ −0.511∗ ∗ 0.509∗ ∗
−0.332∗ −0.682∗ ∗ −0.363∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.003 0.0001 0.001
∗ p < 0.05 significant, ∗ ∗ p < 0.001 high significant. ESR:
Erythrocyte sedimentation rate, C-RP: C-reactive protein, VAS:
Visual analog scale,
HAQ: Health Assessment Questionnaire, DAS 28: Disease
Activity Score, DASH: Disabilities of Arm, Schoulder and
Hand, MHQ: Michigan
Hand Outcomes Questionnaire.
Table 3
MHQ and DASH values based on DAS28 scores in RA patients
DASHtotal MHQtotal
Low DAS 28 (< 3.2) 17.22 ± 16.33 (n = 27) 69.39 ± 10.11 (n =
27)
Moderate DAS 28 (= and > 3.2, < and = 5.1) 43.54 ± 19.02 (n =
40) 58.08 ± 11.64 (n = 40)
High DAS 28 (= and > 5.1) 54.48 ± 23.36 (n = 13) 45.52 ±
12.23 (n = 13)
DAS 28: Disease Activity Score, DASH: Disabilities of Arm,
Schoulder and Hand, MHQ: Michigan Hand Outcomes
Questionnaire.
2.8. Statistical analysis
19. Statistical analyses were performed with SPSS 13.0
for Windows. Descriptive data were presented as mean
± standard deviation (SD). Statistical values were ob-
tained with Pearson chi-square and t test. The Pearson
correlation test was used to find r values and compare
the change of parameters different tests. A p value less
than 0.05 was considered as statistically significant.
3. Results
Eighty consecutive patients with RA (62 Female,
18 Male; mean age: 45.07 [± 14.15] years) were in-
cluded in study.
Demographic data including age, sex, job, duration
of symptoms and the mean MHQ total score, DASH
total score, DAS28, AIMS-2, HAQ, VAS-pain, and SF-
36 subscale scores are shown in Table 1.
The Pearson correlation coefficients of the DAS28,
and components of these activity measurements to the
MHQ and DASH questionnaires are shown in Table 2.
The DASH and the MHQ total scores were mod-
erately correlated with DAS28 (respectively, r =
0.618, r = −0.615) (Table 2). The number of ten-
der joints (r = −0.610), the number of swollen
joints (r = −0.537) and patient’s global VAS (r =
−0.568) showed moderate correlation, but the ESR
(r = −0.211), and CRP (r = −0.235) showed weak
correlation with MHQ total (Table 2).
When patients were grouped according to the activ-
ity based on the three measurements of disease activ-
ity, DASH scores were significantly higher with higher
20. disease activity and MHQ scores were significantly
lower with higher disease activity (p < 0.001) (Ta-
ble 3).
