Hand Therapy最新文献

Background: Hand surgery is commonly required for conditions like Dupuytren's disease, carpal tunnel syndrome, and carpometacarpal osteoarthritis. Hand experts agree that patient education and managing expectations can optimise surgical outcomes. With an aging population, and rising rates of diabetes and obesity, a significant increase in elective hand surgeries is anticipated over the next decade.

Objective: To assess the effectiveness of preoperative therapy interventions on improving postoperative outcomes following elective hand surgery.

Method: A systematic search of six databases accessed journals from January 2011 to April 2024. Included studies assessed postoperative outcomes following preoperative therapy intervention.

Results: Seven articles met the inclusion criteria: six randomised controlled trials (RCTs) and one retrospective cohort study. Five RCTs explored effects of opioid education on postoperative consumption, all reporting statistically significant differences in favour of the intervention, with one showing a decrease of 49.7 morphine equivalent units (95% CI: 11.9 to 87.5), representing a 34.7% decrease between intervention and control. All RCTs scored poorly for risk of bias with the exception of one which assessed the effects of a neuroscience pain education on postoperative pain, reporting a non-significant decrease of 7.7% favouring the control.

Conclusion: There is a lack of quality research assessing preoperative interventions and outcomes for hand surgery. There was some indication of favourable outcomes following preoperative opioid education; however, number of studies were small, the evidence quality was poor, and data were limited. Further research is required to address these gaps and identify the most effective preoperative interventions.

Introduction: Non-adherence to splint wearing following an upper limb traumatic injury is a significant medical issue. Optimal outcome following such injuries relies on people adhering to the prescribed splint, and a failure to do so can negatively impact outcome and increase healthcare burden and costs. This systematic review aims to compare and synthesise the evidence related to measuring adherence to wear recommendations and the barriers to splint wearing following upper limb trauma in adults.

Methods: Databases (EBSCO, PubMed, EMBASE and Science Direct) were systematically searched for articles that met the pre-agreed eligibility criteria between February and May 2023. Data on study characteristics and reported outcomes relating to measuring and quantifying splint adherence and barriers to adherence were extracted.

Results: A total of 16 articles were included for final review. Several methods were used to measure adherence, with no single tool used predominantly. These included patient or therapist reported data, preexisting classification systems and an electronic device. Methods used to quantify adherence was also heterogenous in nature, and a range of investigator and patient reported barriers to splint wearing were reported.

Conclusion: This review demonstrates heterogeneity in both classifying and measuring splint adherence, as well as in the barriers to splint wearing reported. Moving forward, using agreed measurement and reporting practices for splint adherence will enable researchers to complete high quality trials to determine splinting outcomes, and may ultimately enable health care professionals to improve adherence and, subsequently, outcomes in clinical practice.

Background: Carpal tunnel syndrome is a common condition, but some controversies remain regarding diagnostics and the most effective treatments. As a result, patients often experience decisional conflicts, especially when considering carpal tunnel release surgery. Understanding factors that influence decision-making in surgery can help clinicians better grasp patient treatment preferences and priorities, reducing decisional conflicts, and enabling patients to make informed, value-aligned choices through shared decision-making. This qualitative evidence synthesis aims to explore patient perceptions of carpal tunnel release, examine the decision-making factors, and critically appraise and synthesise the existing evidence.

Methods: A systematic search was conducted across four electronic databases (MEDLINE, EMBASE, CINAHL Ultimate, PsycINFO) from inception to August 2023, supplemented by referencing and citation searching to identify eligible qualitative studies. Thematic synthesis was adopted as synthesis methodology, involving a line-by-line coding of the primary study findings, and the development of descriptive and analytical themes. Quality appraisal was conducted using the modified Critical Appraisal Skills Programme checklist, supplemented with the COnsolidated criteria for REporting Qualitative research checklist.

Results: Synthesis of six qualitative studies encompassing 66 participants generated five analytical themes: (1) Journey to normalcy, (2) Patient-centred care, (3) Work and life considerations, (4) Weighing up alternatives, and (5) Shaping the expectations, highlighting the complexity of patient decision-making in carpal tunnel release.

Discussion: In the management of carpal tunnel syndrome, therapists should consider various decision-making factors, prioritising communication and shared decision-making. This, along with personalised interactions, achieves patient-centred care and enhances patient care quality and therapeutic alliance.

Introduction: Scapholunate instability is one of the most frequent types of wrist instability, but optimal management is not established. This research aims to identify current conservative management strategies for stage-one scapholunate instability and how these interventions are evaluated in the UK.

Methods: A cross-sectional online survey of UK physiotherapists and occupational therapists with self-reported experience in the rehabilitation of stage-one scapholunate instability (ReSOS), was developed using the CROSS guideline and a clinical vignette. The frequency of treatment strategies was collated via a five-point Likert-type scale and evaluation strategies via fixed-response answers at three-to-six, seven-to-eleven and after 12 weeks post-injury. Data were analysed descriptively.

