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The intermetacarpal distance method for assessment of active thumb radial abduction has excellent test-retest agreement, reliability, and precision in persons with non-operative thumb carpometacarpal osteoarthritis. 在非手术拇指腕掌骨关节炎患者中,评估拇指主动桡骨外展的掌间距离法具有极好的复测一致性、可靠性和准确性。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-14 DOI: 10.1016/j.jht.2024.12.002
Halil Ibrahim Ergen, Karl Dischinger, Corey McGee
<p><strong>Background: </strong>Limitations in thumb radial abduction (i.e., carpometacarpal extension) are commonly experienced by persons with thumb carpometacarpal osteoarthritis. Restoring this deficit is often a focus of surgical and rehabilitative interventions. Because of this, clinical measures of radial abduction are needed. The ''gold-standard'' assessment of thumb radial abduction is goniometry however it has modest reliability in persons with thumb carpometacarpal osteoarthritis. Conversely, the intermetacarpal distance (IMD) method of assessing radial abduction has promising reliability in healthy persons and excellent inter-rater reliability in those with thumb carpometacarpal osteoarthritis. However, to date, there has been no exploration of its test-retest reliability and precision in persons with thumb carpometacarpal osteoarthritis. Further, while multiple trials are often performed in various hand therapy assessments, it is common practice to take a single measurement of hand joint range of motion. Yet, we do not know if multiple trials might enhance the reliability of these range of motion measurements.</p><p><strong>Purpose: </strong>The current study aimed to (1) assess the test-retest agreement, reliability, and precision of the IMD method when measuring thumb radial abduction and (2) compare these psychometric properties when reporting one trial, the mean of two trials, and the mean of three trials of the IMD method in people with thumb carpometacarpal (CMC1) osteoarthritis (OA).</p><p><strong>Study design: </strong>Prospective Cohort study of test-retest reliability.</p><p><strong>Methods: </strong>Purposive sampling was used to recruit adults with radiographically confirmed CMC1 OA. Participants' radial abduction was assessed using the IMD method to measure radial abduction of the affected hand on two separate occasions approximately two weeks apart. Three trials of the assessment were administered at each visit. The Bland Altman method was uses to assess agreement, the intraclass correlation coefficient (ICC<sub>2,3</sub>) was calculated to examine the reliability, and the standard error of the measurement (SEM), minimum detectable change (MDC) and MDC percentage were calculated to determine the precision of the IMD method for one trial, the mean of two trials, and the mean of three. Descriptive data on demographics and IMD values of the sample were presented.</p><p><strong>Results: </strong>Forty persons with CMC1 OA participated. The mean difference between trials ranged from 0.21 to 0.30 mm, no significant fixed biases (p≥0.48) or proportional biases (p≥0.41) existed between mean test and retest scores, and 38/40 (95%) of test-retest differences fell within the 95% limits of agreement. The Intraclass Correlation Coefficient (ICC<sub>2,3</sub>) values were 0.942 (0.893-0.968), 0.970 (0.943-0.984), and 0.970 (0.942-0.984) for 1 trial, the mean of two trials, and then mean of three trials respectively. The ICC value of
背景:拇指桡侧外展受限(即腕掌骨外展)是拇指腕掌骨关节炎患者常见的症状。修复这一缺陷通常是手术和康复干预的重点。因此,需要对桡骨外展进行临床测量。拇指桡骨外展的“金标准”评估是角度测量,但对于患有拇指腕掌骨关节炎的人来说,它的可靠性并不高。相反,评估桡骨外展的掌间距离(IMD)方法在健康人群中具有良好的可靠性,在拇指腕掌骨关节炎患者中具有良好的趾间可靠性。然而,到目前为止,还没有对其在拇指腕掌骨关节炎患者中的重测信度和准确性进行探索。此外,虽然在各种手部治疗评估中经常进行多项试验,但通常的做法是对手部关节活动范围进行单一测量。然而,我们不知道多次试验是否可以提高这些运动范围测量的可靠性。目的:本研究旨在(1)评估IMD方法在测量拇指桡骨外展时的测试-重测一致性、可靠性和准确性;(2)在报道拇指腕掌骨关节炎(CMC1)患者的IMD方法的一次试验、两次试验的平均值和三次试验的平均值时,比较这些心理测量特性。研究设计:重测信度的前瞻性队列研究。方法:采用目的抽样方法招募影像学证实的成人CMC1 OA患者。参与者的桡骨外展是用IMD方法评估的,在两个不同的场合,大约相隔两周,测量受影响的手的桡骨外展。每次访问时进行三次评估试验。采用Bland Altman方法评估一致性,计算类内相关系数(ICC2,3)检验信度,计算测量的标准误差(SEM)、最小可检测变化(MDC)和MDC百分比,确定IMD方法在一次试验、两次试验的平均值和三次试验的平均值的精度。提供了样本的人口统计学和IMD值的描述性数据。结果:40例CMC1型OA患者参与。试验之间的平均差异范围为0.21 ~ 0.30 mm,平均检验和重测分数之间不存在显著的固定偏差(p≥0.48)或比例偏差(p≥0.41),38/40(95%)的重测差异在95%的一致性范围内。组内相关系数(ICC2,3)分别为0.942(0.893-0.968)、0.970(0.943-0.984)、0.970(0.942-0.984),分别为1个试验、2个试验的平均值和3个试验的平均值。两个试验的平均值的ICC值显著高于1个试验的平均值,表明可靠性较好,但每种方法的可靠性均落入优秀范围(即>0.90)。1次试验(MDC%=13.0)的精度在可接受范围内,2次试验(MDC%=9.1)和3次试验(MDC%=9.1)的平均值精度在优范围内。结论:评估CMC1骨外展的IMD方法在CMC1骨关节炎患者中进行一次试验、两次试验的平均值或三次试验的平均值时具有可接受的一致性、优异的重测信度和可接受到优异的精度。两个或三个试验的平均值的精度和可靠性不高,但两个试验的平均值比单个试验的可靠性和精度高。分别进行一项或两项试验时,IMD测量值1.9 mm和1.4 mm的变化需要超过测量误差,而在进行一项或两项试验时,变化必须超过5.3 mm和3.8 mm才能超过临床有意义的阈值。当使用IMD方法评估CMC1型OA患者的CMC1型桡骨外展时,我们建议采用两次试验的平均值而不是一次试验。
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引用次数: 0
Positive clinical tests for medial epicondylalgia are more common than tests for lateral epicondylalgia in recreational pickleball players: A cross-sectional study. 在娱乐性匹克球运动员中,内侧上髁痛的阳性临床测试比外侧上髁痛的测试更常见:一项横断面研究。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-14 DOI: 10.1016/j.jht.2024.12.013
Betsy A Myers, June Hanks