The highest correlation in this study was between
DASH total score and MHQ total score (r = −0.834)
(Table 4). The MHQ total, and the MHQ subgroups
(activity living, overall hand function, pain, satisfac-
tion with hand function) were moderately correlated
with handgrip strength. The MHQ aesthetics and the
MHQ work performance were weakly correlated with
handgrip strength. Correlations of MHQ total, MHQ
D. Durmus et al. / Michigan Hand Outcomes Questionnaire in
RA patients 471
Table 4
Correlation of MHQ and DASH questionnaire to HAQ, AIMS-2,
SF-36 subscales, and handgrip strength
Factores DASH MHQ MHQ Activity MHQ overall MHQ MHQ
work MHQ Satisfaction MHQ
total total of living hand function pain performance with hand
function aesthetics
DASH total r −0.742∗ ∗ −0.834∗ −0.731∗ ∗ 0.692∗ ∗
−0.429∗ ∗ −0.729∗ ∗ −0.471∗ ∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001
HAQ r 0.844∗ ∗ −0.732∗ ∗ −0.761∗ ∗ −0.622∗ ∗ 0.652∗ ∗
−0.418∗ ∗ −0.703∗ ∗ −0.493∗ ∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001
AIMS−2 r 0.688∗ ∗ −0.635∗ ∗ −0.498∗ ∗ −0.403∗ 0.600∗ ∗
21. −0.427∗ ∗ −0.515∗ ∗ −0.374∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.001
Handgrip strength r −0.492∗ ∗ 0.526∗ ∗ 0.487∗ ∗ 0.448∗ ∗
−0.320∗ ∗ 0.207 0.553∗ ∗ 0.346∗
(right hand)(kg) p 0.0001 0.0001 0.0001 0.0001 0.004 0.066
0.0001 0.002
Handgrip strength r −0.412∗ ∗ 0.573∗ ∗ 0.517∗ ∗ 0.309∗
−0.307∗ ∗ 0.257∗ 0.425∗ ∗ 0.280∗
(left hand)(kg) p 0.0001 0.0001 0.0001 0.005 0.006 0.022
0.0001 0.012
SF−36 subscales
Physical function r −0.580∗ ∗ 0.520∗ ∗ 0.617∗ ∗ 0.371∗ ∗
−0.560∗ ∗ 0.348∗ 0.519∗ ∗ 0.398∗
p 0.0001 0.0001 0.0001 0.001 0.0001 0.002 0.0001 0.001
Social function r −0.549∗ ∗ 0.470∗ ∗ 0.477∗ ∗ 0.366∗ ∗
−0.377∗ ∗ 0.244∗ 0.514∗ ∗ 0.351∗
p 0.0001 0.0001 0.0001 0.001 0.001 0.030 0.0001 0.001
Physical role limitation r −0.502∗ ∗ 0.396∗ ∗ 0.427∗ ∗
0.493∗ ∗ −0.463∗ ∗ 0.364∗ ∗ 0.508∗ ∗ 0.216
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.001 0.0001 0.054
Emotional role limitation r −0.406∗ 0.254∗ 0.310∗ 0.283∗
−0.325∗ 0.185 0.420∗ 0.252∗
p 0.0001 0.023 0.005 0.011 0.003 0.101 0.0001 0.024
Pain r −0.678∗ ∗ 0.477∗ ∗ 0.593∗ ∗ 0.423∗ ∗ −0.550∗ ∗
0.344∗ 0.533∗ ∗ 0.268∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.002 0.0001 0.016
General health r −0.623∗ ∗ 0.466∗ ∗ 0.476∗ ∗ 0.660∗ ∗
22. −0.530∗ ∗ 0.320∗ 0.579∗ ∗ 0.412∗ ∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.004 0.0001 0.0001
Energy r −0.538∗ ∗ 0.456∗ ∗ 0.456∗ ∗ 0.454∗ ∗ −0.412∗ ∗
0.267∗ 0.498∗ ∗ 0.373∗
p 0.0001 0.0001 0.0001 0.0001 0.0001 0.017 0.0001 0.001
Mental health r −0.468∗ ∗ 0.299∗ 0.287∗ 0.415∗ −0.324∗
0.139 0.370∗ 0.296∗
p 0.0001 0.007 0.010 0.007 0.003 0.218 0.001 0.008
∗ p < 0.05 significant, ∗ ∗ p < 0.001 high significant. HAQ:
Health Assessment Questionnaire, DAS 28: Disease Activity
Score, DASH: Disabili-
ties of Arm, Schoulder and Hand, MHQ: Michigan Hand
Outcomes Questionnaire, OHF: Overall hand function, ADL:
Activities of daily living,
SHF: Satisfaction with hand function. SF-36: Short-form 36,
AIMS-2: Arthritis Impact Measurement Scales.
subgroups and DASH questionnaire to HAQ, AIMS-
2, SF-36 subscales, and handgrip strength are shown
Table 4.
