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<h1>Publikation Lieb</h1>
<p>Int. J. Environ. Res. Public Health2021, 18, 9171 3of 15 2.3. Clinical Endpoints and Signs for WMSDs 2.3.1. Disabilities of the Arm, Shoulder, and Hand (DASH) Score As a second questionnaire, the validated DASH outcome measure was applied to assess physical function and symptoms [18,19]. The results of this 30-item questionnaire were used to calculate a scale score ranging from 0 (no disability) to 100 (most severe disability). 2.3.2. Visual Analog Scale (VAS) VAS is an instrument to measure the intensity of pain [20]. A Likert scale between 0 (no pain) and 10 (maximal pain) was used to collect the subjective evaluation for pain at rest and pain under strain in the form of a self-reporting measure. Results for pain at rest and pain under strain were analyzed as independent continuous endpoints. 2.3.3. Range of Motion (ROM) ROM measurements of active wrist joint mobility of both hands were performed using a goniometer in the three planes extension/flexion (E/F), supination/pronation (S/P), and ulnar/radial abduction (U/R). The measurements were recorded according to the neutral zero method [21]. The overall ranges in degrees were calculated for each plane. The primary/non-primary hand and the plane were considered as repeated measures variables in variance analyses. 2.3.4. Grip Strength Grip strength is the measurement of the maximum hand force using the Jamar dynamometer in three consecutive passes per side [22]. The measurement unit is kg. The primary/non-primary hand and the consecutive pass number were also considered as repeated measures variables. Grip strength is the accepted method of measuring the gross motor skills of the hand. 2.3.5. Purdue Pegboard (PPB) Test The neurophysiological PPB Test was performed to determine the dexterity of the participants [23]. As a former industrial test, it now serves primarily to assess disabilities and limitations. The pegboard consists of a board with two parallel rows of 25 holes, into which cylindrical metal pegs are placed by the examinee. The test involves a total of four trials [24]. The subsets for preferred, non-preferred, and both hands require the test person to place the pins in the holes as quickly as possible, with the score being the number of pins placed in 30 s. Purdue Pegboard trial number four was chosen as the representative clinical endpoint as it summarizes trial numbers 1 to 3 well by adding them up, and therefore should show the potential differences more clearly. 2.3.6. Subjective Complaints The presence of subjective complaints regarding the upper extremities of a test person was assessed in the form of a yes/no type of self-reported question. Subjects were asked about general complaints (pain, restriction of movement, and/or numbness of the upper extremity) with the request for differentiation into complaints of the elbow, forearm, wrist, and/or hand [25]. 2.3.7. Clinical Signs of Work-Related Musculoskeletal Disorders Musculoskeletal diagnoses were measured via a structured physical examination of the elbow, forearm, wrist, and hand by one single hand surgeon. The examiner was blinded to the questionnaire responses of the test persons. The diagnoses of De Quervain’s tenosynovitis, lateral epicondylitis, and nerve entrapment syndromes, including carpal tunnel syndrome (median nerve), cubital tunnel syndrome (ulnar nerve), and Guyon’s canal syndrome (ulnar nerve) were made based on pathognomonic clinical signs for upper extremity pathologies, after selection by a multidisciplinary team consisting of an occupational physician, hand surgeon, and occupational therapist [23]. These included</p>
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