Background: Epicondylalgia is a common overuse injury in tennis. However, little is known regarding epicondylalgia in pickleball.

Purpose: This study examined the prevalence of positive epicondylalgia tests in recreational pickleball players and the relationship between positive tests and player characteristics.

Study design: Cross-sectional study.

Methods: Clinical tests for epicondylalgia were performed courtside on the dominant arm of 129 recreational pickleball players. Participants completed a survey with questions related to demographics and play characteristics. Descriptive data were reported for epicondylalgia testing and survey performance. Chi-squared analysis and Fisher's exact test were used to determine associations between testing and survey responses. Relative risk estimates for positive tests for epicondylalgia were calculated based on pickleball playing characteristics.

Results: The prevalence of positive tests was 7% for medial epicondylalgia, 5.4% for lateral epicondylalgia, and 2.3% for both medial epicondylalgia and lateral epicondylalgia. Ninety-two participants (71.3%) completed the survey. Those who participated in tournaments were less likely to have a positive test for medial epicondylalgia (Fisher's exact test, p = 0.017). The relative risk of having a positive epicondylalgia test was lower for those who have played for at least 4 years (medial = 0.875 [CI 0.81-0.95] and lateral 0.913 [CI 0.866-0.979]). Epicondylalgia testing was not associated with age, sex, hand dominance, level of play, location of play, warm-up performance, frequency of play, or length of play.

Conclusions: Among pickleball players, there was a lower prevalence of positive tests for lateral epicondylalgia than for medial epicondylalgia. Compared to tennis, lateral epicondylalgia may be less common due to a lower elbow torque, while medial epicondylalgia may be more common due to methods to impart spin. Given the differences among sports, clinicians may need to utilize different prevention and intervention strategies when working with pickleball players.