4. Discussion
The most frequently involved joints in RA are hand
and wrist joints. Structural damage in these joints dur-
ing disease course can lead to deteriorations in hand
functions [26]. Hand therapists and hand surgeons are
increasingly interested in the problems that patients ex-
perience in performing daily activities [12]. Tradition-
ally, outcomes in hand disorders are based on objec-
tive measures, such as grip strength and range of mo-
tion. Although these variables are useful in assessing
physical changes in the hand, they do not measure out-
23. comes that directly affect patients’ daily lives [27]. For
this purpose the DASH and MHQ are used as objective
measures. As a result we found correlations between
MHQ and disease activity, QL, handgrip strength, and
DASH scores in RA patients.
Waljee et al. [28] evaluated hand measure outcome
of 128 RA patients with severe subluxation of the
metacarpophalangeal joints with MHQ, and they re-
ported that the questionnaire is a favorable instrument
for the assessment of rheumatoid hand disorders. In
this study by Waljee et al. [28], a high correlation, was
obtained between MHQ scores and AIMS-2. Similar
to this study, Van der Giesen et al. [14] found signifi-
cant correlation between MHQ scores and AIMS-2. In
another study by Chung et al. [10], high correlations
were shown between MHQ scores and SF-36 scores
in RA patients. Similar to these studies, we showed
significant correlation between MHQ scores and hand
scores of the AIMS-2 and between MHQ scores and
subgroups of SF-36. In the literature, there are limited
data about the correlation between MHQ and HAQ in
RA patients. In our work, functional disability in RA
patients is measured by the HAQ, and the highest cor-
472 D. Durmus et al. / Michigan Hand Outcomes Questionnaire
in RA patients
relation was obtained between the MHQ and the HAQ.
In the light of these findings MHQ can be used as a
disability index in RA and is as sensitive a method as
HAQ.
24. Functional disability may be the result of pain, re-
flex inhibition, disuse atrophy and mechanical disrup-
tion [29,30]. Weakness of grip strength, correlate with
pain and cause functional disability [31,32]. Waljee et
al. [28] found significant correlation between MHQ
scores and grip strength. In another study by Sahin [33]
et al. used Duruöz’s Hand Index and high correlations
were found between the hand functions and the grip
strength. We used MHQ and found similar correlations
between the hand functions and the grip strength in our
study. As a result functional disability occurs due to
deterioration of motion, coordination, and motor per-
formance. Aktekin et al. [2] used DASH and reported
that the hand functions were correlated with the dis-
ease activity. In another study Birtane et al. [26] found
significant correlations between the Duruöz’s Hand In-
dex scores and the disease activity. In our work, we
used to evaluate the disease activity of RA with DAS-
28. As a result, a moderate correlation was found be-
tween MHQ scores and DAS28, VAS pain, patient’s
global VAS, swollen joint count and tender joint count.
There was no correlation between MHQ and ESR,
CRP. Similar to their study by Aktekin et al. [2], when
we studied the patients after grouping them according
to the disease activity levels using DAS28, we saw that
the MHQ scores decreased as the disease activity in-
creased, and the difference was statistically significant.
In the light of these findings we may consider MHQ to
be an acceptable and reliable disability index, which is
also responsive to change in disease activity.
Limitations of this study are; firstly, this was a
single-center study, and secondly, there were relatively
small number of patients. Powerful aspect of our study
is that it is the first study in which the relationship be-
tween disease activity, and MHQ scores was assessed
25. in patients with RA.
In conclusion, the MHQ scores correlate with dis-
ease activity indices, functional disability, handgrip
strength, and QL. This questionnaire can be used to
assess hand disability in RA patients as effectively as
DASH.
Level of evidence
Diagnostic study Level-I-I (prospective study).
Conflict of interest
None.
References
[1] O’Dell JR, Therapeutic strategies for rheumatoid arthritis, N
Engl J Med, 350 (2004), 2591–602.
