Posts Tagged DASH

[Abstract] Development of the modified simple test for evaluating hand function (modified STEF): Construct, reliability, validity, and responsiveness


Study Design

Clinimetric evaluation study.


Despite the availability of numerous performance tests to measure finger dexterity, there is no international consensus on hand function evaluation.

Purpose of the Study

To evaluate the reliability, validity, and responsiveness of the modified version of the simple test for evaluating hand function (STEF), which is widely used in Japan.


The intrarater (n = 40) and inter-rater (n = 32) reliability of the modified STEF was evaluated by calculating the intraclass correlation coefficient (ICC), models (1,1) and (2,1), respectively, in healthy individuals. The criterion validity of the modified STEF (n = 50) was evaluated by calculating the Pearson correlation coefficient relative to the STEF, the Purdue pegboard test (PPT), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The standardized response mean of the scores was calculated to determine responsiveness (n = 35). The modified STEF was used prospectively to measure the change in hand function in a cohort of patients with hand trauma injuries and inflammatory diseases (n = 30), as well as in a cohort of patients with cervical spondylosis (n = 20), from preoperative baseline to 1 and 3 months postoperatively.


ICC1.1 and ICC2.1 values were ≥0.80, indicative of high intrarater and inter-rater reliability. All correlation coefficients were significant (P < .05): STEF (r = 0.89), PPT (r = 0.69), and DASH (r = −0.34). The standardized response mean indicated greater responsiveness of the modified STEF (0.89) than the STEF (0.71) and PPT (0.68) but a lower responsiveness than the DASH (1.11).


It must be mentioned that modified STEF and DASH cannot be compared without caution. The two types of tools should complement each other when measuring someone’s activity and participation level.


The modified STEF is a reliable measurement tool, with a moderate positive correlation with the PPT and a greater responsiveness than the STEF and PPT.

via Development of the modified simple test for evaluating hand function (modified STEF): Construct, reliability, validity, and responsiveness – ScienceDirect

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[ARTICLE] Food for Thought: Basic Nutrition Recommendations for the Mature Brain – Archives of Physical Medicine and Rehabilitation

Mild changes in memory and the way that we think can be normal as we age, but there are actions you can do to take charge of your brain health! We now better understand the importance of healthy eating for brain health in older adults. Doctors recommend healthy lifestyle changes to maintain or improve brain health, which include getting enough sleep, physical activity, and eating healthy foods. With your brain in mind, we created this page to help you adopt a healthy lifestyle. Most of the foods that we discuss can be found at grocery stores around your neighborhood. In addition, table 1 has useful online resources to help you keep your brain healthy.

Table 1Resources
Alzheimer’s Association: Alzheimer’s and Public Health Resource Center
Caregiver Tips and Tools

The MIND diet The MIND diet and tips on how to follow it.
Adopt a Healthy Diet The DASH and Mediterranean Diets
Administration for Community Living
Nutrition Services The Administration for Community Living’s Administration on aging nutrition programs targeting older adults.
Global Council on Brain Health
Brain-Food Recommendations on nourishing your brain health.
National Institute on Aging
Healthy Eating Choosing healthy meals as you get older, overcoming roadblocks to healthy eating, serving and portion sizes, maintaining a healthy weight

Abbreviations: DASH, Dietary Approaches to Stop Hypertension; MIND, Mediterranean-DASH Intervention for Neurodegenerative Delay.

General dietary recommendations for the aging brain

Plan your meals keeping these tips in mind. It is important to meet with a registered dietitian for individual dietary advice.1, 2, 3, 4, 5

  • 1.

    Eat whole grains with every meal

    • Sources include whole grain bread (wheat, rye, or barley), whole grain pasta, brown or wild rice, quinoa, and oats.

    • By eating at least 3 portions of whole grains a day you give your brain energy in the form of complex carbohydrates, B vitamins (thiamine, riboflavin, niacin, and folate), and minerals (iron, magnesium, and selenium).

  • 2.

    Eat a variety of fruits and vegetables every day

    • Make your plate colorful!

    • Eat berries, especially blueberries, at least twice per week as they are packed with protective substances called antioxidants.

