Rajiv Gandhi University of Health Sciences, Karnataka s9

Rajiv Gandhi University of Health Sciences, Karnataka Bangalore

ANNEXURE II

1. Name of the Candidate and SONIA TALREJA Address (in block letters) DR.M.V.SHETTY COLLEGE OF PHYSIOTHERAPY VIDYANAGAR KULOOR,MANGALORE-575013

2. Name of the Institution DR.M.V.SHETTY COLLEGE OF PHYSIOTHERAPY

MASTER OF PHYSIOTHERAPY (MPT) 3. Course of Study and Subject NEUROLOGICAL AND PSYCHOSOMATIC DISORDERS

4. Date of Admission to Course 12th June, 2008

5. Title of the Topic EFFECT OF DIFFERENT BODY POSITIONS ON MANUAL DEXTERITY IN CLINICAL NURSES

6. Brief Resume of the Intended Work 6.1) Introduction and Need of the Study

Manual dexterity can be defined as the readiness and grace in physical activity; skill and ease in using the hands; expertness in manual acts.

The hand serves as both receiver of information & executor of response. These two functions are closely intervened and influence each other. The mobility of fingers is indispensable for identification of objects.2 There are several ways to measure manual dexterity. We selected the Purdue Pegboard Test (PPT), which has been used in employment settings to make vocational decisions about individuals’ ability to perform highly skilled tasks that require rapid eye-hand coordination and has also been used by neuropsychologists to evaluate patients suspected of experiencing psychomotor slowing secondary to brain dysfunction.

Purdue Pegboard measures 2 types of dexterity : 1) Involving gross movement of hands, fingers, & arm. 2) Fingertip dexterity.2

Purdue Pegboard measures a factor called finger dexterity which is defined as the ability to make rapid, skillful controlled movement of small objects where fingers are primarily involved.2 Need of the study: In ergonomics, handgrip has been perceived as one of the most important hand functions; however, other types of functions of the hand are also important to the ergonomist, such as finger and manual dexterity, on which few ergonomic studies have been done.4

Nurses perform skills that require a high level of manual dexterity and coordination, such as injections, putting intravenous fluids, catheters and dressing changes. These skills are needed to be performed by them in different body postures. Being a part of health care team it is our duty to coordinate with other members of the team to provide total health care to the patient.

This study focuses on instructing nurses to use a position which would be comfortable to them as well as would provide better dexterity to perform those skills mentioned above.

Research Question:

1. Is there any relationship between posture and manual dexterity in nurses? 2. Which is the position which imparts maximum dexterity and is comfortable to nurses?

Hypothesis : Null Hypothesis:

There will not be any significant difference in Purdue Pegboard Test scores in different positions in clinical nurses.

Alternate Hypothesis:

There will be significant difference in Purdue Pegboard Test scores in different positions in clinical nurses.

6.2) REVIEW OF LITERATURE :

Charles W. Buffington, Stanley D. MacMurdo, Christopher M. Ryan (2006) studied the relationship between posture and psychomotor efficiency using Grooved Pegboard Test on 20 anesthesia providers which included 3 positions sitting, kneeling and standing bent forward at the waist. The study demonstrated improved dexterity in subjects seated in a comfortable position.1

Krunal Desai et al (2005) conducted a study on 600 subjects between age group of 5-65 in order to obtain a normative data of Purdue Pegboard Test on Indian population. Results indicated that as age increases dexterity decreases. Normative data collected provides a means of comparing patient’s scores with normal individuals of same age & sex.2

Westwood D.A. et al (1999) also dealt with the relationship between posture and psychomotor efficiency and found a small but significant decrease in performance when subjects were standing bent forward at waist compared to standing with back straight or sitting. The subjects in this study were college age students and mostly women.3

Chan T. (2000) experimented 60 male and female college students and found out that performance of finger dexterity were statistically significantly different between the right and left hands and between women and men.4

Schmidt SL. et al (2000) studied the influences of handedness and gender on Grooved Pegboard Test and concluded that women were faster than men on the Grooved Pegboard Test.5

Bryden PJ, Roy EA (2005) in their study suggested that the Remove task of the Grooved pegboard may provide a purer measure of motor speed of the two hands than the standard administration of the Grooved Pegboard Test and found significant performance differences between the hands for the removal task on Grooved Pegboard Test.6

Nalcaci E. et al (2001) investigated the relationship between handedness and asymmetry in hand performance and the sex difference in motor asymmetry on 310 medical students and confirmed that right handed females tend to have more asymmetric motor function than right handed males.7

6.,3) OBJECTIVES OF STUDY :

1. To establish a relationship between posture and psychomotor efficiency using Purdue Pegboard Test (PPT).

2. To provide a position that imparts maximum dexterity for the functions to be performed skillfully as well as is comfortable for the clinical nurses.

MATERIALS AND METHODS : 7.1) STUDY DESIGN : 7. Cross-sectional Study

7.2) SOURCE OF DATA :

100 healthy nurses from various hospitals in and around Mangalore.

