Journal of Hand Therapy最新文献

Background: The first dorsal interosseous (FDI) and opponens pollicis (OP) muscles are the main stabilizers of the trapeziometacarpal joint. Optimal exercise selection based on surface electromyography (sEMG) activity may help to optimize rehabilitation programs in hand therapy.

Purpose: To compare the sEMG activity of FDI and OP during seven typical rehabilitation exercises.

Study design: Cross-sectional.

Methods: Twelve healthy participants (age: 25.92 ± 5.79, female/male: 6/6) were included. The sEMG activity of the FDI and OP was measured during seven therapeutic exercises; thumb-to-little fingertip pinch, tri-digit tip pinch, intrinsic plus fist with ball, key pinch, four- and five-finger separation with elastic resistance, and thumb-index tip pinch. Root mean square was used and adjusted to the maximum voluntary contraction (MVC) of each muscle. Friedman's test with Dunn's post-hoc was used to compare amplitude signals between exercises.

Results: Intrinsic plus fist with ball showed the highest electromyographic amplitude for FDI and OP. Post-hoc analysis revealed a statistical difference between intrinsic plus fist with ball (45.67% of MVC) and four-finger separation (8.70% MVC, p < 0.0001) for the OP. While for FDI, post-hoc analysis showed statistical differences between intrinsic plus fist with ball (49.70% MVC) and four hand exercises (thumb-to-little fingertip pinch = 12.13% MVC, p < 0.0001; tri-digit tip pinch = 13.21% MVC, p < 0.0001; four-finger separation = 18.51% MVC, p = 0.004; thumb-index tip pinch = 17.66% MVC, p = 0.0028).

Discussion/conclusion: Intrinsic plus fist with ball exercise showed the highest sEMG activation. These findings could guide hand therapists in the optimal selection of exercises, taking into account the level of muscle activity in routine rehabilitation exercises.

Background: Treatment of rotator cuff (RTC) tears commonly involves manual therapy, exercise, and injection methods. These treatments are typically administered together as components of a physical therapy intervention. However, it is not known which intervention is more effective.

Purpose: The objective of this study was to examine the impact of mobilization with movement (MWM) mobilization, a technique from Mulligan approaches, and corticosteroid (CS) injection on pain, functionality, and proprioception in cases of RTC tears.

Study design: This was a single-blinded randomized clinical trial.

Methods: Participants with RTC tears (n = 60) were divided into Mulligan mobilization (MM) and CS groups. The participants in the MM group performed mobilization with movement and a conventional exercise program; the CS group received a CS injection in addition to conventional exercises. The Visual Analog Scale, The Disabilities of the Arm, Shoulder, and Hand questionnaire, active range of motion (AROM), and joint position sense (JPS) were evaluated. The outcomes were analyzed using effect size, minimum clinically important difference, minimal detectable change, Wilcoxon test, and Mann-Whitney U test.

Results: Both groups significantly improved in all measured outcomes at 3 weeks. The MM group showed significantly better (p < 0.05, Cohen d range 0.82-3.2) results in pain, AROM (Flexion, abduction, extension, external rotation, internal rotation), and proprioception (30° and 60° of flexion and abduction). Between-group differences in AROM were also clinically meaningful as they exceeded their MDC₉₀ and minimum clinically important difference values.

Conclusions: Although both of these treatment methods may be successful in the short-term management of chronic RTC, the MM approach combined with conventional exercises seems to be a more effective approach for improving shoulder pain, function, and proprioception in this patient population.

Clinical trial number: NCT05933382.

Background: Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity, making it essential to assess the effectiveness of various physiotherapy treatments.

Purpose: This study aimed to determine the clinical and electrodiagnostic improvement in mild-to-moderate carpal tunnel syndrome patients through manual lymphatic drainage (MLD) versus an orthosis alone.

Study design: This is a prospective randomized controlled study.

Methods: The sample consisted of a total of 36 patients who met the inclusion criteria. Experimental group received MLD and orthosis, and the control group received only orthosis. The patients were evaluated with electrodiagnostic tests, Visual Analog Scale, algometer measurements (pressure pain threshold), Boston Carpal Tunnel Syndrome Questionnaire before and after treatment. Evaluations were made before and after treatment (4 weeks later).

Results: Boston Carpal Tunnel Syndrome Questionnaire scores improved significantly with both treatment methods in both the experimental (p < 0.001, d = 2.0) and control groups (p < 0.001, d = 1.5). The pressure pain threshold significantly increased in the experimental group at the level of the transverse carpal ligament (p = 0.02, d = 0.86, 95% Confidence Interval (CI) = -0.08 to 1.2). At the distal radioulnar joint and extensor digitorum communis muscle levels, the pressure pain threshold similarly increased for two groups after treatment (p = 0.65, d = 0.31, 95% CI = -0.44 to 1.2), but the post-treatment increase in the experimental group was significant (p = 0.007, d = 0.31). In the experimental group, motor velocity (p = 0.001, d = 0.98), amplitude (p = 0.002, d = 1.5), and latency (p = 0.002, d = 0.60) and sensory velocity (p = 0.03, d = 0.91) and latency (p = 0.001, d = 1.2) significantly improved, while in the control group, there was a significant change only in motor velocity and amplitude (p = 0.047, d = 0.59). The post-treatment sensory improvement was significantly higher in the experimental group (p = 0.01, d = 0.81, 95% CI = -0.78 to -0.49).

Conclusions: MLD significantly improved sensory conduction velocity, amplitude, and latency of the median nerve. Additionally, MLD and orthosis increased the pain pressure threshold and led to functional improvement.

Clinical trial registration: This is listed with study ID: NCT05394870.

Background: Prosthesis users need extensive training before they can use a electromyography-controlled prosthesis. Virtual reality seems promising to improve training.

Purpose: The aim was to investigate usability, motivation, workload, virtual reality properties and willingness for implementation of a newly developed virtual reality environment for upper limb prosthesis training, and to investigate if therapists and prosthesis users differed in their assessments.

Study design: This study was a cross-sectional study with a mixed-methods design.

Methods: The virtual task was to make cups of coffee to fulfill coffee orders using an virtual electromyography-controlled prosthesis hand. System Usability Scale, Intrinsic Motivation Inventory, Prosthesis-Task Load Index were used to assess the usability, motivation and workload, respectively. A custom-made questionnaire assessed design aspects of the virtual environment. Short interviews were conducted to investigate the feasibility of implementing virtual reality environment in rehabilitation.

Results: Eleven therapists and 11 prosthesis users participated. System Usability Scale scores were above the minimal level of 70, indicating an acceptable system. Intrinsic Motivation Inventory scores were overall high, with perceived competence being significantly lower than importance, enjoyment and usefulness. Prosthesis-Task Load Index scores indicated very little time pressure and stress, little frustration, mental and physical demand and uncertainty, and some conscious processing and visual attention. Therapists scored significantly higher in the subscales conscious processing and visual attention. The current virtual reality environment incorporated most of the design aspects from the questionnaire. All therapists would consider using the virtual reality environment for rehabilitation practice, however further improvements are necessary to facilitate usage and assure robustness of the system.

Conclusions: Therapists and prosthesis users expressed a high usability and motivation for virtual training and experienced an acceptable workload when using the system to train prosthesis control, with no notable differences between the groups. The current virtual environment included important design elements; both end-users would like to integrate virtual reality in rehabilitation practice.

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: 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.