    • Eat dark green leafy and cruciferous vegetables (spinach, kale, parsley, broccoli, asparagus, and Brussel sprouts) at least 6 times per week as these are rich in antioxidants, vitamins K and C, and folate.

  • 3.

    Eat legumes 3 or more times per week

    • Legumes (peas, beans, lentils, soybeans, and peanuts) are good sources of complex carbohydrates, protein, folate, and fiber.

  • 4.

    Limit red meat to once or twice a week

    • Swap out red meat, which is high in unhealthy saturated fat (lamb, beef, pork, and sausages), for poultry (chicken or turkey), fish, and beans and other legumes.

  • 5.

    Focus on healthy fats

    • Use extra-virgin olive oil instead of butter, margarine, or vegetable shortening.

    • Eat omega-3 rich foods from animal sources such as fish (sardines, mackerel, herring, salmon, sea bass, and trout) at least once a week. Vegetarian? No problem! Plant sources of omega-3 fatty acids include flax seeds, walnuts, and their oils, and Chia seeds.

    • Other sources of healthy fats include almonds, nut butters (eg, peanut butter), seeds, olives, and avocados.

    • Limit baked goods, fast foods, and fried foods since they contain unhealthy saturated and trans fatty acids.

  • 6.

    Don’t forget about dark chocolate

    • Dark chocolate has been shown to aid in brain health and to improve mood, learning, memory, and attention.

    • Aim for a small square (2cm×2cm) of dark chocolate (>70% cocoa) 2 to 3 times a week.

  • 7.

    Spice up meals with herbs and spices

    • Cook with herbs and spices and limit the use of salt.

    • Turmeric, cinnamon, clove, cumin, basil, parsley, cayenne pepper, oregano, and sage can all be helpful for brain health.

  • 8.

    Stay hydrated

    • Drink 6-8 8-oz glasses of water or non-caffeinated herbal teas per day. This helps to keep your entire body, including your brain, in tip top shape.6, 7

  • 9.

    Drink caffeine, but in moderation

    • Caffeine and antioxidants found in coffee can improve mood and increase alertness and attention.8

    • Daily cups of green or black tea brewed from tea leaves have been linked to brain health.

    • However, aim for no more than 1-3 cups of caffeinated tea or coffee daily, and limit drinking caffeine in the afternoon and at night as this can lead to poor sleep.

  • 10.

    If you consume alcohol, enjoy a glass of red wine with meals

    • Red wine contains a number of antioxidants, such as resveratrol, which have been shown to be helpful for the brain.

    • It is best to enjoy red wine in moderation, in other words, one glass a night and always consume with meals.

  • 11.

    Practice balance and do not overeat

    • Control your portion sizes and eat protein-packed snacks such as low fat yogurt with walnuts or seeded bread or rice/quinoa cakes with peanut butter, low fat cheese, or egg whites to help prevent you from overeating.

Practical cooking tips

  • 1.

    Cooking whole grains? Cook the whole bag and store the extra portions in your freezer for later use.

  • 2.

    Make sure you always have lentils in your pantry as they are the quickest legumes to prepare.

  • 3.

    Roasting salmon or other fatty fish? Roast an extra filet and make a fish spread for tomorrow’s sandwiches (puree the fish in a food processor with herbs and add a tablespoon of olive oil or tahini).

  • 4.

    Store berries and other fruits in your freezer to use in shakes or frozen desserts or to put on top of yogurt and hot cereals.

  • 5.

    Increase your vegetable intake by making an antipasto! Mix a variety of vegetables with a few tablespoons of olive oil and roast 20 minutes in a 450°F (230°C) oven.

  • 6.

    Legumes are not only for vegans! Replace beans for half of the meat you are cooking.

  • 7.

    Make homemade soft drinks! Place fruit slices and herbs (eg, mint, lemongrass) in a large container of water and set aside to allow the flavors to blend.

  • 8.

    Thicken soup using nuts! Add a handful of nuts to a soup and puree with a blender to thicken and add flavor.

  • 9.

    Experiment with spices! Cardamom goes great with cauliflower and sage works well with pumpkin.

