Hand Therapy最新文献

Introduction: Access to hand therapy is a challenge in low to middle-income countries but is also restricted for many communities in high-income countries. As an essential part of the global rehabilitation community, hand therapists must consider how to extend access to basic hand therapy services and strengthen the capacity of the therapists who provide these services. This study aimed to identify capacity-strengthening strategies for generalist occupational therapists responsible for delivering hand therapy in the South African public health service.

Methods: A consensus development methodology was employed. A hybrid consensus development conference was used to gather local and international evidence pertinent to the project's aim. A panel representing service users (n = 2), service providers (n = 5), research (n = 1), education (n = 1) and professional organisations (n = 5) systematically considered the evidence presented at the conference using a nominal group technique.

Results: The panel identified ten priority areas for action: supervision and support; resources; policy, leadership and governance; education and training; professional knowledge and skill; effective referral and care pathways; data and evidence for service improvement; professional attitudes, behaviours and dispositions; inter- and intra-disciplinary action and cohesion; and an intersectoral systems approach.

Discussion: The priority areas were categorized and are discussed as strategic, educational, organizational, and operational priorities for strengthening the capacity of generalist occupational therapists to deliver quality hand therapy. We suggest ways that both local and global hand therapy communities can take action to position hand therapy as an essential part of universal health coverage.

Introduction: Limited research exists on the post-operative treatment of extensor pollicis longus (EPL) repair (tendon transfer and direct repair). Early active motion (EAM) and dynamic extension splinting (DES) are becoming more common compared to static casting. The aim of this systematic review was to determine whether EAM was superior to DES post EPL direct repair or tendon transfer. Outcomes of interest included range of motion, strength, and adverse events.

Methods: A systematic search of AMED, EBSCO health database (CINAHL, MEDLINE, and SPORTDiscus), and Scopus was completed. Randomised control trials or cohort studies were included if they followed either an EAM or DES rehabilitation protocol and assessed total active motion, grip strength, pinch strength, or range of motion post EPL surgical repairs. Data extracted included the surgical procedure, rehabilitation protocols, and results. The Downs and Black checklist for clinical trial quality assessment was utilised to assess the methodological quality.

Results: Six studies met the inclusion criteria. Five studies included DES and two studies included EAM. Both interventions resulted in improvements in ROM, grip strength and pinch strength with neither intervention being superior. There was no increase in adverse outcomes by using EAM or DES. The risk of bias following assessment of methodological quality of included studies ranged from good to poor.

Discussion: The use of EAM should be considered post EPL repair or tendon transfer. EAM does not result in superior outcomes post EPL repair compared to DES, equally EAM does not appear to be inferior compared to DES.

Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered across care settings, but current patterns of care and clinicians beliefs about the care they provide remains unclear.

Objective: This study aimed to record management approaches to care for NTWD across clinical groups and care settings.

Methods: Ethical approval was sought for an online cross-sectional survey of clinicians [1 Jul - 1 Nov 2023], comprising 18 questions exploring profession, work setting, exposure to NTWD, alongside diagnostic and management confidence. UK-based musculoskeletal (MSK) clinicians were invited to participate through special interest groups, online forums, social media and professional network emails.

Results: Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure and profession. Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure, profession and clinical setting. Several Patient Related Objective Measures (PROMS) were used by clinicians to assess treatment effect, set goals, and communicate with patients.

Conclusion: This study provides the first description of UK clinicians management of non-traumatic wrist disorders across professional groups and healthcare settings. As evidence-based management remains elusive, deeper understanding of the clinical decision-making and practice behaviour of clinicians would have value in future studies into NTWD.

Introduction: The first web space of hands has been understood to be important in daily activities involving the motions of cylindrical grasp and pinch. However, surgical and rehabilitation decision-making based on first web deficiency is challenging without clear definitions of function. This study aimed to evaluate the methods used to measure first web space and synthesize the evidence on its functional definition in children up to 18 years old.

Methods: This review followed Arksey and O'Malley's six-stage framework operationalized by the Joanna Briggs Institute (JBI) methodology for conducting a scoping review. In conjunction with a medical librarian, 4440 term combinations were searched on MEDLINE from inception until January 2023. Title/abstract and full-text screening processes were conducted, followed by charting, collating, and summarizing included articles by two independent reviewers.

