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Clinical outcomes from nonoperative management of pediatric metacarpal and phalangeal fractures: A scoping review 儿童掌骨和指骨骨折非手术治疗的临床结果:一项范围综述。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-07-05 DOI: 10.1016/j.jht.2025.05.008
Alice Pratt BOT , Danielle Hitch PhD

Background

Pediatric hand fractures are often managed nonoperatively, however literature comparing the outcomes of various nonoperative approaches is scarce. Nonoperative management approaches such as plaster cast immobilization and thermoplastic orthoses, are typically chosen when surgery is not indicated or necessary. Comparing the effectiveness of nonoperative management practices is crucial for enhancing pediatric hand therapy.

Purpose

The objectives of this review were to: (1) consolidate and evaluate research on nonoperative management of pediatric hand fracture management; (2) identify trends, gaps, and opportunities within this body of research; and (3) highlight areas for future research and the development of clinical guidelines.

Study Design

Scoping review.

Methods

An extensive database search was conducted via AMED, CINAHL, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete, MEDLINE, and Open Dissertations. Included studies recruited children and adolescents aged 0 to 18 years receiving nonoperative management for metacarpal and phalanx fractures. Data were extracted and synthesized narratively, focusing on key characteristics and emerging themes.

Results

Only three peer-reviewed studies met the inclusion criteria, highlighting a significant lack of high-quality research. Clear clinical guidelines were not reported, and the included studies varied in their methodology, sample size and outcome measures. All studies emphasized the need for more rigorous and comparative research to establish effective management strategies.

Conclusions

This scoping review highlights the critical need for comprehensive, comparative studies in pediatric hand fracture management. The evidence base is limited and fragmented, underscoring the necessity for rigorous clinical guidelines and the development of multicenter trials to optimize care for pediatric patients.
背景:小儿手部骨折通常采用非手术治疗,但是比较各种非手术方法治疗效果的文献很少。非手术治疗方法,如石膏固定和热塑性矫形器,通常在不需要手术或不需要手术时选择。比较非手术治疗方法的有效性对加强小儿手部治疗至关重要。目的:本综述的目的是:(1)巩固和评价儿童手部骨折非手术治疗的研究;(2)确定本研究领域的趋势、差距和机会;(3)强调未来的研究领域和临床指南的制定。研究设计:范围审查。方法:通过AMED、CINAHL、Global Health、Health来源:护理/学术版、MEDLINE Complete、MEDLINE和Open Dissertations进行广泛的数据库检索。纳入的研究招募了0 - 18岁接受掌骨和指骨骨折非手术治疗的儿童和青少年。数据提取和综合叙事,重点关注关键特征和新兴主题。结果:只有三个同行评议的研究符合纳入标准,突出了高质量研究的严重缺乏。没有明确的临床指南报告,纳入的研究在方法、样本量和结果测量方面各不相同。所有研究都强调需要进行更严格和比较的研究,以制定有效的管理战略。结论:本综述强调了对小儿手部骨折处理进行全面、比较研究的迫切需要。证据基础有限且支离破碎,强调了制定严格的临床指南和开展多中心试验以优化儿科患者护理的必要性。
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引用次数: 0
Study of the normal response to the upper limb neurodynamic test 2b and 1 in asymptomatic violin and viola players 无症状小提琴和中提琴演奏者上肢神经动力学测试2b和1的正常反应研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-07-04 DOI: 10.1016/j.jht.2025.05.010
Alberto Montaner-Cuello PT, PhD, , Inés Ruíz-Maqueda PT , Pilar Pardos-Aguilella PT, PhD , Gianluca Ciuffreda PT, PhD , Isabel Albarova-Corral PT, PhD , Elena Bueno-Gracia PT, PhD

Background

Professional musicians exhibit a high prevalence of work-related musculoskeletal disorders, with nerve entrapment syndromes and dysfunctions of the peripheral nervous system accounting for a significant proportion of these issues. The radial and median nerves of the upper limb are among the most commonly injured nerves due to mechanical and repetitive work. The upper limb neurodynamic test for the radial nerve (ULNT2b) and the upper limb neurodynamic test for the median nerve (ULNT1) are two of the most frequently used tests to assess the mechanosensitivity of these nerves. Currently, there are no studies that describe the normal responses in populations of violinists and violists.

