Journal of Hand Therapy最新文献

Background: Patients with distal radius fractures (DRFs) encounter significant difficulties and challenges in their daily lives due to their medical condition and a lack of strategies for modifying activities. Occupation-based interventions have emerged as promising strategies to improve occupational performance and participation outcomes, addressing these challenges.

Purpose: This study aims to develop the aid for decision-making in occupation choice for distal radius fracture (ADOC-DRF), a novel decision-aid tool designed to facilitate patient-centered and occupation-based goal-setting by offering illustrations tailored to the postsurgical recovery period and prescribed activity loads.

Study design: We utilized consensus development methods, including the nominal group technique and a web-based Delphi survey.

Methods: Through the nominal group technique with three experts, we established the development concept, items, and illustrations for the ADOC-DRF prototype. Subsequently, a Delphi web survey was conducted to gather expert opinions using a five-point Likert scale (1 = disagree and 5 = agree) and achieve consensus among 22 experts, aiming for a consensus point of 3.75 (75%) or higher.

Results: Three rounds of Delphi web surveys were conducted, involving a variety of items and comments, ultimately achieving the required consensus rate. This process identified 52 items, which were categorized into four distinct post-DRF progression phases: phase 1: immobilization, phase 2 early: immobilization removal (start of active motion), phase 2 late: immobilization removal (callus formation), and phase 3: resistance period (bone healing).

Conclusions: The ADOC-DRF shows promise as an innovative tool for facilitating occupation-based intervention in hand therapy for DRF patients. However, its generalizability is currently limited to Japan. To ensure broader applicability and utility, it is essential to validate the tool in diverse cultural contexts through international multicenter studies, thereby enhancing its global relevance.

Background: The Activities Measure for Upper Limb Amputation (AM-ULA), an activity measure for prosthesis users, uses a complex grading rubric to assign a single score to task performance which may limit responsiveness.

Purpose: To enhance AM-ULA responsiveness by exploring a scoring that uses multiple grading elements.

Study design: Cross-sectional study.

Methods: AM-ULAs of 50 participants were videotaped. Two raters evaluated completion of subtasks, speed of performance, movement quality, skillfulness of prosthetic use, and independence. Intraclass correlation coefficients (ICC) assessed intra-rater and inter-rater reliability.

Results: Rater 1 had fair (0.72) to excellent (0.99) intra-rater reliability in all elements except for independence. Rater 2 had excellent reliability (≥0.96) in all elements. Inter-rater reliability ICC ranged from 0.83 (very good) to 0.99 (excellent) for all elements except independence.

Conclusions: Video scoring of the AM-ULA utilizing individual grading elements showed good intra-rater and inter-rater reliability and is recommended to improve responsiveness of the AM-ULA.

Background: Physical rehabilitation is considered an important component of recovery following digital flexor tendon repair (FTR), but no studies have thoroughly characterized nationwide therapy utilization in the United States.

Purpose: The current study characterized national trends in the timing and amount of hand therapy utilization following FTR and assessed factors associated with the lack of postoperative hand therapy.

Study design: Retrospective cohort study.

Methods: Zone II FTRs between 2010 and 2020 were identified in PearlDiver. Exclusion criteria included age <18 years, concomitant procedures besides nerve repair, and follow-up in the database of <6 months. The occurrence, timing, and frequency of hand therapy within 6 months of surgery were identified. Odds of not receiving hand therapy were assessed based on clinical and nonclinical characteristics using logistic regression.

Results: Of 6700 FTRs identified, hand therapy was identified for 3319 (50%). The proportion of patients utilizing therapy increased from 2010 to 2020 (44%-56%, p < 0.001). Weekly therapy utilization peaked in postoperative week 4 (41% of all patients attended hand therapy). Lack of hand therapy utilization was associated with several clinical factors (male sex, lower Elixhauser Comorbidity Index score, decreasing number of repairs) and nonclinical factors (geographic region, Medicare insurance).

Conclusions: Despite the reported importance of hand therapy following digital FTR, it may be underutilized in the United States. Patient factors associated with not using hand therapy suggest that more uniform clinical practice should be sought.

Background: Non-invasiveness and comfort are crucial in the conservative management of distal radius and scaphoid fractures. While fiberglass casts are standard, three-dimensional (3D)-printed orthoses offer a promising alternative.

Purpose: To compare patient experiences, safety perceptions, and satisfaction between a 3D orthosis and fiberglass cast for distal radius or scaphoid fractures.

Study design: Randomized feasibility trial.

Methods: Nineteen adult patients were randomly assigned (3D orthosis group, n = 10; fiberglass cast group, n = 9) and followed until orthosis or cast removal at 6-8 weeks. X-rays at weeks 1 and 6 documented bone healing, with weekly hand therapy visits assessed orthosis satisfaction and function. The Patient-Rated orthosis Satisfaction Questionnaire (PRSEQ) measured satisfaction at weeks 2, 4, and removal. Descriptive statistics and non-parametric correlation tests were used for data analysis.

