Journal of Hand Therapy最新文献

Background: The utilization of standardized patient-rated outcome measures (PROMs) by hand therapists is essential to evaluate treatment and clinical outcomes and underpins evidence-based and patient-centered practice. However, research indicates that the routine use of PROMs is inconsistent in clinical practice.

Purpose: To explore the barriers and enablers experienced by hand therapists in the routine use of standardized and valid PROMs. Additionally, it aimed to describe appropriate strategies, based on the barriers and enablers identified, to improve the administration of PROMs in hand therapy practice.

Study design: Qualitative.

Methods: Semistructured interviews were used to explore the experiences of hand therapists in routinely using PROMs in clinical practice at two Australian tertiary public hospital hand clinics. Qualitative data were analyzed for themes using reflexive thematic analysis described by Braun and Clarke.

Results: Ten participants were interviewed. Interview findings generated three core themes-Culture is King, It's All Too Hard and When I do it, I value it. The core themes-Culture is King and It's All Too Hard reflected the cultural and institutional factors that present as barriers to the routine uptake of standardized PROMs, such as lack of infrastructure to support data collection and a lack of knowledge of PROMs. The third core theme, "When I do it, I value it" reflects the value and importance of completing PROMs to facilitate evidence-based practice and benefits in tracking treatment progress and providing feedback regarding their progression. Suggested strategies for addressing barriers included using appropriate and standardized methods of collecting and storing PROM data, improving accessibility to PROMs in clinical practice and forming peer education groups and training opportunities.

Conclusions: Hand therapists identify the value and importance of completing PROMs in daily practice; however, culture in the workplace and organizational infrastructure adversely influence the routine use of standardized PROMs by hand therapists.

Background: In 1998, the American Hand Therapy Foundation (AHTF) surveyed Certified Hand Therapists and active Charter Members of the American Society of Hand Therapists to identify hand rehabilitation research priorities, guide grant awards, and confirm alignment with the foundation's mission.

Purpose: The American Hand Therapy Foundation repeated the survey in 2021 to confirm that its award funding was consistent with hand therapists' research priorities.

Study design: Convergent parallel mixed method study design.

Methods: The survey was sent to 7093 hand therapists from the United States and overseas. Respondents' demographic information was captured using quantitative questions analyzed with descriptive statistics and weighted means. Research priorities and interests were captured using qualitative questions, Grounded Theory analysis, and Constant Comparative Methods.

Results: A total of 397 surveys were returned and analyzed (5.6% return rate, 95% confidence level, 5% margin of error). Participants' top research priorities were outcome studies and research grants. Tendon injuries and lateral epicondylitis were the highest prioritized diagnoses for further research. Intervention study priorities included hand rehabilitation management strategies and use of orthoses. Responses presented a need for funded outcomes research validating hand rehabilitation interventions. Level of interest in research participation was in data collection and as coauthor. Top barriers to participation in research activities were time constraints and lack of proficiency. Research education for clinicians and mentorship programs were identified as specific needs.

Conclusions: American Hand Therapy Foundation research award funding was consistent with practice and reported research concerns. Participants identified their top concerns for diagnostic and outcomes research and prioritized continuing Foundation involvement in funding clinical research.

Background: For patients who experience atypical neurogenic pain thought to be complex regional pain syndrome (CRPS) after Dupuytren's fasciectomy early recognition has been reported to improve outcomes. Furthermore, given the progressive nature of Dupuytren's, individuals with a history of CRPS have been "at risk" for further surgical intervention.

Purpose: To familiarize therapists with a Budapest criteria (BC) checklist for early diagnosis of CRPS, describe how tracking sudomotor/vasomotor signs alongside differences in skin temperature were used to monitor vasomotor instability and intervention effectiveness for a patient with atypical pain after fasciectomy and to detail management of the same patient with a CRPS history who had collagenase clostridium histolyticum (CCH) injection of her other hand without exacerbating CRPS.

Study design: Case report.

Methods: Medical record review was done by the author. Part 1- patient-reported symptoms and therapist-observed signs were mined and scored against the BC. Part 2- vasomotor/sudomotor signs and differences in skin temperatures (>1˚C) were used to interpret response to therapy and medical interventions. Part3- description and pictures of the process this patient underwent for CCH and manipulation.

Results: Part 1- therapist documentation failed to satisfy the BC. Part 2- vasomotor/sudomotor signs and skin temperature differences of >1˚C reflected the patient's incomplete response to therapy and medication, thus strengthening need for percutaneous stellate ganglion sympathetic nerve blocks. Part 3- CRPS was not exacerbated with CCH procedure.

Conclusions: Use of a BC checklist may guide documentation, speed recognition for an earlier diagnosis of CRPS in patients with Dupuytren's and an atypical post-fasciectomy response. Once identified, observed signs and measures of skin temperature could be used to monitor response to therapy and medical interventions. The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection are encouraging.

Background: Stenosing tenosynovitis, or trigger finger, is a common cause of hand disability. This study outlines a trigger finger management protocol that redirects referrals for surgical consultations to conservative management first.

