Journal of Hand Therapy最新文献

Background: De Quervain's tenosynovitis (DQT) is a common tendinopathy of the first dorsal compartment, managed conservatively or surgically. Among conservative options, the comparative effectiveness remains unclear.

Purpose: To evaluate the effectiveness of conservative treatments for DQT.

Study design: Systematic review and network meta-analysis (NMA).

Methods: Following PRISMA and a PROSPERO registration (CRD42023494486), seven databases were searched for randomized controlled trials (RCTs) and non-RCTs. Twenty-one studies (1,178 adults) were included in the qualitative synthesis; 12 entered the NMA. Pain was measured with the visual analog scale or Numerical Pain Rating Scale; function with the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, or the Duruöz Hand Index. Data were analyzed with frequentist multivariate and univariate NMAs. Interventions were ranked using p scores and the Surface Under the Cumulative Ranking curve. Risk of bias and certainty of evidence were assessed with the Cochrane Risk of Bias 2.0 tool, Risk of Bias in Non-randomized Studies of Interventions, and Grading of Recommendations Assessment, Development, and Evaluation criteria.

Results: Full-time orthosis use plus corticosteroid injection ranked highest for pain and functional improvement, followed by corticosteroid injection alone and acupuncture. All active treatments outperformed waitlist controls. Pain outcomes showed high heterogeneity (I² = 83.5%), whereas functional outcomes were more consistent. No major inconsistencies were detected between direct and indirect estimates. Most studies had high risk of bias; certainty of evidence ranged from low to very low.

Conclusions: Full-time orthosis use g with corticosteroid injection appears the most effective conservative treatment for DQT, though based on low-certainty evidence. Where combined therapy is inaccessible, monotherapies such as orthosis or corticosteroid injection may still provide meaningful benefits. Future high-quality trials should investigate active interventions (e.g., progressive tendon loading and patient education) to address DQT's functional demands beyond passive symptom relief.

Background: Peripheral nerve injuries (PNI) result in pain and functional impairments, significantly affecting quality of life. Early rehabilitation is essential, and graded motor imagery (GMI) has demonstrated potential in improving recovery outcomes.

Purpose: The aim of the study was to determine the effect of GMI training in addition to the Physiotherapy and Rehabilitation (PTR) program in PNI.

Study design: Randomized controlled trial.

Methods: Pain levels were assessed by Visual Analog Scale, range of motion by goniometer, hand grip strength by Jamar Dynamometer, and pinch grip strength by pinch meter. The Disabilities of the Arm, Shoulder, and Hand, and the Michigan Hand Outcome Questionnaire were used. Kinesiophobia was evaluated with the Tampa Kinesiophobia Scale.

Results: A total of 20 participants (4 F, 16 M) were followed up for 6 weeks. Group-I (n = 10) received GMI training in addition to the PTR program and Group-II (n = 10) received only the PTR program. Both groups were similar in all parameters before treatment (p > 0.05). After treatment, GMI training was more effective on functionality (p = 0.029), appearance perception (p = 0.003), and kinesiophobia level (p = 0.050).

Conclusions: GMI training can be added to PTR programs in PNI.

Background: Manual dexterity impairments are among the most common and debilitating motor symptoms in Parkinson's disease, significantly impacting patients' quality of life. Assessment of dexterity is therefore critical for evaluating upper limb function and guiding therapeutic interventions.

Purpose: To determine the test-retest reliability, minimum detectable change, concurrent, and discriminant validity of the Minnesota Manual Dexterity Test in people with Parkinson's disease, and cut-off times that best distinguish people with Parkinson's disease from healthy controls.

Study design: Cross-sectional study.

Methods: Forty people with Parkinson's disease and 30 healthy people were included. The test-retest reliability was evaluated by determining the intraclass correlation coefficient. The standard error of measurement and minimal detectable change were calculated by using intraclass correlation coefficient results. The concurrent validity of Minnesota Manual Dexterity Test was determined by investigating its relationship with the Nine-Hole Peg Test (9-NHPT), Jebsen Hand Function Assessment Test (JHFT), Unified Parkinson's Disease Rating Scale, and Hoehn and Yahr scale. The cut-off times that best discriminated between people with Parkinson's disease and healthy controls were investigated by plotting receiver operating characteristic curves.