Results: Forty-three electronic surveys were completed and analysed. Thirty physiotherapists and 13 occupational therapists responded, with 90% working in the NHS. Activity advice and education was the most frequently used treatment at all time-points (100%, 98%, 98%). Quick-DASH was most frequently used region-specific patient reported outcome measure at all time-points (72%, 60%, 67%).

Discussion: Despite some identified themes, including neuromuscular rehabilitation strategies, the supporting evidence is limited in the ReSOS. It is unclear what rehabilitation and evaluation strategies are optimal and the development of a consensus on best practice is recommended.

Introduction: In recent years, three-dimensional (3D) printing has emerged as a new manufacturing technique for orthoses, showing comparable stability and wearing comfort to traditional orthoses. However, the lengthy designing and printing process is assumed to take more time than the common practice of manufacturing low-temperature thermoplastic orthoses (LTTOs). The aim of this prospective cross-sectional study was to compare the production time of 3D-printed orthoses (3DPO) to LTTOs.

Methods: The active and passive time needed to manufacture the orthoses was measured in a clinical setting. 17 orthoses (8 3DPOs and 9 LTTOs) were included in the data analysis.

Results: The mean total production time of a 3DPO (12:14:50h total time; 0:44:35h active production time) was significantly longer than in LTTOs (0:14:14h; p < 0.001).

Discussion: The longer production time might be a hurdle regarding the implementation of 3DPOs in hand therapy. Although 3D-printing might become more cost- and time-efficient due to future developments in technology and growing experience, some practical advantages of LTTOs prevail, such as the fast and efficient provision of orthoses and the adaptability of the material if subsequent changes are needed. A combination of both manufacturing techniques may be a feasible solution to provide patient-centred orthosis provision in future hand therapy practice.

Introduction: The dominance of the biomedical approach has previously caused a limited focus on occupation within hand therapy. This study aimed to investigate the rehabilitation offered to patients with a hand-related disorder (HRD) in Denmark including to determine the extent to which occupation-focused and/or occupation-based assessments and interventions are used and to identify barriers against their use.

Methods: A cross-sectional survey with 45 questions was conducted among members of the Danish Association for Hand Therapy. Data were analysed with descriptive statistics. Categorical variables were reported with frequency and percentage, and continuous variables with average and standard deviation.

Results: One hundred and six occupational therapists working as hand therapists (n = 106) completed the survey. They reported common use of assessments measuring range of motion, pain, edema, and occupational performance. Occupational performance was assessed by non-standardized occupation-focused assessments, such as informal conversations. Exercise, pain management, and occupation-focused informal conversations were reported as the most frequently used interventions. Out of 82 respondents, 74 (91.4%) reported that they used interventions focused on body function and structures to the extent they wanted. Only 41 (50.0%) used occupation-focused or occupation-based interventions to the extent they wanted.

Discussion: Assessments and interventions reporting body function and structure were used most frequently whereas assessments and interventions reporting activity and participation were used to a lesser extent. Occupation-focused assessments and interventions were used more commonly than occupation-based. Hand therapists considered occupation-based assessments and interventions to be important in rehabilitation after HRD, despite using them with few patients. Several barriers were reported regarding the implementation of an occupation-centered approach: habit, workload, time constraints, and setting.

Purpose: This study presents the use of dry needling (DN) as an intervention to support functional rehabilitation for an adult diagnosed with lateral epicondylosis.

Methods: A retrospective, single subject, AB design was implemented. A 50-year-old male with a six-month history of dominant left lateral epicondylosis received traditional interventions for 4 weeks (baseline phase; A) followed by the same interventions with the addition of DN (intervention phase; B). The QuickDASH assessment, numeric rating scale (NRS) for pain, grip strength (elbow flexed and neutral), and Maudsley's test were used as measures of effectiveness along with patient self-report of ability to perform activities of daily living (ADLS), instrumental ADLs, work, and leisure occupations.

Results: The patient made minimal progress for the initial 4 weeks of traditional treatment. There were no changes to his initial pain rating of 7/10 on the NRS, left hand grip strength (67 lbs.), or initial QuickDASH score. DN was initiated at week five with a reduction in pain from 7/10 to 2/10 from weeks six to eight. He was discharged at week 12 with no pain, a score of 0/100 on the QuickDASH, non-painful grip of 83 lbs., and a self-report of the ability to perform all ADLs, instrumental ADLs, work, and leisure occupations independently.

Conclusions: Dry needling appears to have been an effective intervention when integrated with a holistic approach for an individual with chronic lateral epicondylosis. More research is needed to evaluate dry needling as an intervention to support functional rehabilitation with a larger sample size and randomization.