Purpose

Study of the normal response to the ULNT2b and ULNT1 in asymptomatic violin and viola players.

Study Design

A prospective epidemiological study of consecutive cases was designed, characterized as observational, descriptive, comparative, cross-sectional, and double-blind, following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Methods

The normal responses of the ULNT2b and ULNT1 tests were reported in violin and viola musicians. The range of motion (ROM) in degrees was recorded with structural differentiation, along with the location and characteristics of the reported symptom.

Results

The total sample consisted of 56 cases (n=56). In the ULNT2b, the mean range of motion (ROM) was 10.1° ± 16.2, with the most prevalent symptoms being tightness in the dorsal aspect of the forearm. In the ULNT1, the mean ROM was 115.4° ± 39.4, with tightness in the palmar aspect of the forearm being the most commonly reported symptom.

Conclusions

Asymptomatic viola and violin players exhibit greater mechanosensitivity in the radial and median nerves during the ULNT2b and ULNT1 compared to an asymptomatic population. Furthermore, there are no significant differences in the responses of both tests concerning ROM, affected areas, or symptoms, regardless of sex, instrument, or side.
背景:职业音乐家表现出与工作相关的肌肉骨骼疾病的高患病率,神经卡压综合征和周围神经系统功能障碍占这些问题的很大比例。上肢的桡神经和正中神经是机械和重复性工作中最常见的损伤神经。上肢桡神经神经动力学试验(ULNT2b)和上肢正中神经神经动力学试验(ULNT1)是评估这些神经力学敏感性的两种最常用的试验。目前,还没有研究描述小提琴手和中提琴手群体的正常反应。目的:研究无症状小提琴和中提琴演奏者对ULNT2b和ULNT1的正常反应。研究设计:遵循《加强流行病学观察性研究报告指南》,设计了一项连续病例的前瞻性流行病学研究,其特征为观察性、描述性、比较性、横断面和双盲。方法:对小提琴和中提琴演奏者进行ULNT2b和ULNT1测试。运动范围(ROM)的程度被记录与结构分化,以及位置和特征的报告症状。结果:共56例(n=56)。在ULNT2b中,平均活动范围(ROM)为10.1°±16.2,最常见的症状是前臂背侧紧绷。在ULNT1中,平均ROM为115.4°±39.4°,前臂掌侧紧绷是最常见的症状。结论:与无症状人群相比,无症状中提琴和小提琴演奏者在ULNT2b和ULNT1中表现出更大的桡神经和正中神经的机械敏感性。此外,无论性别、器械或侧面,两种测试在ROM、受影响区域或症状方面的反应没有显著差异。
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引用次数: 0
The results of serial casting in the treatment of proximal interphalangeal joint contractures in patients with systemic sclerosis 连续铸造治疗系统性硬化症患者近端指间关节挛缩的效果。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-06-16 DOI: 10.1016/j.jht.2025.04.021
Ümit Uğurlu OT, PT, MSc, PhD

Background

Systemic sclerosis can lead to significant disability. Flexion contractures of the proximal interphalangeal joints are common in systemic sclerosis. Serial casting can be used to correct these contractures. The literature lacks data on the use of this method for this purpose.

Purpose

To analyze the results of serial casting intervention in the treatment of proximal interphalangeal joint flexion contractures and identify the factors that may affect outcomes.

Study Design

Retrospective case series.