背景:上髁痛是网球运动中常见的过度使用损伤。然而,对匹克球的上髁痛知之甚少。目的:本研究探讨休闲匹克球运动员上髁痛测试阳性率及其与运动员特征的关系。研究设计:横断面研究。方法:对129名休闲匹克球运动员的主臂进行场边上髁痛临床试验。参与者完成了一项与人口统计和游戏特征相关的调查。报告了上髁痛测试和调查表现的描述性数据。使用卡方分析和Fisher精确检验来确定测试和调查反应之间的关联。根据匹克球运动特征计算上髁痛阳性测试的相对风险估计。结果:内上髁痛的阳性率为7%,外上髁痛为5.4%,内上髁痛和外上髁痛均为2.3%。92名参与者(71.3%)完成了调查。参加比赛的患者内侧上髁痛检测呈阳性的可能性较小(Fisher精确检验,p = 0.017)。对于那些至少踢了4年球的人来说,上髁痛测试呈阳性的相对风险较低(内侧= 0.875 [CI 0.81-0.95],外侧= 0.913 [CI 0.866-0.979])。上髁痛测试与年龄、性别、手优势、游戏水平、游戏位置、热身表现、游戏频率或游戏时长无关。结论:在匹克球运动员中,外上髁痛的阳性检测率低于内上髁痛。与网球相比,由于肘关节扭矩较低,外侧上髁痛可能不太常见,而内侧上髁痛可能由于施加旋转的方法而更常见。鉴于运动之间的差异,临床医生在治疗匹克球运动员时可能需要使用不同的预防和干预策略。
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引用次数: 0
Effects of high-intensity laser therapy in patients with De Quervain's tenosynovitis: A systematic review and meta-analysis. 高强度激光治疗对De Quervain氏腱鞘炎患者的影响:系统回顾和荟萃分析。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-14 DOI: 10.1016/j.jht.2024.10.001
Hernán Andrés de la Barra Ortiz, Nivaldo Antonio Parizotto, Claudio Chamorro Lange, Richard Eloin Liebano

Background: De Quervain's tenosynovitis (QT) is common among individuals performing repetitive manual tasks and significantly affects daily activities due to pain. While traditional treatments often provide limited relief, high-intensity laser therapy (HILT) shows as a potential analgesic resource.

Purpose: This systematic review aimed to evaluate the analgesic effects of HILT in patients with QT.

Study design: This study is a systematic review with meta-analysis with an observational, retrospective, and secondary design.

Methods: The search was conducted in PubMed, Web of Science, Scopus, EBSCOhost, Embase, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar (last updated September 17, 2024) to identify clinical trials comparing HILT with other treatments for QT. Pain intensity, measured with a Visual Analog Scale (VAS), was the main outcome. Disability and handgrip strength, measured with the quick disabilities of the arm, shoulder and hand (Q-DASH) and patient-rated wrist and hand evaluation (PRWE) questionnaires and dynamometry, were the secondary outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool 2 (RoB2), and a meta-analysis was performed using mean difference (MD) or standardized mean difference (SMD). The GRADE approach guided evidence-based recommendations for statistically significant outcomes.

Results: Three studies were included, demonstrating an overall low bias (66%), with outcome measurements being the principal sources of bias. The meta-analysis did not reveal statistically significant advantages for HILT in terms of pain intensity and disability (VAS MD=0.21 cm; 95% CI: -1.43,1.86) (SMD=-0.31; 95% CI: -0.75,0.13). Despite individual studies reporting significant differences favoring HILT, the meta-analysis lacks statistical significance, preventing definitive recommendations.

Conclusions: Despite the potential benefits of HILT in managing QT, the current evidence does not support its superiority over conventional treatments like splinting or splinting combined with exercise. Further clinical trials are necessary to confirm HILT's efficacy and refine treatment guidelines in line with the dosage proposed by the included studies.