[2] Aktekin LA, Eser F, Baskan BM, Sivas F, Malhan S, Öksüz
E,
and Bodur H, Disability of arm shoulder and hand question-
naire in rheumatoid arthritis patients: relationship with dis-
ease activity, HAQ, SF-36, Rheumatol Int, 31 (2011), 823–6.
[3] Katz JN, Fossel KK, Simmons BP, Swartz RA, Fossel AH,
and Koris MJ, Symptoms, functional status and neuromuscu-
lar impairment following carpal tunnel release, J Hand Surg
(Am), 20 (1995), 549–555.
[4] Levine DW, Simmons BP, and Koris MJ, A self-
administered
questionnaire for the assessment of severity of symptoms and
functional status in carpal tunnel syndrome, J Bone Jointt
26. Surg Am, 75 (1993), 1585–1592.
[5] Guyatt GH, Feeny DH, and Patrick DL, Measuring health-
related quality of life, Ann Intern Med, 118 (1993), 622–629.
[6] Guyatt GH, A taxonomy of health status instruments, J
Rheumatol, 22 (1993), 1188–1190.
[7] Tugwell P, Idzerda L, and Wells GA, Generic quality of life
assessment in rheumatoid arthritis, Am J Manag Care, 13
(2007), 224–236.
[8] Fries JF, Spitz P, Kraines RG, and Holman HR,
Measurement
of patient outcome in arthritis, Arthritis Rheum, 23 (1980),
137–145.
[9] Wolfe F, Pincus T, and Fries JF, Usefulness of the HAQ in
the
clinic, Ann Rheum Dis, 60 (2001), 811.
[10] Chung KC, Pillsbury MS, Walters MR, and Hayward RA,
Re-
liability and validity testing of the Michigan Hand Outcomes
Questionnaire, J Hand Surgery, 23 (1998), 575–587.
[11] Massy-Westropp N, Krishnan J, and Ahern M, Comparing
the
AUSCAN osteoarthritis hand index, Michigan hand outcomes
questionnaire, and sequential occupational dexterity assess-
ment for patients with rheumatoid arthritis, J Rheumatol, 31
(2004), 1996–2001.
[12] Oksüz C, Akel BS, Oskay D, Leblebicioğlu G, and Hayran
KM, Cross-cultural adaptation, validation, and reliability pro-
cess of the michigan hand outcomes questionnaire in a Turk-
27. ish population, J Hand Surg, 36 (2011), 486–492.
[13] Ilhanlı I, Durmus D, and Orekici G, The cultural
adaptation,
reliability, and validity of Michigan hand outcomes question-
naire (MHQ) in patients with carpal tunnel syndrome, a Turk-
ish version study. 23rd National Physical Medicine and Reha-
bilitation Congress, 2011, Poster: 158, Page: 231.
[14] Van der Giesen FJ, Nelissen RG, Arendzen JH, de Jong Z,
Wolterbeek R, and Vliet Vlieland TP, Responsiveness of the
Michigan hand outcomes questionnaire – Dutch language ver-
sion in patients with rheumatoid arthritis, Arch Phys Med Re-
habil, 89 (2008), 1121–1125.
[15] Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries
JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, and
Luthra HS, The ACR 1987 revised criteria for classification
of rheumatoid arthritis, Arthritis Rheum, 31 (1988), 315–324.
[16] Aletaha D, Smolen J, The simplified disease activity in-
dex and clinical disease activity index (CDAI): a review of
their usefulness and validity in rheumatoid arthritis, Clin Exp
Rheumatol, 23 (2005), 100–108.
D. Durmus et al. / Michigan Hand Outcomes Questionnaire in
RA patients 473
[17] Kucukdveci AA, Sahin H, Ataman S, Griffiths B, and
Tennant
A, Issues in cross-cultural validity: example from the adapta-
tion, reliability, and validity testing of a Turkish version of the
Stanford Health Assessment Questionnaire, Arthritis Rheum,
15 (2004), 14–19.