Methods

The data of 10 patients treated with serial casting for their proximal interphalangeal joint contractures were analyzed. Range of motions of the finger joints, grip pressures, pinch strengths and hand functions at the initial and final evaluations were compared. A finger goniometer, a modified sphygmomanometer, B&L pinchmeter and Duruöz Hand Index were used for the measurements, respectively.

Results

A total of 38 fingers were serially casted. The serial casting intervention resulted in significant (p < 0.001) reduction in the average proximal interphalangeal joint extension loss. Some flexion decreases in this joint accompanied this gain (p < 0.001). Range of motions of the other finger joints increased (p < 0.001). The average grip pressures (p = 0.005 and 0.007), lateral pinch strengths (p = 0.04) and total hand function (p = 0.013) improved. The magnitude of the extension loss in the beginning, severity of Raynaud phenomenon, disability and disease durations were all moderately important factors in predicting the gains in the proximal interphalangeal joints. Sixty percent of the gains (adjusted R2 = 0.6) could be explained by these factors.

Conclusions

Serial casting may be an effective method to decrease flexion contractures of proximal interphalangeal joints as an adjunctive method to other rehabilitation modalities in patients with systemic sclerosis. Clinicians should consider disease-specific constraints both in the selection of patients for serial casting application and their follow-up.
背景:系统性硬化症可导致严重的残疾。近端指间关节屈曲挛缩在系统性硬化症中很常见。连续铸造可用于纠正这些挛缩。文献中缺乏这种方法用于此目的的数据。目的:分析连续铸造介入治疗近端指间关节屈曲挛缩的效果,探讨影响疗效的因素。研究设计:回顾性病例系列。方法:对10例近端指间关节挛缩采用连续铸造治疗的患者资料进行分析。在初始和最终评估时比较手指关节的运动范围,握力,捏力和手功能。测量时分别使用手指测角仪、改良血压计、B&L测针仪和Duruöz手部指数。结果:38根手指连续铸造。连续铸造干预导致显著(p2=0.6),可以用这些因素来解释。结论:连续铸造可作为系统性硬化症患者指间关节近端屈曲挛缩的辅助治疗方法。临床医生在选择连续铸型应用的患者及其随访时应考虑疾病特异性限制。
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引用次数: 0
Joint position sense is affected in individuals with shoulder pain having type 2 diabetes mellitus: A technical report 2型糖尿病患者肩关节疼痛对关节位置感的影响:一份技术报告。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-07-04 DOI: 10.1016/j.jht.2025.05.017
Palakh J. Rathod MPT, Charu Eapen PhD, Ashish John Prabhakar PhD
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引用次数: 0
Effectiveness of instrument-assisted soft tissue mobilization in patients operated for distal radius fracture: A randomized controlled blinded clinical study 桡骨远端骨折手术中器械辅助软组织活动的有效性:一项随机对照盲法临床研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-07-05 DOI: 10.1016/j.jht.2025.05.009
Basak Cigdem-Karacay MD , Levent Horoz MD , Ismail Ceylan PT, PhD , Halil Alkan PT, PhD

Background

Data on the effectiveness of Instrument-Assisted Soft Tissue Mobilization, one of the mobilization methods, in Distal Radius Fracture rehabilitation are quite limited.

Purpose

The aim of this study was to investigate the effectiveness of Instrument-Assisted Soft Tissue Mobilization on pain, range of motion and edema, grip strength and functionality in patients who underwent surgery with open reduction and internal fixation due to Distal Radius Fracture.

Study Design

Randomized controlled blinded trial.

Methods

Forty-eight patients who underwent open reduction and internal fixation with volar plate due to Distal Radius Fracture were randomized into two groups as Instrument-Assisted Soft Tissue Mobilization and control group. While all patients received conventional rehabilitation (CRP), patients in the Instrument-Assisted Soft Tissue Mobilization group additionally received Instrument-Assisted Soft Tissue Mobilization with the Graston method. Circumference measurement, Patient-Rated Wrist Evaluation, Visual Analog Scale, grip strength, wrist joint range of motion measurements were performed at the beginning, fourth week and sixth week.

