Journal of Hand Therapy最新文献

Background: Complex regional pain syndrome type I (CRPS-I) is a painful condition with peripheral and central nervous system dysfunction, disproportionate inflammation, and the resultant muscle atrophy and restriction of motion. The use of high-intensity laser therapy (HILT) is being considered to reduce inflammation and neural and musculoskeletal pain. As maladaptive neuroplasticity occurs, peripheral treatment may not be enough and a combination of peripheral and centrally-focused interventions may be required.

Purpose: To explore the impact of HILT combined with mirror therapy (MT) on pain intensity, swelling, functional ability, range of motion (ROM), and electromyography (EMG) activity in CRPS-I.

Study design: Randomized, sham-controlled, single-blind clinical trial.

Methods: Twenty-four CRPS-I patients were randomly assigned to two groups of HILT at 5 watts with an energy density of 20 J/cm², combined with MT and sham HILT and MT for six sessions. Pain was assessed by the Visual Analog Scale (VAS) before, the third session, and after the treatment. Hand swelling, function, and ROM were measured by a motion analysis system, and EMG of the hand muscles was also evaluated.

Results: Pain significantly decreased in the HILT group. Compared to before treatment, the VAS mean difference in the third session was -2 ± 0.8 in the HILT group versus -0.4 ± 0.5 in the sham group (p < 0.001, ηp2 = 0.57). The VAS mean difference for before-after treatment was -4.2 ± 1.2 in the HILT group versus -1.4 ± 0.6 in the sham group (p < 0.001, ηp2 = 0.69). The other outcomes, like function, effusion, ROM, and EMG activity, were also in favor of the HILT group (p < 0.05).

Conclusions: Our study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. Additionally, HILT effectively reduced swelling, improved performance, and enhanced muscle activity in CRPS-I.

Background: Lateral elbow tendinopathy is a common condition that causes pain and functional impairments, limiting daily activities.

Purpose: This study aimed to compare the efficacy of high-intensity laser therapy, kinesio taping, and therapeutic exercises in terms of pain, function, disability, and muscle strength.

Study design: Prospective randomized controlled trial.

Methods: Fifty-five patients were randomly assigned into three groups. The first group received high-intensity laser therapy + therapeutic exercises, the second group received kinesio taping + therapeutic exercises, and the third group received therapeutic exercises alone. Evaluations were performed before treatment (PreT), immediately after treatment (PostT), and 4 weeks after treatment (PostT-4). Outcomes were measured using the Visual Analog Scale (VAS), Quick Disability of the Arm, Shoulder and Hand (Q-DASH), the Patient-based Lateral Epicondylitis Evaluation (PRTEE), and grip strength.

Results: Both high-intensity laser therapy and kinesio taping showed significant improvements in PRTEE scores at PostT and PostT-4. Kinesio taping was superior to therapeutic exercises but showed no difference compared to high-intensity laser therapy. All groups showed significant improvements in Q-DASH scores at PostT-4, with high-intensity laser therapy and kinesio taping being more effective than therapeutic exercises. No significant differences were found between the groups for VAS and grip strength.

Conclusions: Therapeutic exercises alone is effective in treating lateral elbow tendinopathy, while high-intensity laser therapy and kinesio taping provide additional benefits in improving function and reducing disability. There was no superiority between high-intensity laser therapy and kinesio taping, but both were more beneficial than therapeutic exercises alone.

Background: Assessing upper extremity function accurately in the clinic hinges on valid, reliable outcome measures and patient engagement. Especially in pediatric care and research, video-game-based and play-based assessments may help motivate performance and support more effective clinical evaluation.

Purpose: This systematic review critically appraised the gamified assessments available for pediatric upper extremity function.

Study design: Systematic review (PROSPERO: CRD42023460034).

Methods: Databases included PubMed, Embase, CINAHL, and Scopus. Eligible studies evaluated psychometrics and included children under 18 years. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, two reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics and evidence quality by the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology.

