Research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta says that joint damage caused by rheumatoid arthritis can lead to difficulties in typing and can force people to seek alternative-but potentially more destructive-ways of putting their fingers to the keyboard.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
People who suffer from RA often experience work limitations. In fact, without adequate treatment, 60 percent of people with RA are unable to work 10 years after the onset of their disease. The U.S. Census Bureau reports that nearly 215,000 professionals are employed as typists. For those with RA whose work depends on touch typing -typing based on knowing the location of keys on a keyboard, rather than using sight to find the keys-understanding the mechanism of hand motions during touch typing may provide insight into how people with RA can safely and efficiently type.
In a study funded in part by the ACR Research and Education Foundation, researchers recently set out to determine the effects of structural deformities on the postures and motions of the hands and wrists during touch typing. They hypothesized that touch typists with structural deformities caused by RA would have significantly different typing postures, motions and speeds than those without structural deformities. They studied 33 participants with RA to determine if their hypothesis would hold true.
Researchers videotaped each participant and studied their postures and motions while typing. Additionally, each participant''s video was rated by a certified hand therapist for the presence of visual structural deformities - damage to varying joints, which causes a visible change in the shape of the hand. Finally, typing postures and motions were rated by two raters trained in the use of the Keyboard-Personal Computer Style Instrument - an observational instrument that documents postures and actions of keyboard users.
The 22 participants with structural deformities were compared to those without. Researchers found that participants with structural deformities due to RA showed more whole hand and wrist motions-commonly called the 'hunt-and-peck'' method of typing-than those without (64 percent) structural deformities. These participants used this style of typing to activate the keys rather than individual finger motions. Finally, researchers found that significantly fewer participants with structural deformities used a wrist support, and there was no significant difference in typing speed between the two groups of participants.
Based on these findings, researchers concluded that structural deformities can affect the typing styles of touch typists with RA. Moreover, biomechanical research that examines the degree to which different postures and actions increase or reduce mechanical stress on joints suggests that alternative typing strategies-such as the hunt-and-peck style, floating the wrists, using fewer fingers, and keeping fingers straight rather than curved-may increase existing problems by putting additional stress on already affected joints.
"This research suggests that as people develop changes in the structures of their joints, they may find alternative ways to accomplish tasks," says Nancy Baker, ScD, MPH, OTR/L; associate professor at the University of Pittsburgh and lead investigator in the study. "The alternative methods are often to change their physical performance; for example they may slow down, change their postures, or move differently. While changing their performance may allow the continuance of doing the task, it may place them at risk for other problems. Thus, touch typists with joint damage may shift to techniques that place biomechanical stress on their already weakened joints."
For touch typists with RA, researchers offer alternative suggestions to ensure proper working hand and wrist posture including using an ergonomic keyboard and moveable wrist support and/or redesigning your computer workstation to better suit your individual typing needs.
"While altering tasks is almost certainly necessary in any disease or injury that causes physical changes, there are ways to make changes that are less likely to place a person at risk," says Dr. Baker. "It is often better to change the environment to support the person doing the task than it is to change the performance itself.
Occupational therapists are experts in the identification of safe and effective alternative methods to perform daily tasks and can help people with limitations to develop the method that best suits their needs. Providing access to occupational therapists may allow people with diseases like RA to identify and implement strategies that can keep them at work and at play and living life to the fullest."
The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Scientific Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.rheumatology.org/education. Follow the meeting on twitter by using the official hashtag: #ACR2010.
Editor''s Notes: Nancy Baker, ScD, MPH, OTR/L will present this research during the ACR Annual Scientific Meeting at the Georgia World Congress Center at 3:30 PM on Wednesday, November 10 in Room B311.
Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover how the ACR Research and Education Foundation''s Within Our Reach: Finding a Cure for Rheumatoid Arthritis campaign is accelerating RA research.
Presentation Number: 2142
The Effect of Structural Deformities on Typing Styles of Touch Typists with Rheumatoid Arthritis
Nancy A Baker, ScD OTR/L (University of Pittsburgh, Pittsburgh, Pa.)
Norman P. Gustafson, MS, OTR/L, CHT (University of Pittsburgh, Pittsburgh, Pa.)
Hyekyoung Shin, MSOT (University of Pittsburgh, Pittsburgh, Pa.)
Joan C Rogers, PhD, OTR/ L, FAOTA (University of Pittsburgh, Pittsburgh, Pa.)
Body: Purpose: Rheumatoid arthritis (RA) may lead to severe fixed structural deformities of the hand and wrist that may change postures/motions during touch typing. Understanding the mechanism of hand motions during touch typing may provide insight into how people with RA can use their computer safely. This cross-sectional study examined the effect of structural deformities on the postures/motions of the hand/wrist during touch typing. We hypothesized that touch typists with RA with structural deformities would have significantly different typing postures/motions and speeds than those without structural deformities.
Method: A total of 33 subjects with RA were recruited from the University of Pittsburgh Medical Center (UPMC). Subjects were adults with RA, aged from 18 to 65 years, who self-reported being touch typists. Subjects'' posture/motions during typing were videotaped and rated for visual structural deformities (VSD) by a certified hand therapist. Typing postures/motions were rated by two trained raters using the Keyboard-Personal Computer Style Instrument (K-PeCS). Typing speed was calculated in words per minute. Based on the presence of any VSD, subjects were divided into two groups: 22 subjects with VSD and 11 subjects without VSD. Chi Square statistics and independent t-test were used to compare the K-PeCS items and typing speed between the two groups.
Results: The subjects were primarily female (88%), a mean age of 56.3 8.8, and white (91%). Touch typists with VSD showed more fixed hand/wrist motions than those without VSD (Figure 1). Significantly more subjects with VSD showed whole hand motions to activate the keys rather than individual finger motions (i.e., no ulna deviation, no MCP hyperextension, straight finger joints, and use of 2 or less fingers). Significantly fewer subjects with VSD also used a wrist support. There was no significant difference for typing speed between the subjects with VSD (25.9 13.0 wpm) and without VSD (27.7 11.4 wpm) (p = .70).
Conclusion: Structural deformities can affect the typing styles of touch typists with RA. To compensate for inflexible hand movements, touch typists with VSD showed alternative typing strategies, such as hunt and peck style: moving whole hands rather than individual joints, floating the wrists, using fewer fingers, and keeping their fingers straight rather than curved. However these strategies may exacerbate existing problems by putting additional stress on already affected joints. Further evaluation by age should be considered. Possible suggestions to ensure proper working posture include ergonomic keyboard, moveable wrist support, or redesign of computer workstation.
Acknowledgements: Funding was provided by the American College of Rheumatology Research and Education Health Professional Investigator Award.
Disclosure: Nancy Baker, nothing to disclose; Norman Gustafson, nothing to disclose; Hyekyoung Shin, nothing to disclose, Joan Rogers, nothing to disclose.