7.2(I) Definition of Study Subjects:

100 clinical nurses aged 20-40 years will be selected based on inclusion and exclusion criteria

7.2(II) Inclusion and Exclusion Criteria:

INCLUSION CRITERIA :

 Clinical nurses

 Age group of 20-40 years

 Females

 Dominant hand

EXCLUSION CRITERIA :

 Long sightedness / hypermetropia (can see far off objects but unable to see nearby objects)

 Males

 Non dominant hand

 Alcoholic

7.2(III) Study Sampling Design, Method and Size:

SAMPLE – DESIGN:

Purposive sampling

SAMPLE – SIZE:

Total of 100 subjects fulfilling the inclusion and exclusion criteria. 7.2(IV) Follow Up:

One time study, no follow up required.

7.2(V) Parameters used for comparison and statistical analysis used:

Collected data will be analyzed by Analysis of Variance (ANOVA) and by Chi Square test.

7.2(VI) Duration of study:

The study will be conducted over duration of 12 months.

7.2(VII) Methodology:

Considering the inclusion and exclusion criteria, 200 subjects will be included in the study. Informed consent will be obtained prior to conducting tests from each subject.The study would be in a single group form that is all subjects in the study would undergo the same tests.

Each subject will be instructed to complete a demographic questionnaire that includes questions about handedness, medications, and chronic diseases that might influence the interpretation of the Purdue Pegboard Test.

Each subject will be instructed to maintain a particular position for 60 seconds considered as warm up following which the subject is instructed to insert pegs in to the pegboard holes with the dominant hand while the non dominant hand is held loosely against abdomen throughout the warm up and the test period.

The position of the peg board will be in front of the subjects at a height that allows their forearms to be parallel to the floor in a given position.

The score is the maximum number of pegs inserted into the holes of Purdue pegboard in 30 seconds.

Three different positions which are commonly needed by a nurse to carry out tasks such as standing with waist bent, standing erect, and sitting straight will be tested for the Purdue Pegboard Test scores. The positions will be chosen randomly by flipping a coin.

Scores will be evaluated and each subjects will be asked to rate the 4 positions on a 5 point scale in the pattern 1 2 3 4 5 “That was easy” “That was painful” “I was comfortable in that position”

Where 1=strongly disagree 2=disagree 3=neutral 4=agree 5=strongly agree

Results obtained will be analyzed.

7.3) Does the study require any investigations to be conducted on patients or other human or animal? If so, please describe briefly.

Yes, Purdue Pegboard Test

7.4) Has ethical clearance been obtained from your institution in case of 7.3.

LIST OF REFERENCES :

1. Charles W. Buffington, Stanley D. MacMurdo, and Christopher M. Ryan. Body Position 8. Affects Manual Dexterity. Anesthesia Analogue 2006; 102:1879-1883

2. Krunal Desai, Kirti Kene, Mita Doshi, Shubhangi More, Snehal Desai. Normative Data of Purdue Pegboard on Indian Population. Indian Journal of Occupational Therapy 2005;37;3

3. Westwood DA, Bryden PJ, Roy EA, Kalbfleisch L. Exploring the relationship between postural demands and manual asymmetries in pegboard performance. Brain Cogn 1999;40,272-5

4. Chan T; An investigation of finger and manual dexterity. Percept Motor Skills 2000Apr; 90(2):537-42.

5. Schmidt SL, Oliveria RM, Rocha FR, Abreu-Villaca Y. Influences of handedness and gender on the Grooved Pegboard Test. Brain Cogn 2000;44:445–54

6. Bryden PJ, Roy EA. A new method of administering the Grooved Pegboard Test: performance as a function of handedness and sex. Brain Cogn 2005;58;258–68. 7. Nalçaci E, Kalaycioğlu C, Ciçek M, Genç Y. The relationship between handedness and fine motor performance. Cortex 2001 Sep; 37(4):493-500.

8. Ruff RM, Parker SB. Gender- and age-specific changes in motor speed and eye-hand coordination in adults: normative values for the Finger Tapping and Grooved Pegboard Tests. Percept Mot Skills 1993;76:1219–30

9. Jinhua Guan and Michael G. Wade . The Effect of Aging on Adaptive Eye-Hand Coordination. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences,2000;55:P151-P162.

10. Ryan CM, Morrow LA, Bromet EJ, Parkinson DK. Assessment of neuropsychological dysfunction in the workplace: normative data from the Pittsburgh Occupational Exposures Test Battery. J Clin Exp Neuropsychol 1987;9:665–7.

11. Mitrushina MN, Boone KB, D’Elia LF. Handbook of normative data for neuropsychological assessment. New York: Oxford University Press, 1999.

12. Lezak MD. Neuropsychological assessment. New York: Oxford University Press, 1995,Page 136.

13. Reddon JR, Gill DM, Gauk SE, Maerz MD. Purdue Pegboard: test-retest estimates.Percept Mot Skills. 1988 Apr;66(2):503-6

14. Barbara M. Haward, Michael J. Griffin. Repeatability of grip strength and dexterity tests and the effects of age and gender;International Archives of Occupational & Environmental Health;2004;75;111-119

15. William K.Cody, Jennet W.Kenney. Philosophical and Theoretical Perspectives for Advanced Nursing Practice. Jones and Barlett Publisher, 2006.Page 136.