Purpose: The primary outcome variable was the protocol endpoint based on the resolution of trigger finger symptoms (i.e. pain and triggering). Secondary outcome measures were to identify which patient characteristics were associated with an increased need for (i) surgical management and (ii) corticosteroid injections.

Study design: Retrospective chart review.

Methods: The study sample included all patients referred for surgical consultation for trigger finger who were redirected to physical therapy first between the dates of August 2018 and January 2023 (n = 72). Participants initially received a physical therapy assessment and three treatment sessions. Further management was determined based on patient presentation following our protocol. Descriptive analysis involved frequency calculations of studied variables. Comparison of patient characteristics and treatment modalities across different sub-groups was examined as well as associations between various patient characteristics and increased need for (i) surgical management and (ii) corticosteroid injection.

Results: Seventy-two patients were included in the study, and 60 patients completed the protocol. Of these patients, 22% (n = 16) resolved with physical therapy (PT) alone, 48.5% (n = 35) resolved with 1-2 corticosteroid injections following initial PT management and 12.5% (n = 9) were referred back for surgical consult. Sub-group comparisons revealed no significant differences in patient characteristics and treatment modalities across patients who resolved with physical therapy alone, physical therapy plus 1-2 injections, or in cases referred back for surgical consults.

Conclusion: The interdisciplinary care protocol in this study demonstrated that conservative management was successful in a majority of cases; facilitating timely access to evidence-based care, including corticosteroid injections and surgical management if necessary. Physical therapy treatment provides self-management and education strategies to those requiring further interventions, potentially reducing recurrence rates.

Background: Epicondylalgia is a common overuse injury in tennis. However, little is known regarding epicondylalgia in pickleball.

Purpose: This study examined the prevalence of positive epicondylalgia tests in recreational pickleball players and the relationship between positive tests and player characteristics.

Study design: Cross-sectional study.

Methods: Clinical tests for epicondylalgia were performed courtside on the dominant arm of 129 recreational pickleball players. Participants completed a survey with questions related to demographics and play characteristics. Descriptive data were reported for epicondylalgia testing and survey performance. Chi-squared analysis and Fisher's exact test were used to determine associations between testing and survey responses. Relative risk estimates for positive tests for epicondylalgia were calculated based on pickleball playing characteristics.

Results: The prevalence of positive tests was 7% for medial epicondylalgia, 5.4% for lateral epicondylalgia, and 2.3% for both medial epicondylalgia and lateral epicondylalgia. Ninety-two participants (71.3%) completed the survey. Those who participated in tournaments were less likely to have a positive test for medial epicondylalgia (Fisher's exact test, p = 0.017). The relative risk of having a positive epicondylalgia test was lower for those who have played for at least 4 years (medial = 0.875 [CI 0.81-0.95] and lateral 0.913 [CI 0.866-0.979]). Epicondylalgia testing was not associated with age, sex, hand dominance, level of play, location of play, warm-up performance, frequency of play, or length of play.

Conclusions: Among pickleball players, there was a lower prevalence of positive tests for lateral epicondylalgia than for medial epicondylalgia. Compared to tennis, lateral epicondylalgia may be less common due to a lower elbow torque, while medial epicondylalgia may be more common due to methods to impart spin. Given the differences among sports, clinicians may need to utilize different prevention and intervention strategies when working with pickleball players.

Background: De Quervain's tenosynovitis (QT) is common among individuals performing repetitive manual tasks and significantly affects daily activities due to pain. While traditional treatments often provide limited relief, high-intensity laser therapy (HILT) shows as a potential analgesic resource.

Purpose: This systematic review aimed to evaluate the analgesic effects of HILT in patients with QT.

Study design: This study is a systematic review with meta-analysis with an observational, retrospective, and secondary design.

Methods: The search was conducted in PubMed, Web of Science, Scopus, EBSCOhost, Embase, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar (last updated September 17, 2024) to identify clinical trials comparing HILT with other treatments for QT. Pain intensity, measured with a Visual Analog Scale (VAS), was the main outcome. Disability and handgrip strength, measured with the quick disabilities of the arm, shoulder and hand (Q-DASH) and patient-rated wrist and hand evaluation (PRWE) questionnaires and dynamometry, were the secondary outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool 2 (RoB2), and a meta-analysis was performed using mean difference (MD) or standardized mean difference (SMD). The GRADE approach guided evidence-based recommendations for statistically significant outcomes.

Results: Three studies were included, demonstrating an overall low bias (66%), with outcome measurements being the principal sources of bias. The meta-analysis did not reveal statistically significant advantages for HILT in terms of pain intensity and disability (VAS MD=0.21 cm; 95% CI: -1.43,1.86) (SMD=-0.31; 95% CI: -0.75,0.13). Despite individual studies reporting significant differences favoring HILT, the meta-analysis lacks statistical significance, preventing definitive recommendations.

Conclusions: Despite the potential benefits of HILT in managing QT, the current evidence does not support its superiority over conventional treatments like splinting or splinting combined with exercise. Further clinical trials are necessary to confirm HILT's efficacy and refine treatment guidelines in line with the dosage proposed by the included studies.