Journal of Hand Therapy最新文献

Background: Hand edema is common complication following stroke that can significantly impair quality of life. Despite its prevalence, there is no established consensus on optimal management.

Purpose: The objective of this review is to identify and evaluate the range of interventions studied for poststroke hand edema, synthesize their reported effects on edema reduction, and examine their accessibility and application across diverse stroke populations.

Study design: Scoping review METHODS: A systematic search was conducted in five databases following methodology criteria outlined by the Joanna Briggs Institute for scoping reviews. Two independent reviewers screened titles, abstracts, and full texts for inclusion, and performed data extraction with a third reviewer resolving conflicts.

Results: In total, 19 studies with 653 patients were included. Three groupings of interventions were created based on mechanism of action: physical and mechanical modalities, neuromodulatory therapies, and pharmacologic or alternative therapies. Most interventions showed some degree of hand edema reduction. Among these, physical and mechanical modalities, particularly compressive wrapping, wrist hand orthoses (WHO), and fluidotherapy, demonstrated positive results in multiple studies. Neuromodulatory and pharmacologic/alternative therapies showed inconsistent or limited evidence with interventions often assessed in single studies. Methodological heterogeneity, small sample sizes, and short follow-ups limited the ability to compare and draw conclusions. Accessibility of interventions also varied, but compressive wrapping and WHOs stood out as offering potential for home use and reduced clinic visits.

Conclusions: The included studies were heterogeneous and lacked strong evidence for any specific intervention. Treatment should be individualized and emphasize accessible approaches that may improve adherence. Further research should focus on larger sample sizes, longer follow-up, standardized outcome measures, and clearly defined stroke chronicity to inform clinical practice.

Background: Trapeziometacarpal osteoarthritis (TMC OA) is a common degenerative condition, characterized by pain and functional limitations, predominantly affecting older women. While conservative treatments are the primary approach, functional outcomes are highly variable, and the predictive factors influencing these outcomes remain uncertain.

Purpose: This systematic review aims to identify demographic, clinical, and psychological factors that predict functional outcomes following conservative management of TMC OA.

Study design: Systematic Review.

Methods: The protocol was prospectively registered in PROSPERO (CRD42024626957). A systematic literature search was conducted in MEDLINE, PubMed, Cochrane Library, Scopus, and Web of Science up to December 2024, following PRISMA guidelines. Eligible studies included longitudinal observational studies and randomized controlled trials reporting on functional outcomes of conservative treatments within 3-12 months. Functional outcomes were assessed using validated tools such as the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Michigan Hand Outcomes Questionnaire (MHQ), and the Functional Index for Hand Osteoarthritis (FIHOA). Data synthesis focused on predictive factors including pain levels, radiographic severity and psychosocial variables.

Results: Six studies (n=1040 patients) met the inclusion criteria. The most consistently reported patient factors included baseline pain levels (5/6 studies), radiographic severity (3/6 studies), gender (3/6 studies), and psychosocial factors such as depression and treatment expectations (2/6 studies). Radiographic staging was associated with functional outcomes in a complex manner: advanced stages predicted poorer outcomes, while early stages were linked to acute impairments due to synovitis. Biopsychosocial factors, such as psychological health and education level, accounted for substantial variance in functional outcomes.

Conclusion: Individual demographic, clinical, and psychosocial factors predict functional outcomes following conservative TMC osteoarthritis treatment. Clinicians should take into account baseline pain levels, radiographic severity, gender, and psychological factors when counseling patients and setting realistic treatment expectations. Future prospective studies are needed to confirm these predictive factors, followed by research to determine which specific interventions may be most effective for patients with different predictor profiles.

Background: Pediatric patients with congenital upper limb differences often experience challenges in performing daily activities such as bike riding. This skill supports physical activity, social participation, and independence, yet adaptive devices are often costly and lack personalization.

Purpose: This case study describes the impact of a custom 3D-printed adaptive device on bike riding skills, muscular strength and endurance, and motivation in a child with a congenital upper limb difference.

Study design: Case study.

Methods: A single case study was conducted with a pediatric patient with a right congenital upper limb difference. The adaptive device was designed using 3D printing software and lightweight polylactic acid (PLA) filament based on the patient's needs and bike handle dimensions. The participant completed pre- and post-assessments surrounding a two-week bike riding protocol (5 sessions per week, 30 minutes each). Motivation toward bike riding was assessed using the intrinsic motivation subscale of the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3), and perceived competence was evaluated with the Pictorial Scale of Perceived Movement Skill Competence. Core muscular endurance was measured using the FitnessGram curl-up and trunk extension tests, and shoulder strength was measured via handheld dynamometry (flexion, abduction, horizontal abduction, and adduction). Bike riding ability was analyzed using observational criteria from the Special Olympics Cycling Manual.

Results: Post-assessment results demonstrated increased motivation (BREQ-3: 4.67 to 5.0), improved core endurance (curl-ups: 33 to 39; trunk lift: 11.5 to 12.5 in.), and bilateral shoulder strength gains, most notably in right abduction (+8.6 lbs) and left horizontal abduction (+8.1 lbs). Observable skill gains included improved stopping, dismounting, and steering.

Conclusion: A personalized 3D-printed adaptive device enhanced motivation, perceived competence, strength, and bike riding ability in a child with a congenital upper limb difference. Future studies with larger samples are recommended to validate these findings.

Background: The Stroke Upper Limb Capacity Scale (SULCS) is a practical and useful performance-based tool designed to assess upper limb functional capacity, including both basic and advanced movement.

Purpose: The aim of this study was to investigate the psychometric properties of the Turkish version of the SULCS in post-stroke patients.

Study design: Cross-Cultural Translation Study METHODS: A total of 56 patients with upper limb hemiparesis participated in the study. The Turkish SULCS was administered twice by the same researcher, with a one-week interval between assessments to determine intra-rater reliability. Additionally, the Fugl-Meyer and ABILHAND instruments were used to assess convergent validity.

Results: The Turkish SULCS demonstrated strong intra-rater reliability, with an intraclass correlation coefficient (ICC) of.97 (95% confidence interval:.95-.98). For the total SULCS-Turkish score, the standard error of measurement (SEM) was calculated to be 0.61 (SEM% = 9.76), and the minimum detectable change (MDC) was 1.69. Excellent correlations were also found between the Turkish SULCS and both Fugl-Meyer and ABILHAND scales (r = 0.77 and r = 0.86, respectively).

Conclusions: The findings suggest that the Turkish SULCS has strong intra-rater reliability and excellent convergent validity, supporting its use in clinical settings to assess upper limb functional capacity in post-stroke patients.