Investigation of Functional Parameters

Primary outcomes

1. The Purdue Pegboard Test was used to assess bimanual coordination.

   Time frame: Participants will be evaluated only once.

   In the Purdue Pegboard test, participants, seated in front of the test board, were asked to placed pins into the holes on both sides of the board simultaneously with both hands as many pins as possible within 30 seconds. The total number of pins placed was recorded as the score for bimanual coordination.

2. The Purdue Pegboard Test was used to assess manual dexterity.

   Time frame: Participants will be evaluated only once.

   In the Purdue Pegboard test, participants, seated in front of the test board, were first asked to use their dominant hand to pick up pins from the dominant side and place them into the holes on the same side, from top to bottom. They were instructed to place as many pins as possible within 30 seconds. The number of pins placed was recorded as the score for dominant hand manual dexterity. The same test was then conducted for the nondominant side.

3. The active joint position sense was assessed using an isokinetic dynamometer.

   Time frame: Participants will be evaluated only once.

   For the assessment of wrist proprioception, an isokinetic dynamometer with demonstrated reliability [Cybex NORM®, Humac, CA, USA] was used.

   Wrist proprioception was assessed by Active Joint Position Sense (AJPS) measurement. During the test, participants wore eye masks. For the AJPS assessment, the target angle was set at 30° extension, which is the functional position of the wrist. Participants were asked to actively move their wrist from the neutral position to the 30° extension and hold this position for 5 seconds. This trial was repeated three times. Participants were then asked to find the target angle three times. The amount of error between the target angle and the achieved angle was used to define the accuracy of the active joint position sense. The arithmetic mean of these three measurements was calculated and recorded.

4. The flexion-extension strengths of the wrist were assessed using an isokinetic dynamometer.

   Time frame: Participants will be evaluated only once.

   Wrist flexion and extension strengths were also evaluated using the Cybex isokinetic dynamometer. These strength assessments were conducted in the same position and range of motion as the proprioception evaluations. Before starting the measurements, participants were informed about the test. At the beginning of the test, three practice trials were performed. The concentric-concentric strength measurement was conducted with an angular velocity of 60°/s for 5 repetitions. A 20-second rest period was allowed between the practice and test trials. The peak torque parameters for wrist flexion and extension in both wrists were measured.

   Assessments began with the dominant side. Subsequently, the same measurements were repeated on the other extremity by adjusting the position of the dynamometer and chair. The device was calibrated before the participants were evaluated. All measurements were conducted by the same person to prevent inter-rater variability.

5. Grip and pinch strengths were measured using a digital dynamometer.

   Time frame: Participants will be evaluated only once.

   The assessment of gross grip strength was performed using a digital dynamometer (J-Tech Commender Grip Track). Measurements were taken with the participant seated, the elbow flexed at 90 degrees, the wrist in up to 30 degrees of extension, and the forearm in a neutral rotation position. The dynamometer's grip width was set to the second level. Maximum grip force was measured by having the participant squeeze as hard as possible three times, and the arithmetic mean of these three measurements was calculated. Key pinch, palmar pinch, and tip pinch strength measurements were conducted using a pinch gauge (Baseline Mechanical Pinch Gauge, 60 lb) in the same position and with the same measurement technique as the gross grip strength assessment. All evaluation protocols were established according to the recommendations of the American Society of Hand Therapists.