Results: Reviewers screened 2513 studies; 27 reports describing nine outcome measures were included. The observer-rated Assisting Hand Assessment (AHA) family, which includes four age-based versions for children with unilateral hand dysfunction and the Both Hands Assessment for bilateral dysfunction, has extensive psychometric evidence. These are well-structured, reliable, and feasible assessments that engage patients with age-appropriate toys and board games while evaluating functions such as grasp, fine-motor adjustment, and bimanual coordination. Validation for additional upper extremity conditions is warranted. We also recommend two video-game-based kinematic measures, which quantify upper extremity function objectively. Abilities Captured Through Interactive Video Evaluation (ACTIVE) is appropriate for degenerative neuromuscular diseases; ACTIVE was the only kinematic assessment in this review with at least moderate-quality evidence of sufficient psychometrics. However, based on preliminary evidence, a recently developed dragon-themed video game is a strong candidate for quantifying joint range of motion, potentially serving a broader patient population than ACTIVE.

Conclusions: Overall, we endorse the AHA family as a set of well-structured, reliable, and feasible observer-rated assessments that engage patients through play sessions thoughtfully geared toward different developmental stages. Two kinematic measures are promising and warrant further study.

Background: The Michigan Hand Questionnaire (MHQ) is a widely used patient-reported outcome measure (PROM) for assessing hand function. Cross-cultural adaptations are necessary to ensure its applicability and validity in diverse cultural contexts. However, the quality and psychometric properties of these adaptations remain unclear.

Purpose: This systematic review and meta-analysis aim to evaluate the psychometric properties, specifically reliability and content validity, of cross-cultural adaptations of the MHQ.

Study design: Systematic review and meta-analysis.

Methods: A systematic review following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted across four electronic databases, encompassing studies published between 1998 and 2024. Quality and content validity assessment was performed using the COSMIN methodology. Random effects meta-analysis was conducted for interclass correlation coefficient (ICC) and Cronbach's alpha.

Results: Twenty-one studies were included. We identified two studies with high-quality evidence for content validity and ICC, and two studies demonstrating strong internal consistency. The MHQ demonstrated strong internal consistency (Cronbach's alpha: 0.73-0.99) and moderate to high test-retest reliability (ICC: 0.91-0.93). However, significant heterogeneity was observed in Cronbach's alpha and ICC values across domains, likely due to factors beyond test-retest duration. Meta-regression analysis revealed publication bias, possibly influenced by participant and study characteristics.

Conclusion: This meta-analysis supports the reliability of the MHQ for assessing hand function across cultures. However, variability in ICC values suggests a need for further investigation into factors influencing reliability. While the MHQ is a valuable tool, future research should address limitations in structural validity and explore cultural factors to enhance its cross-cultural applicability.

Background: Rotator cuff disease treatment typically involves manual therapy and exercise as part of physical therapy.

Purpose: This study aims to investigate the effects of Mulligan and Maitland mobilization methods on pain, functionality, quality of life, and proprioception in individuals with rotator cuff lesions. STUDY DESIGN: This was a single-blinded randomized clinical trial.

Methods: The study included 45 individuals with rotator cuff lesions. Participants were randomly divided into three groups: conventional exercise, Maitland mobilization, and Mulligan mobilization. All participants were assessed pretreatment and post treatment using the Visual Analog Scale, Disabilities of the Arm, Shoulder, and Hand, Rotator Cuff Quality of Life, range of motion (ROM), and proprioception.

Results: All parameters, except proprioception, improved significantly in all three groups post treatment (p < 0.05). Mulligan group (MG) and Maitland mobilization group (MMG) had higher improvements to the conventional exercise group (CG) in terms of flexion ROM (p = 0.05, effect size = 0.22), abduction ROM (p = 0.02, effect size = 0.26), Disabilities of the Arm, Shoulder, and Hand (p < 0.001, effect size = 0.56). Also, the MG group had greater improvements to the MMG and CG groups in terms of Rotator Cuff Quality of Life/symptoms (p < 0.001, effect size = 0.43), job (p < 0.001, effect size = 0.61), lifestyle (p < 0.001, effect size = 0.42), emotional parameters (p < 0.001, effect size = 0.29). MG was more effective than the MMG in Visual Analog Scale activity (p < 0.001, effect size = 0.32), external rotation (p = 0.012, effect size = 0.19), and abduction ROM (p = 0.002, effect size = 0.26). However, no improvement in proprioception was observed across all groups (p > 0.05).