Results

When the changes in Visual Analog Scale (rest, activity), range of motion (Flexion, Extension, Supination and Pronation), Edema, Handgrip Strength and Total Patient-Rated Wrist Evaluation data of the Instrument-Assisted Soft Tissue Mobilization group and the control group over time (intra-group changes) were compared, a statistically significant change was found for all parameters except the Handgrip Strength variable (p < 0.05). In time-group comparisons, no statistical difference was found in Visual Analog Scale activity, range of motion extension, edema and Total Patient-Rated Wrist Evaluation parameters (p > 0.05), while a statistical difference was found in Visual Analog Scale rest, range of motion flexion, supination and pronation and hand grip strength parameters (p < 0.05).

Conclusions

Adding Instrument-Assisted Soft Tissue Mobilization applied to the CRP of patients who underwent surgery for Distal Radius Fracture is effective on grip strength and pronation. The addition of Instrument-Assisted Soft Tissue Mobilization application to the conventional rehabilitation application did not provide additional effect on edema and functionality. Conventional rehabilitation alone is more effective on rest pain.
背景:器械辅助软组织活动作为桡骨远端骨折康复的一种活动方法,其有效性的研究资料相当有限。目的:本研究的目的是探讨器械辅助软组织活动对桡骨远端骨折行切开复位内固定手术患者疼痛、活动范围和水肿、握力和功能的影响。研究设计:随机对照盲法试验。方法:48例桡骨远端骨折行掌侧钢板切开复位内固定的患者随机分为器械辅助软组织活动术组和对照组。在所有患者接受常规康复(CRP)的同时,器械辅助软组织动员组患者还接受了Graston方法的器械辅助软组织动员。在开始、第4周和第6周进行围度测量、患者评定腕关节评估、视觉模拟量表、握力、腕关节活动范围测量。结果:比较器械辅助软组织活动组与对照组的视觉模拟量表(休息、活动)、活动度(屈伸、旋前、旋前)、水肿、握力和患者总腕关节评估数据随时间的变化(组内变化),除握力变量外,其余参数变化均有统计学意义(p < 0.05)。在时间组比较中,两组在视觉模拟量表活动度、运动范围伸展、水肿和总患者评定腕关节评价参数上无统计学差异(p < 0.05),而在视觉模拟量表休息、运动范围屈曲、旋前、旋前和握力参数上有统计学差异(p < 0.05)。结论:在桡骨远端骨折手术患者的CRP中加入器械辅助的软组织活动对握力和旋前是有效的。在常规康复应用中增加器械辅助软组织活动应用,对水肿和功能没有额外的影响。单纯的常规康复治疗对休息痛更有效。
{"title":"Effectiveness of instrument-assisted soft tissue mobilization in patients operated for distal radius fracture: A randomized controlled blinded clinical study","authors":"Basak Cigdem-Karacay MD ,&nbsp;Levent Horoz MD ,&nbsp;Ismail Ceylan PT, PhD ,&nbsp;Halil Alkan PT, PhD","doi":"10.1016/j.jht.2025.05.009","DOIUrl":"10.1016/j.jht.2025.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Data on the effectiveness of Instrument-Assisted Soft Tissue Mobilization, one of the mobilization methods, in Distal Radius Fracture rehabilitation are quite limited.</div></div><div><h3>Purpose</h3><div><span>The aim of this study was to investigate the effectiveness of Instrument-Assisted Soft Tissue Mobilization on pain, range of motion and edema, grip strength and functionality in patients who underwent surgery with open reduction<span> and internal fixation due to </span></span>Distal Radius Fracture.</div></div><div><h3>Study Design</h3><div>Randomized controlled blinded trial.</div></div><div><h3>Methods</h3><div><span><span><span>Forty-eight patients who underwent open reduction and internal fixation with </span>volar plate due to </span>Distal Radius Fracture were randomized into two groups as Instrument-Assisted Soft Tissue Mobilization and control group. While all patients received conventional rehabilitation (CRP), patients in the Instrument-Assisted Soft Tissue Mobilization group additionally received Instrument-Assisted Soft Tissue Mobilization with the Graston method. Circumference measurement, Patient-Rated Wrist Evaluation, </span>Visual Analog Scale, grip strength, wrist joint range of motion measurements were performed at the beginning, fourth week and sixth week.</div></div><div><h3>Results</h3><div><span><span>When the changes in Visual Analog Scale (rest, activity), range of motion (Flexion, Extension, </span>Supination and Pronation), Edema, Handgrip Strength and Total Patient-Rated Wrist Evaluation data of the Instrument-Assisted Soft Tissue Mobilization group and the control group over time (intra-group changes) were compared, a statistically significant change was found for all parameters except the Handgrip Strength variable (</span><em>p</em> &lt; 0.05). In time-group comparisons, no statistical difference was found in Visual Analog Scale activity, range of motion extension, edema and Total Patient-Rated Wrist Evaluation parameters (<em>p</em> &gt; 0.05), while a statistical difference was found in Visual Analog Scale rest, range of motion flexion, supination and pronation and hand grip strength parameters (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Adding Instrument-Assisted Soft Tissue Mobilization applied to the CRP of patients who underwent surgery for Distal Radius Fracture is effective on grip strength and pronation. The addition of Instrument-Assisted Soft Tissue Mobilization application to the conventional rehabilitation application did not provide additional effect on edema and functionality. Conventional rehabilitation alone is more effective on rest pain.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"39 1","pages":"Pages 236-244"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576985","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}
引用次数: 0
Effectiveness of mirror therapy to treat musculoskeletal injuries of the hand and wrist: A systematic review 镜像疗法治疗手部和手腕肌肉骨骼损伤的有效性:一项系统综述。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-10-13 DOI: 10.1016/j.jht.2025.04.013
Stephanie Reischl PhD , Rochelle Furtado PhD , Joy MacDermid PhD , Ruby Grewal MD , Siobhan Schabrun PhD , Ana Luisa Trejos PhD