Results: Of 162 studies screened, 20 studies were included. The first web space was most commonly measured in palmar abduction (50%) of the carpometacarpal angle (45%) radiographically (30%). Systematic methods were rarely used (5%) to evaluate activity and participation function of first web limitations. Definition of a cutoff angle or first-web span that represented sufficient functional outcome was difficult to synthesize due to a lack of standard measurement methods.

Discussion: While the first web function was quantified in the studies, these values are problematic due to inconsistent measurement methods. A standardized assessment of first web space impairment and its relationship with activity and participation function is clinically significant for evaluating the need and meaningful outcomes of surgical and therapy interventions in children.

Introduction: To our knowledge, no previous studies have directly compared the effects of orthosis wear in males and females with thumb carpometacarpal (CMC) joint osteoarthritis. Therefore, this study aimed to analyze whether there are differences between males and females in pain, hand function, and grip strength following hand-based orthosis wear.

Methods: The study included 14 male and 14 female participants with first- and second-degree CMC joint osteoarthritis. A hand-based orthosis was custom-molded for each participant. Pain, function, grip strength, and pinch strength were evaluated at baseline and after a 6-week period of orthosis wear.

Results: Twenty-eight participants (mean age: males 64.6 ± 5.1 years; females 63.5 ± 3.2 years) completed the study. After 6 weeks of orthosis use, both males and females showed significant improvements in grip strength, pinch strength, hand function, daily activity performance, and pain reduction (all p < .05). Although both sexes benefited similarly in grip strength, pain, and function, females reported significantly greater improvement in satisfaction with hand function (p = .020). Mean adherence was 84.75%, with higher compliance observed in females.

Conclusion: Although both groups experienced significant improvements in pain, function, grip strength, pinch strength, and overall satisfaction with orthosis wear, greater improvement in satisfaction with hand function was observed among females.

Background: Handgrip strength (HGS) is a key indicator of upper limb function and overall health. While the Jamar dynamometer is considered the gold standard for HGS assessment, alternatives like the Jamar Plus+ and Biodex have emerged, though their reliability and agreement remain underexplored.

Aim: To evaluate the test-retest reliability and agreement of the Jamar, Jamar Plus+, and Biodex dynamometers in healthy young adults.

Methods: This exploratory cross-sectional study included 35 participants (22 females, 13 males; mean age 23.4 years). HGS was assessed using the three devices, following standardised protocols, with retest after 7 days. Reliability was analysed using the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). Agreement was examined through Bland-Altman plots and Limits of Agreement (LoA %).

Results: Jamar and Jamar Plus+ showed excellent reliability (ICC = 0.96-0.98) and strong agreement, with narrow LoA percentages and low measurement error, especially on the non-dominant hand. In contrast, comparisons involving the Biodex revealed wider LoA (up to ±73%) and higher SEM and MDC values, indicating lower agreement with handheld devices. These discrepancies are likely due to differences in measurement principles, hand positioning, and unit conversion. Male participants showed significantly higher grip strength across all instruments.

Conclusion: The Jamar and Jamar Plus+ can be used interchangeably. The Biodex may be considered when appropriate adjustments are made, though its agreement with handheld dynamometers is limited. These findings highlight the need for standardised protocols and further research to ensure consistent and reliable HGS assessment across devices.

Background: Objective evaluation of grip strength is crucial for determining functional status of patients and demonstrating treatment effectiveness. A novel dynamometer, K-Force® Grip, has been developed that can work in conjunction with smart devices. However, the device has a smaller circumference compared to the Jamar®Plus+ and lacks an adjustable grip width, unlike the Jamar®Plus+. The aim of this study was to assess the validity and reliability of the K-Force® Grip across different hand sizes in healthy subjects.

Methods: We recruited 1 23 healthy subjects (n=246 hands) and categorized them based on hand length and span. Grip strength was measured using both the Jamar®Plus + hydraulic hand dynamometer and the K-Force® Grip dynamometer.

Results: Inter-device consistency was excellent for the overall population (ICC=0.937) and for individuals with large hand spans and long hand lengths. It was good for other anthropometric groups. However, ICC estimates for absolute inter-device agreement indicated high variability and were unstable (as indicated by the confidence intervals including zero). BlandAltman plots suggest K-Force® values are systematically lower than those from the Jamar®Plus+.