Conclusions: This study concluded that, in addition to conventional treatment, both Mulligan and Maitland mobilization therapy effectively improve range of motion, functionality, and quality of life.

Background: Flexor tendon injuries in zone II of the hand pose serious clinical complications due to the high risk of adhesion formation and suboptimal clinical outcomes, although controlled active motion (CAM) and early passive mobilization (EPM) are standard protocols used during rehabilitation.

Objective: This randomized trial compared functional outcomes between CAM and EPM systems after zone II flexor tendon repair.

Methods: Forty patients with entire zone II flexor digitorum profundus and superficialis tears were randomly assigned to either the CAM or EPM protocol for 12 weeks' rehabilitation. Total active motion (TAM), grip strength, and disability of the arm, shoulder, and hand (DASH) scores were assessed in the 6th and 12th week after the repair. Two-way mixed ANOVA was used to determine the effect of the treatment regarding the type of protocol and time within and between groups, as well as, Cohen's d was used to calculate the effect size.

Results: There was a significant improvement over time in both groups for all measured outcomes (p < 0.001). However, CAM showed superior results than EPM across all time points (6th and 12th week); for TAM (p < 0.05, Cohen's d =11.8 and 9.9), grip strength (p < 0.05, Cohen's d = 7.97 and 9.7), and DASH score (p < 0.05, Cohen's d = 5.8 and 5.5). By 12 weeks, 80% of CAM patients achieved an "excellent" rating according to the Strickland formula of the TAM grading compared with 55% for the EPM group.

Conclusion: While both CAM and EPM protocols improve functional status after zone II flexor tendon repair, CAM confers a distinct early advantage in a digital range of motion and manual function compared with EPM. These data support the preferred adoption of the CAM rehabilitation approach after area II flexor tendon surgical repair.

Background: Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease. Musculoskeletal and neurological system involvement occurs in patients with pSS, which may lead to impairment in hand function. Hand dysfunction and its underlying causes remain an underexplored area in pSS.

Purpose: This study aims to evaluate hand function in patients with newly diagnosed pSS, exploring the associations with disease activity, clinical parameters, and radiographic and ultrasonographic findings.

Study design: Cross-sectional.

Methods: Fifty patients with newly diagnosed pSS and 50 healthy controls were recruited in this study. Hand functions were evaluated using the Duruöz Hand Index (DHI) and hand grip strength measurements. Detailed hand physical examination was made. Carpal tunnel syndrome (CTS) was assessed with the CTS -6 questionnaire and electrodiagnostic methods. Hands A-P radiography was evaluated for joint erosion, joint space narrowing. Ultrasonographic assessment of hand was made for intercarpal and metacarpophalangeal joint synovitis and extensor tenosynovitis. Additional evaluations included the Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36), Fatigue severity scale (FSS) and the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI).

Results: Patients with pSS exhibited significantly higher DHI scores compared to controls (p = 0.027, r = 0.22) and lower non-dominant hand grip strength (p = 0.016, r = 0.30), while dominant hand grip strength did not differ significantly (p = 0.520, r = 0.08). Higher HADS anxiety (p < 0.001, r = 0.63) and depression scores (p < 0.001, r = 0.55) were noted in pSS patients. Additionally, these patients had reduced SF-36 scores (p < 0.001, r = 0.53). DHI scores were significantly correlated with ESSDAI (ρ = 0.413, p = 0.003), SF-36 (ρ = -0.605, p < 0.001), HADS (**ρ = 0.307 for anxiety, p = 0.030; ρ = 0.286 for depression, p = 0.044), hand grip strength (ρ = -0.298 for dominant hand, p = 0.036; ρ = -0.280 for non-dominant hand, p = 0.049), Health Assessment Questionnaire (HAQ) (ρ = 0.893, p < 0.001), and FSS (ρ = 0.378, p = 0.007). Ultrasonographic evaluations revealed synovitis and/or tenosynovitis in 18% of patients, while CTS was detected in 32%.