背景:De Quervain的腱鞘炎(QT)在重复性体力劳动的个体中很常见,并且由于疼痛而显著影响日常活动。而传统的治疗方法往往提供有限的缓解,高强度激光治疗(HILT)显示出一种潜在的镇痛资源。目的:本系统综述旨在评价hirt对qt患者的镇痛作用。研究设计:本研究是一项采用观察性、回顾性和二次设计的荟萃分析系统综述。方法:检索PubMed, Web of Science, Scopus, EBSCOhost, Embase, Cochrane Library,物理治疗证据数据库(PEDro)和谷歌Scholar(最后更新于2024年9月17日),以确定将HILT与其他QT治疗方法进行比较的临床试验,以视觉模拟量表(VAS)测量疼痛强度为主要结果。残障和握力,用手臂、肩膀和手的快速残障(Q-DASH)和患者评定的手腕和手评估(PRWE)问卷和动力测量法测量,是次要结果。采用Cochrane风险偏倚工具2 (RoB2)评估研究质量,并采用均差(MD)或标准化均差(SMD)进行meta分析。GRADE方法为统计上显著的结果提供循证建议。结果:纳入3项研究,显示总体偏倚低(66%),结果测量是偏倚的主要来源。meta分析并未显示HILT在疼痛强度和残疾方面的统计学显著优势(VAS MD=0.21 cm;95% ci: -1.43,1.86) (smd =-0.31;95% ci: -0.75,0.13)。尽管个别研究报告了支持HILT的显著差异,但meta分析缺乏统计学意义,因此无法给出明确的建议。结论:尽管HILT治疗QT有潜在的益处,但目前的证据并不支持其优于夹板或夹板联合运动等传统治疗方法。需要进一步的临床试验来证实HILT的疗效,并根据纳入研究建议的剂量完善治疗指南。
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引用次数: 0
A valid and reliable 3D-printed electronic grip strength assessment tool. 一个有效和可靠的3d打印电子握力评估工具。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-14 DOI: 10.1016/j.jht.2024.11.010
Amelia Sorensen, Lily Brosnan, Yong Hao Pua, Julian Thumboo, Yee Sien Ng, Laura Tay Bee Gek, Ross Clark
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引用次数: 0
Is it prudent to interpret findings from nonblinded RCTs relying solely on patient-reported outcome measures for outcome assessment? 仅仅依靠患者报告的结果评估来解释非盲随机对照试验的结果是否谨慎?
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-14 DOI: 10.1016/j.jht.2024.09.001
Manigandan Chockalingam, Laura Pearson, Orla Daly
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引用次数: 0
Development of decision-aid of goal-setting for patients with distal radius fracture: Aid for decision-making in occupation choice for distal radius fracture. 桡骨远端骨折患者目标设定决策辅助系统的开发:辅助桡骨远端骨折患者职业选择决策。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-04 DOI: 10.1016/j.jht.2024.08.001
Kanta Ohno, Kounosuke Tomori, Tatsunori Sawada, Hitomi Kogiri, Kazuhiko Misaki, Ryota Kimura, Terufumi Iitsuka, Kazuo Saito

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.

背景:桡骨远端骨折(DRFs)患者由于其医疗状况和缺乏改变活动的策略,在日常生活中遇到了重大的困难和挑战。基于职业的干预措施已经成为改善职业表现和参与结果的有希望的策略,解决了这些挑战。目的:本研究旨在开发桡骨远端骨折职业选择决策辅助工具(ADOC-DRF),这是一种新颖的决策辅助工具,旨在通过提供适合术后恢复期和规定活动负荷的插图,促进以患者为中心和基于职业的目标设定。研究设计:我们采用共识发展方法,包括名义群体技术和基于网络的德尔菲调查。方法:通过三位专家的名义小组技术,建立了ADOC-DRF原型的开发理念、项目和插图。随后,通过德尔福网络调查,采用李克特五点量表(1 =不同意,5 =同意)收集专家意见,并在22位专家中达成共识,目标是达成3.75(75%)或更高的共识点。结果:进行了三轮德尔菲网络调查,涉及各种项目和意见,最终达到了要求的共识率。该过程确定了52个项目,分为四个不同的drf后进展阶段:第1阶段:固定化,第2阶段早期:固定化去除(主动运动开始),第2阶段后期:固定化去除(骨痂形成),第3阶段:抵抗期(骨愈合)。结论:ADOC-DRF有望成为促进DRF患者手部治疗中基于职业的干预的创新工具。然而,它的普遍性目前仅限于日本。为了确保更广泛的适用性和实用性,必须通过国际多中心研究在不同文化背景下验证该工具,从而增强其全球相关性。
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引用次数: 0
Updated, detailed scoring of the activities measure for upper limb amputation (AM-ULA). 更新,详细的上肢截肢活动测量评分(AM-ULA)。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-03 DOI: 10.1016/j.jht.2024.07.005
Linda Resnik, Matthew Borgia, Christine Cowen, Jemy Delikat

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.

背景:上肢截肢活动测量(AM-ULA)是一种针对义肢使用者的活动测量,它使用复杂的评分标准对任务表现进行单一评分,这可能会限制反应性。目的:通过探索使用多个评分元素的评分来提高AM-ULA的响应性。研究设计:横断面研究。方法:对50例受试者的am - ula进行录像。两名评分员评估子任务的完成情况、表现速度、运动质量、假肢使用的熟练程度和独立性。分类内相关系数(ICC)评估了分类内和分类间的信度。结果:评判者1在除独立性外的所有要素中具有一般(0.72)至优异(0.99)的评判者内信度。评价者2在所有要素上具有极好的信度(≥0.96)。除了独立性外,所有因素的信度ICC范围从0.83(非常好)到0.99(极好)。结论:利用单个评分元素对AM-ULA进行视频评分具有良好的评分者内部和评分者之间的可靠性,建议用于提高AM-ULA的反应性。
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引用次数: 0
Hand therapy utilization following digital flexor tendon repair: Trends, timing, predictive factors, and association with reoperation. 指屈肌腱修复后手部治疗的应用:趋势、时机、预测因素和与再手术的关系。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-03 DOI: 10.1016/j.jht.2024.07.002
Alexander J Kammien, Kevin G Hu, Catherine Yu, Jonathan N Grauer, David L Colen

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.