Conclusion: The devices should not be used interchangeably in research settings. For clinical follow-up, the Jamar®Plus + dynamometer is recommended, especially in adolescent populations where hand growth continues over time.

Background: An ageing population and increasing chronic health disorders explain the predicted rise in hand surgeries. Preoperative care has the potential to optimise patients' psychological and physical status, making it a promising area for enhancing surgical outcomes. Despite its established use in other surgical specialties, preoperative therapy in hand surgery remains underexplored.

Objective: This study uses an anonymous survey to gather therapists' opinions on the hand procedure whose outcomes benefit most from preoperative therapy. The research focuses on five common elective hand procedures: Carpal Tunnel Release (CTR); Cubital Tunnel Release (CuTR); Dupuytren's Fasciectomy (DF); Trapeziectomy (TZ); and Trigger Finger Release (TFR).

Method: British Association of Hand Therapy members were targeted in an online survey. Thirty-seven respondents (5% response rate) participated over 3 months. Questions explored how preoperative therapy improves surgical outcomes, the efficacy of postoperative therapy, and the importance of patient compliance postoperatively.

Results: TZ emerged as the procedure with the highest potential for preoperative therapy benefit, TZ and DF as top procedures for postoperative therapy requirements and importance of patient engagement and compliance. CTR had contradictory responses, while TFR and CuTR received the fewest endorsements for preoperative therapy benefits.

Conclusion: The survey offers insight into hand therapists' perspectives on preoperative therapy. TZ and DF stand out as having significant potential for optimisation. Uncertainty surrounding efficacy of therapy on Dupuytren's Disease indicates the necessity for further research. Education is considered an essential preoperative component. The small sample size warrants caution when interpreting results.

Introduction: In the United Kingdom [UK], Advanced Clinical Practice (ACP) roles are being developed to improve access to high-quality patient care, where healthcare services are struggling to meet steadily increasing service demands. Increasingly, ACP hand therapists are assessing and treating acute closed hand fractures. However, the knowledge and skills required of these roles has not been identified or standardised.

Methods: Consensus recommendations were developed from an expert panel of medical doctors and hand therapists using an electronic Delphi process. Participants were recruited from purposive and snowball sampling. Delphi questions were developed from a literature review and clinician survey and included rating of items open text responses. Consensus was defined as ≥75% agreement. Summary feedback was provided after each round.

Results: There were 20 panellists (12 medical doctors and 8 hand therapists), of which 18 (90%) completed all rounds. 23 competencies were consistently identified as very important; there was less agreement on how to evidence these competencies.

Conclusion: These findings can be used to develop ACP hand therapist roles and provide a framework to guide individual therapists to base their own learning and development. They underpin safe, efficient and costeffective patient care.

Introduction: Hand allotransplantation is a treatment option available for individuals who have suffered a traumatic upper extremity injury. To date, there is not an industry-standard recognized measurement tool to assess post-hand allotransplantation functional performance. A commonly used observational functional assessment tool is the Carroll Upper Extremity Function Test (UEFT). This study explored therapists' perceptions of the Carroll UEFT applicability to measure functional outcomes post-hand allotransplantation.

Methods: The study employed a qualitative phenomenological approach with in-depth, semi-structured interviews with five occupational therapists and two physical therapists representing five hand transplant centers in the United States. Braun and Clarke's six-phase thematic analysis approach was utilized for data analysis.

Results: The findings generated four themes: (1) scoring is too vague and subjectivity prevails, (2) questionable reliability of the scores, (3) translates to real-life functional tasks, and (4) outcomes affecting decisions.

Conclusion: The study identified limitations of the Carroll UEFT as applied to a targeted population, hand transplant recipients. The scoring is too vague and subjectivity prevails theme was the most resonant theme generated from the participants, with a call for standardization of the assessment. This theme was followed by questionable reliability of the scores, which identifies concerns regarding the reliability of the Carroll UEFT. Rehabilitation services associated with hand allotransplantations can incorporate the findings of this study and collaborate to identify and navigate the transition to an evaluation tool with strong psychometrics for best practice in the assessment of functional outcomes for hand-transplant recipients.