Results: The Minnesota Manual Dexterity Test demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.975-0.994). The minimum detectable change values of Minnesota Manual Dexterity Test subtests ranged from 7.26 to 12.39. Subtests showed fair to strong correlations with other outcomes (correlation coefficients ranged from 0.39 to 0.78, p ≤ 0.02). Significant differences in the Minnesota Manual Dexterity Test subtests were found between people with Parkinson's disease and healthy controls (p < 0.001). Cut-off times ranging from 61.20 to 93.71 seconds were found to be good discriminants people with Parkinson's disease from healthy controls.

Conclusions: The Minnesota Manual Dexterity Test is a reliable and valid tool for assessing manual dexterity in people with Parkinson's disease.

Background: Manual dexterity is negatively affected in ataxic individuals and determining the determinants of manual dexterity is very important for maintaining functional independence, especially in activities of daily living related to the upper extremities.

Purpose: The aim of this study was to evaluate manual dexterity in ataxic individuals, to examine the factors affecting manual dexterity and the effects of these factors on each other.

Study design: This is a clinical measurement study.

Methods: The study included 26 ataxic individuals (16 female, 10 male). Manual dexterity was assessed with the Minnesota Manual Dexterity Test, hand functions with ABILHAND, balance with the Berg Balance Scale, disease severity with the International Cooperative Ataxia Rating Scale and trunk position sense with a digital inclinometer. Hierarchical multiple linear regression analyses were conducted to examine the effect of the independent variables of hand functions (model 1-2-3), balance (model 2-3) and disease severity and trunk position sense (model 3) on the dependent variable of manual dexterity.

Results: The mean age of the individuals was 45.7 ± 11.7 years. Hand functions in model 1 (unstandardized beta coefficient [B] = -2.14, p = 0.029), balance in model 2 (B = -2.53, p = 0.001) and ataxia severity in model 3 (B = 2.04, p = 0.010) were the factors affecting manual dexterity. Trunk position sense was not found to be a factor affecting manual dexterity (p > 0.05).

Conclusions: Disease severity has a predominantly negative impact on manual dexterity when evaluated together with hand function, balance and trunk position sense. To alleviate accompanying symptoms such as lack of coordination, tremor, dysmetria and instability, rehabilitation programs planned to prevent the increase in ataxia severity from the early stages of ataxia may ensure the maintenance of manual dexterity. Integrating task-oriented rehabilitation for clinical settings and individualized strategies that can be implemented in the home environment into ataxia rehabilitation may improve hand functionality in activities of daily living.

Background: Three-dimensional (3D) printing is a manufacturing technique that is increasing in its application to produce methods of bespoke care for patients. An area of clinical care that has mixed outcomes and lacks consensus on the gold standard of treatment is mallet injury.

Purpose: There may be an opportunity to provide custom care to patients with mallet injury using 3D printing. To determine the feasibility of using 3D-printed custom orthoses to treat mallet injury, it is necessary to evaluate the prior evidence surrounding this topic. Thus, a scoping review of the literature is warranted.

Study design: The Population Concept & Context Framework was used to develop the research question and inform the inclusion criteria. The population is adults and children of all ages and ethnicities. The concept is all reference to 3D printing for mallet injuries. The context framework is all locations, both research and clinical bases.

Methods: The databases searched were CINAHL, MEDLINE/PubMed, Embase, Cochrane, EbscoHost, Science Direct, Web of Science, and Google Scholar. As the earliest applications of 3D printing were in the 1980s, the search ranged from 1980-September 2023. English language filters were applied.

Results: A total of 10 results met the final inclusion criteria and were included in the review. The results of the review have demonstrated that the current body of evidence is represented by a low number of studies with heterogeneous methodologies, orthosis design, materials testing, and healthy vs injured subjects.

Conclusions: Expanding research to focus on clinical outcomes of 3D-printed mallet orthosis on a wider scale could provide the data-driven evidence base needed to provide a meaningful addition to current health care orthosis options.

Registration: The protocol was registered on September 6, 2023, with the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/FSJPK.

Background: Using a motor unit number estimation (MUNE) method, MScanFit MUNE enables simple, fast, noninvasive, and automated analysis of the number of motor units in patients.

Purpose: To investigate the validity of the MScanFit MUNE method (number of motor units) against the compound muscle action potential method (compound amplitude of motor units) at identifying of motor axonal damage in carpal tunnel syndrome, particularly in the early stages, thereby providing a basis for timely treatment and surgical intervention.