28. [18] Kvien TK, Kaasa S, and Smedstad LM, Performance of the
Norwegian SF-36 health survey in patients with rheumatoid
arthritis, II A comparison of the SF-36 with disease specific
measures, J Clin Epidemiol, 51 (1998), 1077–86.
[19] Pınar R, The Life Quality of the Patients with Diabetes
Mel-
litus and Investigation of Factors Effecting the Life Quality,
Doctorate Thesis, Istanbul University, Institute of Ministry of
Health, 1995, Istanbul.
[20] Riemsma RP, Taal E, Rasker JJ, Houtman PM, Van Paassen
HC, and Wiegman O, Evaluation of a Dutch version of the
AIMS2 for patients with rheumatoid arthritis, Br J Rheumatol,
35 (1996), 755–60.
[21] Atamaz F, Hepguler S, and Oncu J, Translation and
validation
of the Turkish version of the Arthritis Impact Measurement
Scales 2 in patients with knee osteoarthritis, J Rheumatol, 32
(2005), 1331–1336.
[22] Harkonen R, Harju R, and Alaranta H, Accuracy of the
Jamar
dynamometer, J Hand Ther, 6 (1993), 259–62.
[23] Hudak PL, Amadio PC, and Bombardier C, Development of
an upper extremity outcome measure: the DASH (disabilities
of the arm, shoulder and hand) [corrected] The Upper Extrem-
ity Collaborative Group (UECG), Am J Ind Med, 29 (1996),
602–8.
[24] Navsarikar A, Gladman DD, Husted JA, and Cook RJ,
Valid-
ity assessment of the Disabilities of Arm, Shoulder, and Hand
29. questionnaire (DASH) for patients with psoriatic arthritis, J
Rheumatol, 26 (1999), 2191.
[25] Gummesson C, Atroshi I, and Ekdahl C, The disabilities of
the arm, shoulder and hand (DASH) outcome questionnaire:
longitudinal construct validity and measuring self-rated health
change after surgery, BMCMusculoskelet Disord, 4 (2003),
11.
[26] Birtane M, Kabayel DD, Uzunca K, Unlu E, and Tastekin
N, The relation of hand functions with radiological damage
and disease activity in rheumatoid arthritis, Rheumatol Int, 28
(2008), 407–412.
[27] Bell MJ, Bombardier C, and Tugwell, Measurement of
func-
tional stratus, quality of life, and utility in rheumatoid arthri-
tis, Arthritis Rheum, 33 (1990), 591–601.
[28] Waljee JF, Chung K, Kim HM, Burns PB, Burke FD,
Wilgis
EF, and Fox DA, The validity and responsiveness of the
Michigan hand questionnaire in patients with rheumatoid
arthritis a multicenter, International Study, Arthritis Care &
Research, 2010, 1–28.
[29] van Leeuwen MA, van der Heijde DM, van Rijswijk MH,
Houtman PM, van Riel PL, van de Putte LB, and Limburg
PC, Interrelationship of outcome measures and process vari-
ables in early rheumatoid arthritis. A comparison of radi-
ologic damage, physical disability, joint counts, and acute
phase reactants, J Rheumatol, 21 (1994), 425–429.
[30] Guillemin F, Briancon S, and Pourel J, Functional
disability
in rheumatoid arthritis: two different models in early and es-
30. tablished disease, J Rheumatol, 19 (1992), 366–369.
[31] Pincus T, Callahan LF, Brooks RH, Fuchs HA, Olsen NJ,
and
Kaye JJ, Self-report questionnaire scores in rheumatoid arthri-
tis compared with traditional physical, radiographic, and lab-
oratory measures, Ann Intern Med, 110 (1989), 259–266.
[32] Clarke AE, St-Pierre Y, Joseph L, Penrod J, Sibley JT,
Haga
M, and Genant HK, Radiographic damage in rheumatoid
arthritis correlates with functional disability but not direct
medical costs, J Rheumatol, 28 (2001), 2416–2424.