  • 10.

    Make your own sauces! Mix 4 tablespoons of olive oil, 4 tablespoons of soy sauce, 1 crushed garlic clove, and 1 tablespoon of chopped spring onion for a great sauce that can be used on pasta or meat.


This page was developed by the members of the American Congress of Rehabilitation Medicine (ACRM) Neurodegenerative Diseases Networking Group and the ACRM Culinary Medicine Task Force: Elena Philippou, RD, PhD (e-mail address:, Rani Polak, MD, Chef, MBA, Ana Michunovich, DO, Michele York, PhD, Julie M. Faieta, MOT, OTR/L, Mark A. Hirsch, PhD, and Patricia C. Heyn, PhD, FGSA, FACRM.


This information is not meant to replace the advice of a medical professional. You should always talk to your health care provider if you have any specific medical concerns or questions about treatment. This Information/Education Page may be used noncommercially by health care professionals to help educate patients and their caregivers. Any other reproduction is subject to approval by the publisher.


  1. Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate.National Academies PressWashington (DC)2005
  2. Institute of Medicine. Dietary reference intakes. The essential guide to nutrient requirements.National Academies PressWashington (DC)2006
  3. Masento, N.A., Golightly, M., Field, D.T., Butler, L.T., and van Reekum, C.M. Effects of hydration status on cognitive performance and mood. Br J Nutr20141111841–1852
  4. Morris, M.C., Tangney, C.C., Wang, Y., Sacks, F.M., Bennett, D.A., and Aqqarwal, N.T. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement2015111007–1014
  5. Ngandu, T., Lehtisalo, J., Solomon, A. et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet20153852255–2263
  6. Panza, F., Solfrizzi, V., Barulli, M.R. et al. Coffee, tea, and caffeine consumption and prevention of late-life cognitive decline and dementia: a systematic review. J Nutr Health Aging201519313–328
  7. Petersson, S.D. and Philippou, E. Mediterranean diet, cognitive function, and dementia: a systematic review of the evidence. Adv Nutr20167889–904
  8. Solfrizzi, V., Custodero, C., Lozupone, M. et al. Relationships of dietary patterns, foods, and micro- and macronutrients with Alzheimer’s disease and late-life cognitive disorders: a systematic review. J Alzheimers Dis201759815–849

via Food for Thought: Basic Nutrition Recommendations for the Mature Brain – Archives of Physical Medicine and Rehabilitation

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[Abstract] Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity – Occupational and Environmental Medicine.


Objectives To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity.

Methods A retrospective cohort study using a population-based database from the Workers’ Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability.

Results The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34).

Conclusions The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score.

Source: Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity — Armijo-Olivo et al. — Occupational and Environmental Medicine

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[ARTICLE] Predictors of return to work with upper limb disorders


Background: Return to work (RTW) is a key goal in the proper management of upper limb disorders (ULDs). ULDs stem from diverse medical aetiologies and numerous variables can affect RTW. The abundance of factors, their complex interactions and the diversity of human behaviour make it difficult to pinpoint those at risk of not returning to work (NRTW) and to intervene effectively.

Aims: To weigh various clinical, functional and occupational parameters that influence RTW in ULD sufferers and to identify significant predictors.

Methods: A retrospective analysis of workers with ULD referred to an occupational health clinic and further examined by an occupational therapist. Functional assessment included objective and subject ive [Disability of the Arm, Shoulder and Hand (DASH) score] parameters. Quantification of work requirements was based on definitions from the Dictionary of Occupational Titles web site. RTW status was confirmed by a follow-up telephone questionnaire.

Results: Among the 52 subjects, the RTW rate was 42%. The DASH score for the RTW group was 27 compared with 56 in the NRTW group (P < 0.001). In multivariate analyses, only the DASH score was found to be a significant independent predictor of RTW (P < 0.05).

Conclusions: Physicians and rehabilitation staff should regard a high DASH score as a warning sign when assessing RTW prospects in ULD cases. It may be advisable to focus on workers with a large discrepancy between high DASH scores and low objective disability and to concentrate efforts appropriately.

via Predictors of return to work with upper limb disorders.

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