Study design: Electrophysiological data were collected from 170 hands of 128 patients with different stages of carpal tunnel syndrome. A further 30 healthy subjects were included. Observe the motor axonal damage at different stages.

Methods: Compound amplitude of motor units and MScanFit MUNE values were used to analyze differences in motor axonal damage between the mild, moderate, severe patient groups, and control group. Plot the ROC curves for diagnosing carpal tunnel syndrome using the two methods.

Results: The mean MScanFit MUNE values for the mild, moderate, and severe groups were 79.4 ± 19.2, 55.2 ± 17.9, and 27.4 ± 11.7, respectively. The compound amplitude of motor units for these groups were 6.5 ± 2.4 mV, 5.2 ± 2.9 mV, and 3.1 ± 1.7 mV, respectively. The values for both methods were lower in the severe group than in the mild and moderate groups (p < 0.05). The MScanFit MUNE values were lower in the mild group than in the control group (p < 0.05), whereas this difference was not observed in another method. The respective areas under the ROC curves for diagnosis were 0.78 for compound amplitude of motor units and 0.86 for MScanFit MUNE.

Conclusions: The MScanFit MUNE method is more effective in identifying motor axonal damage at different stages of carpal tunnel syndrome, especially in the early stages.

Background: Norms for children aged 6-19 years were developed in 1985 for the Box and Block Test (BBT) and updated in 2013 for 3-10-year-olds. Evidence suggests that past normative data may need to be updated due to changes in children's hand use over the past 40 years.

Purpose: To compare children's performance on the BBT with existing 1985 normative data.

Study design: Secondary analysis of a cross-sectional observational study to validate the Complete Minnesota Dexterity Test (CMDT) using the BBT.

Methods: All were healthy volunteers, aged 7 to 18 years, with no known physical, cognitive, or emotional conditions. Participants completed study procedures in a pediatric hospital. During data collection we noted low performance on the BBT and hypothesized a decline compared to the 1985 norms. Participants completed one trial of the BBT with each hand. We compared our sample to the normative sample using mean number of blocks placed in 60 seconds and standard error of the means using two-tailed, one sample t-tests.

Results: Of 816 children screened, 181 were eligible and consented to participate. A total of 98 females and 83 males participated. Each gender-by-age group-by-hand category ranged from 4-21 participants. In each group, means were statistically significantly lower than norms, indicated by nonoverlapping 95% confidence intervals and t-test results. The difference in blocks placed in 60 seconds ranged from 9.1 to 31.3 fewer blocks.

Discussion: This study suggests that children's manual dexterity has declined over the past 40 years. Clinicians should consider this when using the BBT to evaluate performance. This study lacked enough subjects to establish new normative data but suggests the 1985 norms need to be updated.

Conclusions: Our findings provide evidence of a decline in manual dexterity among children on the BBT since 1985.

Background: Australian Sign Language (Auslan) relies heavily on precise finger movements, alongside wrist, forearm, and elbow coordination. Prior studies have examined upper limb biomechanics in Auslan communication but have not quantified the specific range of motion (ROM) required of the fingers.

Purpose: To determine the finger ROM necessary for effective Auslan communication, providing evidence to guide rehabilitation strategies for patients reliant on Auslan.

Study design: Biomechanical analysis METHODS: Two right-handed native Auslan communicators were recruited for biomechanical analysis. Reflective markers tracked finger joint movement during the signing of 28 commonly used Auslan phrases, repeated five times each. Data were processed to calculate the coronal, sagittal, and axial ROM for the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints. Descriptive statistics summarized the required ROM and interquartile ranges.

Results: Greater ROM was required in the distal interphalangeal joints of the right index, middle, and ring fingers and the left little finger. Metacarpophalangeal joint motion was comparable bilaterally for the index and middle fingers but was significantly greater on the dominant hand for the ring and little fingers. The right hand demonstrated higher ROM and interquartile ranges overall, reflecting its dominant role in Auslan articulation.

Conclusions: Effective Auslan communication requires greater finger ROM on the dominant hand, particularly for the index, middle, and ring fingers. Rehabilitation strategies should prioritize motion preservation in these joints. Conversely, lower ROM demands on the non-dominant hand suggest motion-sacrificing interventions may be more viable and appropriate for certain joints without compromising function.