Conclusions: This study highlights significant hand function impairments in newly diagnosed pSS patients, with DHI scores correlating with disease activity, psychological well-being, and general health. These findings underscore the importance of early and comprehensive hand assessments using advanced diagnostic tools to improve patient outcomes.

Background: The COVID-19 pandemic prompted a shift in healthcare delivery, necessitating the rapid adoption of technology, including telerehabilitation. This study focused on understanding the current perspectives and experiences of hand therapists in Canada and the United States regarding implementation of telerehabilitation in hand therapy, traditionally reliant on in-person interactions.

Purpose: The study aimed to assess the utilization, perceptions, and barriers of telerehabilitation among hand therapists, providing insights into challenges and opportunities for incorporation into practices.

Study design: A cross-sectional survey collected responses from hand therapists through electronic surveys distributed via the American Society of Hand Therapists (ASHT) and the Canadian Society of Hand Therapists (CSHT) mailing lists.

Methods: The survey, approved by the Western University Health Sciences Research Ethics Board, included nine demographic questions, eight rating questions, and four open-ended questions, focusing on technology acceptance and telerehabilitation satisfaction. Participants met criteria as licensed therapists with expertise in hand rehabilitation, practicing in Canada or the United States.

Results: A total of 129 participants completed the survey. Most therapists (84.3%) reported high comfort with basic technology, yet only 56.8% used technology in practice. Common modalities included internet (71.2%), telephone (61.8%), and smartphone applications (53.2%). Only 1.6% reported frequently using biometrics, and 0.0% for advanced technologies like wearables. While 75% recognized telerehabilitation's usefulness in improving patient accessibility, 91.5% believed it could not fully replace traditional methods. Concerns included poor quality in assessing orthoses fit (69.9%) and strength (53.3%). United States respondents were less likely to report current use of telerehabilitation (OR: 0.195; 95% CI [0.064-0.595]).

Conclusions: The study addressed technology-related challenges and highlights hand therapists' perceptions towards integrating telerehabilitation. Barriers related to rural areas and diverse patient conditions emphasize the importance of tailored approaches. Future directions should explore emerging technologies like virtual reality and artificial intelligence for enhanced clinical effectiveness of telerehabilitation.

Background: Restoration of hand function postextended radial forearm free flap (E-RFFF) is vital but challenging due to complex forearm anatomy and potential complications like reduced range of motion and sensory deficits. Traditional rehabilitation protocols often do not effectively address these issues.

Purpose: This study aims to explore the effectiveness of a hand therapy protocol that incorporates early active motion to enhance recovery outcomes after E-RFFF.

Study design: Case series.

Methods: The protocol was applied retrospectively to eight patients undergoing E-RFFF between 2022 and 2024, assessing variables such as edema, pain, range of motion, strength, and sensation at two postoperative follow-ups.

Results: Initial findings indicate the protocol facilitated improvements in thumb opposition, wrist movements, and forearm rotations with stable sensory outcomes. Pain management and edema control were effectively addressed, highlighting the protocol's comprehensive nature. There were no instances of flap failure among the patients.

Discussion: The approach centers on early active motion, including "Dart Thrower's Motion," tailored to individual recovery phases. This method showed promising results in enhancing function and reducing complications, suggesting potential modifications to standard post-E-RFFF care.

Conclusions: The study suggests that integrating early active and patient-specific hand therapy post-E-RFFF can significantly improve outcomes, challenging the conventional reliance on more passive postsurgery practices. Future research should expand on these findings to refine and generalize the protocol.