[33] Sahin F, Kotevoglu N, Taspinar S, Yilmaz F, and Kuran B,
Comparison of functional disability scales and their relevance
to radiological progression in patients with rheumatoid arthri-
tis in remission, Clinical and Experimental Rheumatology, 24
(2006), 540–545.
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Group 1, Project 2, Page 9
31. Ohio AgrAbility requested a universal adaptive design
solution to help farmers with physical and/or cognitive
limitations continue farming safely. The solution could cost no
more than fifty dollars. The Ohio AgrAbility clients presented
an open-ended problem, leaving it up to the team to define a
specific problem and create a solution. Requests were that the
design solution be completed in the given amount of time, it
was safe and easy for all to use. In order for the design to
function properly it was crucial that the device was universal,
helpful to farmers, durable, and easy to fix. Group 1 created
their own objectives and constraints that ultimately resulted in
the generation of several design ideas.
Once Group 1 was given the open-ended problem
statement, they individually brainstormed for possible specific
agriculture design problems. The group discussed a variety of
safety concerns present in agriculture work for people with
disabilities. People dependent on wheelchairs struggle to carry
tools and transfer themselves to farm equipment. The group
decided to focus on aiding those with hand impairments
function on a farm. Group 1 aimed to create a device that would
allow the use of a variety of tools, whilst being both
comfortable and easy to equip. Each group member was
instructed to create three different ideas. The group narrowed
the design idea pool to three alternative designs. Design 1 was
a 3D printed plastic device that surrounded the majority of the
user's forearm. It had a small shovel and three pronged rake
molded to the arm casing. Design 2 was to be created with a
medical wrist brace with velcro straps. Upper sockets would be
attached to the brace, thus allowing the exchange of tools. The
third design was a halved PVC pipe given Velcro straps,
internal padding(mattress pad) , and adjustable clamps on the
outside of the pipe. It featured the ability to swap tools.
Group 1 chose to complete numerical evaluation matrices to
32. make a final design decision. Two matrices were used; the first
evaluated whether or not each design idea satisfied all of the
constraints on a pass or fail basis, with a value of one meaning
the design passed, and zero meaning that the design failed. The
second matrix compared designs by how well they satisfied the
design objectives on a scale of one to three, with one being the
best, and three being the worst. The criteria used in the matrices
were the time to construct, cost of supplies, job efficiency,
universality, durability, and safety. Design 2 and Design 3 both
scored an 8, while Design 1 scored an 11. Given the equal
scores, the group decided to go with Design 3 because it was
most cost efficient. Both designs were under $50, however,
Design 3 was cheaper. The design was a halved PVC pipe given
velcro straps, internal padding, and tool sockets on the outside
of the pipe. Design 3 was best overall because it contained a
padded sleeve that covered the arm comfortably, was easy to
take on and off, could be adjusted to work with various types of
tools, the design could be used by anyone, and it was created
with inexpensive and recycled materials. The design was 6
inches in length and had a circumference of 11 inches. The
chosen design easily helps solve the problem of helping those
with a hand amputation or arthritis use tools on the farm.
Group 1 completed testing to check how well the device
functioned by using a diverse pool of testers. The first test
conducted tested how universal the device was, this was tested
by having a variety of people with different arm sizes try on the
device. The second test tested efficiency by timing how long it
took each person, who tried on the device in the first test, to put
the device on their arm and tighten the straps. The third test
conducted had tested how comfortable the device was, by
having each of the testers rate the comfort level of the device on
their arm using a scale from 1 to 5 — 5 being extremely
comfortable and 1 being uncomfortable. The last test conducted
was to test how durable and universal the device was; this was
done by sampling the device with a screwdriver, a hammer, and
a broom.
33. Group 1 passed in solving the problem statement, since the
device works well for a variety of tools and works well for
those who may have arthritis or a hand amputation.