Results: The 3D orthosis group achieved significantly higher PRSEQ scores (mean difference [MD]= 15.7%, p = 0.005 to 0.01, r = -.581 to -.638) and lower perceived pain (MD=-1.0 to -2.2, p = 0.001 to 0.048, r = -0.45 to -0.75) compared to the cast group. By week 4, the 3D group reported less discomfort (MD=-2.2, p = 0.03, r = -0.5) and felt safer (MD=1.6, p = 0.043, r = -0.46). Routine activities were easier for the 3D group at weeks 2 and 6 (MD=-2.8 to -3.0, p = 0.033 to 0.034, r = -0.49). Satisfaction scores were higher in the 3D group (mean 8.4 vs. 5.6 points, p < 0.001 to 0.01, r = -0.57 to -0.82). Compliance was excellent in both groups. No significant differences were observed in radiological outcomes, finger sensibility, or edema. Bone healing occurred in both groups without fracture displacement; however, one cast patient required subsequent surgery for scaphoid non-union.

Conclusions: Treatment with a 3D-printed orthosis appeared feasible and safe, with patients reporting higher satisfaction and better self-perceived hand function compared to a custom-made fiberglass cast, although further research is needed to confirm these findings.

Background: Pectoralis minor (PM) shortening and posterior shoulder tightness (PST) are considered potential soft tissue alterations associated with rotator cuff related shoulder pain (RCRSP). Yet, their precise contribution to pain and disability remains unclear.

Purpose: To explore the association between both PM length and PST and self-reported shoulder pain and disability in individuals with and without RCRSP. Demographic characteristics and shoulder active range of motion (AROM) were also considered for their potential contributions to RCRSP.

Study design: This was a cross-sectional study.

Methods: Using Shoulder Pain and Disability Index (SPADI), 144 individuals were grouped by pain and disability severity: SPADI total score ≤20 and SPADI total score >20. PM length was measured using a tape measure. PST, glenohumeral joint flexion, internal (IR) and external (ER) rotation AROM were quantified using an inclinometer. Demographic and AROM measurements were compared between groups and regression analyses identified SPADI predictors.

Results: Age, PST, glenohumeral flexion, and ER AROM were associated with SPADI total score (p < 0.05). Higher age (odds ratio (OR [95%CI]): 1.07 [1.02-1.12]) and increased PST (OR: 1.16 [1.04-1.29]) were associated with higher self-reported shoulder pain and disability scores (SPADI score >20). In contrast, increased flexion (OR: 0.93 [0.88-0.97]) and ER AROM (OR: 0.96 [0.93-0.99]) served as protective factors against increased levels of self-reported shoulder pain and disability. No other variables were associated with SPADI (p > 0.05).

Conclusions: PST is associated with increased levels of self-reported shoulder pain and disability, as are age, while PM length and IR AROM were not significantly associated variables. Glenohumeral flexion and ER AROM prevented increased levels of self-reported shoulder pain and disability.

Background: Usually, patients with hand, wrist/forearm disorders report musculoskeletal complaints in the shoulder. Although, role of scapula is fundamental for movement and functional stability across the upper limb kinetic chain; however, there are no systematic reviews and meta-analyses that have analyzed the effect of scapular exercises in these patients.

Purpose: This study aimed to determine the effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders.

Study design: Systematic review with meta-analysis.

Methods: An electronic search was performed of the MEDLINE, EMBASE, Web of Science, Scopus, CENTRAL, Epistemonikos, CINAHL, SPORTDiscus, PEDro, and LILACS databases. The eligibility criteria included randomized clinical trials that investigated the effects of scapular exercises added to a conventional physiotherapy program on functional outcomes in patients with hand, wrist or elbow injuries or pathologies. Two authors independently performed the search, study selection, data extraction, and risk of bias assessment.

Results: Six trials met the eligibility criteria and were included in the quantitative synthesis. For the comparison of scapular exercises plus conventional physiotherapy versus conventional physiotherapy alone, the mean difference for elbow and wrist function was 7.6 points (p = 0.04), upper limb function was 16.1 points (p < 0.01), grip strength was 15.4% (p = 0.01), pain free grip strength was 19.1 N (p = 0.13) and pain intensity at rest was -1.1 cm (p < 0.01). Additionally, there was a significant increase in muscle strength of serratus anterior 46.2 N (p < 0.01), middle trapezius 29.9 N (p = 0.01) and lower trapezius 45.9 N (p < 0.01).

Conclusions: In the short term, adding scapular exercises to conventional physiotherapy showed statistically significant differences in functional outcomes in patients with lateral elbow tendinopathy and distal radius fracture. However, most of these differences did not reach the minimum threshold to be considered clinically important. The evidence strength was high to low according to the GRADE approach. More quantity and quality of clinical trials is needed to confirm our findings.

Prospero registration: CRD42022364829.