背景:物理康复被认为是指屈肌腱修复(FTR)后恢复的重要组成部分,但没有研究彻底描述美国全国范围内的治疗使用情况。目的:本研究描述了FTR术后手部治疗使用时间和数量的全国趋势,并评估了与术后手部治疗缺乏相关的因素。研究设计:回顾性队列研究。方法:选取2010 ~ 2020年珠光蝶II区ftr。排除标准包括年龄。结果:在发现的6700例ftr中,手部治疗被发现3319例(50%)。从2010年到2020年,接受治疗的患者比例有所增加(44%-56%),p结论:尽管报道了数字FTR后手部治疗的重要性,但在美国,这种治疗可能没有得到充分利用。与不使用手部疗法相关的患者因素提示应寻求更统一的临床实践。
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引用次数: 0
The Corbett Targeted Coin Test demonstrated good to moderate reliability as compared to other standardized dexterity assessments. 与其他标准化灵巧性评估相比,Corbett目标硬币测试显示出良好到中等的可靠性。
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-03 DOI: 10.1016/j.jht.2024.11.003
Lydia Stout, Jeanine Beasley, Spencer Jackson, Alayna Kagande, Allison Range, Sarah Corder, Carla Floyd-Slabaugh, Kirk Anderson
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引用次数: 0
Effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders: A comprehensive systematic review with meta-analysis. 肩胛骨锻炼计划对手、腕或肘部疾病患者功能结局的有效性:一项综合系统综述和荟萃分析
IF 2.1 4区 医学 Q2 ORTHOPEDICS Pub Date : 2025-01-03 DOI: 10.1016/j.jht.2024.07.006
Héctor Gutiérrez-Espinoza, Felipe Araya-Quintanilla, Evelin Estrella-Flores, Iván Cuyul-Vásquez, Elisabet Hagert, Filip Struyf

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.

背景:通常,手、腕/前臂疾病的患者报告肩部肌肉骨骼主诉。尽管肩胛骨的作用对于整个上肢运动链的运动和功能稳定至关重要;然而,目前还没有系统的综述和荟萃分析分析肩胛骨运动对这些患者的影响。目的:本研究旨在确定肩胛骨锻炼计划对手、腕或肘部疾病患者功能结局的有效性。研究设计:采用荟萃分析的系统评价。方法:电子检索MEDLINE、EMBASE、Web of Science、Scopus、CENTRAL、Epistemonikos、CINAHL、SPORTDiscus、PEDro、LILACS数据库。入选标准包括随机临床试验,研究在常规物理治疗方案的基础上进行肩胛骨锻炼对手部、手腕或肘部损伤或病变患者功能结局的影响。两位作者独立完成了检索、研究选择、数据提取和偏倚风险评估。结果:6项试验符合入选标准,纳入定量综合。肩胛骨运动加常规物理治疗与单纯常规物理治疗比较,肘关节和手腕功能的平均差异为7.6分(p = 0.04),上肢功能的平均差异为16.1分(p)。结论:在短期内,常规物理治疗加肩胛骨运动对肘关节外侧肌腱病变和桡骨远端骨折患者的功能结局有统计学意义。然而,这些差异中的大多数没有达到被认为具有临床重要性的最低阈值。根据GRADE方法,证据强度从高到低。需要更多数量和质量的临床试验来证实我们的发现。普洛斯彼罗注册:CRD42022364829。
{"title":"Effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders: A comprehensive systematic review with meta-analysis.","authors":"Héctor Gutiérrez-Espinoza, Felipe Araya-Quintanilla, Evelin Estrella-Flores, Iván Cuyul-Vásquez, Elisabet Hagert, Filip Struyf","doi":"10.1016/j.jht.2024.07.006","DOIUrl":"https://doi.org/10.1016/j.jht.2024.07.006","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Purpose: </strong>This study aimed to determine the effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders.</p><p><strong>Study design: </strong>Systematic review with meta-analysis.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Prospero registration: </strong>CRD42022364829.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Journal of Hand Therapy
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