I. Introduction
II. Generation of Design Alternatives Comment by Kenya
Crosson: add dimensions/size information to these descriptions
Group 1 generated three design alternatives primarily through
the use of bisociation and painstorming methods. Bi-sociation
was done through the examination of medical equipment and
farming tools, whilst painstorming done by restricting the use of
the hand to various degrees.
Figure 1 was a cylindrical arm-piece that had a tool attached to
the end of it. It was focused on the use of specific pre-selected
tools that were part of the design. It was intended to be both
durable and easy to use.
Figure 2 was a fingerless wrist brace with upper sockets to hold
the tools. It was to allow the exchange of various tools as
opposed to having them pre-set, and it was also intended to be
moderately comfortable.
Figure 3 was a halved PVC pipe given Velcro straps, internal
padding, and some tool sockets on the topside. It featured the
ability to swap tools similarly to design 2, but it exchanged the
brace for the internal padding and adjustable straps. It also
featured more easily attainable parts.
III. Design Selection Process
The group evaluated the top three designs based on the design
objectives and constraints. The design objectives were that they
should be universal, helpful, durable, and easy to fix. The
design constraints were the build time, cost limitation, safety,
weight, job efficiency, and ease of use. The group used two
numerical evaluation matrices. The first was a pass or fail
matrix that evaluated each design’s ability to fulfill the
constraints. Design 1 failed because it did not meet the $50
cost constraint. The Designs 2 and 3 did met all of the design
constraints. Matrix two compared designs by how well they
satisfied the design objectives on a scale of one to three, with
34. one being the best, and three being the worst.
The chart below shows the ratings for each design based on the
objectives and constraints. The constraints were rated as either
a pass or fail, and if any of the constraints were failed, the
design was considered unusable. The objectives were rated on a
scale of three down to one, with one being the best and three
being the worst. The designs with the lowest scores were
determined as the best possible options. design 1 got a score of
11 points which means the worst of the three designs because it
didn’t meet all of the design objectives. designs 2 and 3 had the
same points (8) so the group had to select one of them. Group 1
chose design 3 over design 2 because it was cheaper and easier
to fix.
Table 1. Decision Analysis Chart
Design constraints
Design 1
Design 2
Design 3
1
Time
1
1
1
2
Costs
0
1
1
1=pass
3
Safety
1
1
35. 1
2=fail
4
Will it be heavy
1
1
1
5
Efficiency
1
1
1
6
Easy to use
1
1
1
7
Design objectives
1
Universal
1
1
37. 8
IV. Final Design Comment by Kenya Crosson: Your report is
missing the concept refinement section
The team’s final design provides an affordable way to use tools
around a farm. Team’s one design is comprised of a pvc pipe
cut in half, 2 adjustable clamps, an elastic knee brace, two
elastic Velcro straps and a mattress pad. The two adjustable
clamps are connected to the pvc pipe by a nut and bolt that goes
through the pvc pipe and each clamp. Each Velcro strap is
woven through slits in the pvc pipe and wraps completely
around the person’s arm when the device is on. Comfort of the
forearm in the device is provided by the mattress pad that lines
the inside of the pvc pipe. The knee brace is slide over top of
the halved pvc pipe so it helps prevent the device from moving
on the arm. The device is an arm sleeve that covers the
majority of a person’s forearm. Tools that have a handle that fit
into the adjustable clamps can be fastened to the device
enabling the user to use the tool without their hand. In addition
to the tools the devices hard shell protects the user's forearm.
Pros of the device are that it successfully allows the use of
tools, it’s inexpensive, parts can be easily replaced, it’s
universal and it can be adjusted to use a wide range of tools.
Cons of the device are that it is a little heavy, aesthetically it is
not pleasing, it can get hot and adjusting the tool into position
takes significant time when trying to complete small tasks.
V. Technical Aspects of the Design Comment by Kenya
Crosson: missing discussion about math used (multiplication);
and science used.