Background: Hand-arm Vibration Syndrome (HAVS) is a disorder caused by prolonged exposure to hand-held vibrating instruments, commonly observed in industrial contexts such as mining, construction, and manufacturing. It involves symptoms affecting the musculoskeletal, neurological, and vascular systems of the arm and hand.

Purpose: The main aim of this study is to determine the prevalence of HAVS among laborers working in the Khewra salt mines.

Study design: This study utilized a cross-sectional observational design.

Methods: A total of 140 drill machine operators from the Khewra salts mines were selected through purposive sampling. Handgrip strength was assessed using the Camry-EH101 hand dynamometer and the data was collected through structured questionnaire focusing on neurological, vascular and musculoskeletal symptoms. The prevalence of HAVS was determined from the collected data and the severity of symptoms was as analyzed across different age groups and working conditions.

Results: Out of the participants, n = 121 (86.4%) were found to be right-hand dominant, with average grip strength of 40.9 ± 3.1 kg, while n = 19 (13.6%) were left hand dominant, with average grip strength of 45.9 ± 2.6 kg. Compared to normative data, right-hand dominant workers showed a 15% reduction in grip strength, while left-hand dominant workers showed a 5% decreased. The most common reported neurological symptoms included prolonged hand vibration (52.9%), tingling sensation (60%) and numbness (46.4%). Vascular symptoms included discoloration of fingers (50%), felling cold (48.6%) and needle like sensations (45.7%). Musculoskeletal symptoms included reduced grip strength (51.4%), hand discomfort (46.4%) and hand cramping, tiredness or itching (46.4%).

Conclusion: The high prevalence of HAVS among miners emphasizes the importance of targeted clinical interventions and workplace policies modifications to reduce vibration exposure and improve occupational health.

Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is an evidence-based exercise program for adults with hand function difficulties due to rheumatoid arthritis. A self-guided online version of the program has been developed for direct access by patients.

Purpose: To evaluate the delivery of the online program in routine therapy care and its impact on clinical outcomes, before making it widely available.

Study design: An effectiveness-implementation study.

Methods: Volunteer patients were identified from National Health Service (NHS) hand therapy departments in the United Kingdom. Patients were given access to the 4-week program, delivered via text, videos, polls, and social discussion forums. Self-reported pain and hand function were collected at baseline, discharge, and telephone follow-up at 4 months. Delivery of baseline and discharge sessions, acceptability, and patient engagement and experience were also explored.

Results: A total of 78 patients were enrolled from 18 therapy departments in 15 NHS trusts in England, Scotland, and Wales. Sixty-five patients took part, of whom 46 (71%) registered with the online SARAH program. The majority of baseline and discharge sessions were delivered face-to-face. Pain improved at discharge and was stable at follow-up. Hand function significantly improved with medium effect sizes of Cohen's d of 0.6 and 0.52 respectively. The majority of patients rated themselves as improved and were continuing the SARAH exercises at discharge and 4 months. No related adverse effects were reported. Patient engagement was high during the first week of the program but gradually declined. Most patients were satisfied and found the program useful.

Conclusions: The online SARAH program delivered in routine therapy care was acceptable and beneficial to patients. Improvements in clinical outcomes were similar to the SARAH clinical trial and our previous implementation work.

Background: Distal radius fractures (DRF) and ulnar neuropathy (UNE) present with reduced motor function, restricted range of motion, pain, and reduced grip strength that may lead to similar treatment approaches. With rapid and insidious onset for DRF and UNE, respectively, the contextual factors impacting an individuals' experience with the condition can vary.

Purpose: The aim of this secondary analysis is to compare ratings of quality of life (QoL) domains prior to treatment and 3 months post treatment for DRF and UNE.

Study design: This is a retrospective cohort study conducted at the Roth McFarlane Hand and Upper Limb Centre.

Methods: 36-Item Short Form Survey (SF-36) data from 781 patients treated nonoperatively for DRF, operatively for DRF, or operatively for UNE was extracted from the Hand and Upper Limb Centre database. Group differences for the eight SF-36 domains were calculated using analysis of covariance (ANCOVA) with sex as a covariate. Differences from prior to treatment to 3 months post were assessed using separate repeated measures ANCOVA (RM-ANCOVA) with sex as a covariate.

Results: Nonoperative DRF, operative DRF, and operative UNE groups reported 8%-11% improvements in QoL domains at 3 months follow-up despite some persisting impairments for physical domains. Prior to treatment, the DRF patients report greater impairments for physical domains, while the UNE patients managed operatively reported greater impairments to psychosocial domains. Operatively managed DRF patients report greater physical and psychosocial impairments than those conservatively treated. Males report less severe impairments for physical and psychosocial domains than females.

Conclusions: Assessing QoL domains for two upper extremity conditions with different contextual factors provides insight into the implications of those factors on QoL. Incorporating early screening and continual monitoring of QoL domains impacted by upper extremity conditions like DRF and UNE could help identify factors impacting prognosis and direct the focus of treatment to improve outcomes at 3 months.