The team considered the mechanic of leverage (mechanical
advantage through force multiplication at a fulcrum), and the
calculations for tension and circumference in the design
process.
38. VI. Testing the Design
During and after the construction of the arm device, Group
1 conducted four different tests which can be referred to in
Table 2 of this section. The first test evaluated the device’s ease
of use, and whether the device is universal. Testing was
completed by using a diverse pool of testers. The second test
tested how universal and efficient the device was, this was done
by timing how long it took each tester to put on the device and
tighten the straps. The third test conducted tested how
comfortable the device was by having each tester rate the device
on a scale of one to five, one being uncomfortable and five
being extremely comfortable. The last test conducted tested how
durable the device was by sampling it with a screwdriver, a
hammer, and a broom.
Table 2. Testing the Device
Benchmark
Method
Equipment
Durability/Purpose
Minimal damage
Successfully does job
Sampling different tools
Hammer, broom, screwdriver
Universality
Successfully fits
Multiple people trying on device
Diverse pool of people
Efficiency
Sub 20 seconds
Testing the time to put on device
Timer
Comfort level
Average rating above 3
Rating the comfortability from 1-5 (5-good, 1-bad)
Wide range of people
39. VII. Results
The device passed all of the tests. With the device users were
able to use a hammer, screwdriver, broom and hand shovel.
Turning motion with the use of screwdriver only caused slight
movement of the device. The timed putting on the device test
showed an average of seven seconds for the time it takes to put
the device on. The last test was an subjective comfortability
rating given by users.
VIII. Conclusion
Group 1 found a way to create a device that allows those with
arthritis or a hand amputation to easily hold a tool on the farm.
The device creates less strain on the already weak hand because
it reduces gripping pressure and avoids awkward joint positions
(Hand Tool Ergonomics). In addition, the device provides an
easy use of different farm tools and gives the users the ability
to contribute to more tasks on the farm since those with arthritis
are struggle with basic farming tasks (Taylor-Gjevre). The
device was created with recycled and scrap materials. The
device is 6 inches in length and has a diameter of 4 and a half
inches as halved PVC pipe. The key features of the device are
that it is a universal design, it is easy to take on and off, very
inexpensive, it is adjustable to be used with various types of
tools, and a padded sleeve covers the arm comfortably. The
design form is that of a halved PVC pipe covered on the outside
with a stretchy, cloth knee brace, an internal padding(mattress
pad), and two velcro straps to fasten the device on the arm.
Connected to the PVC piping is two adjustable clamps, these
allow for a variety of farming tools to be placed inside for use.
The device can be used with hand tools and tools with a long
handle, similar to a broom.
IX. Recommendations
The group incorporated ethics into the final design by making
the design more safe. The hand tool was stuffed with soft
padding so the user will not get hurt when using it. Group 1
improved the design by finding an easier way to tighten the
hand tool, and extend the design to the elbow so it would be
40. easier to control. Comment by Kenya Crosson: what was
done to make the design safer? be specific
References Comment by Kenya Crosson: references are not
formatted properly
References are not cited in the textbook
Taylor-Gjevre, Regina M. (2015). "Prevalence and
Occupational Impact of Arthritis in Saskatchewan Farmers."
Journal of Agromedicine, v. 20 n. 2 : p. 205-16.
Tipler, Paul, and Gene Mosca. Physics For Scientists and
Engineers; Sixth Edition. New York: W.H. Freeman and
Company, 2008. Print..
Thomas, George, and Maurice Weir, Joel Hass, and Christopher
Heil. Thomas Calculus: Early Transcendentals; Thirteenth
Edition. Pearson, 2013. Print.
Dym, Clive, and Patrick Little and Elizabeth Orwin.
Engineering Design; Fourth Edition. Wiley, 2013. Print.
"Hand Tool Ergonomics." Canadian Centre for Occupational
Health and Safety. N.p., 1 Oct. 2015. Web.
X. Appendices