Background

Mirror therapy is an effective intervention for improving outcomes when an affected extremity has severe movement restrictions or pain.

Purpose

To investigate the effects of mirror therapy interventions on musculoskeletal injuries of the hand/wrist.

Study Design

Systematic review.

Methods

This systematic review was conducted in accordance with Cochrane and PRISMA guidelines and registered with Open Science Framework (DOI:XXX). The search was conducted in EMBASE, PubMed, and Scopus in April 2024. Search terms included hand and wrist injuries, mirror therapy, pain, range of motion, strength, and function. Descriptive synthesis was used to summarize the data for interventions and outcomes. The Cochrane RoB 2 tool was used for quality assessment.

Results

Samples ranged from 22 to 40 participants with a total of 220 participants. Five studies combined mirror therapy with active exercise and had comparator groups performing active exercises for the same duration. Mirror therapy intervention ranged from 20 to 75 minutes per session, two to five times a week for 3-8 weeks. Mirror therapy interventions reduced pain, improved range of motion, strength, and function in most studies. Greater improvements for the mirror therapy groups than the comparator group were reported for pain, range of motion, and function in 20%-75% of the studies. Risk assessment for the seven studies resulted in one high, four moderate, and two low quality studies.

Conclusions

Moderate quality evidence suggests that mirror therapy interventions may be effective at reducing pain, improving range of motion, strength and function for musculoskeletal hand and wrist injuries. Further investigation is warranted with larger trials with more homogenous interventions.
背景:当患肢有严重的运动限制或疼痛时,镜像治疗是改善预后的有效干预措施。目的:探讨镜像疗法干预对手/腕部肌肉骨骼损伤的影响。研究设计:系统评价。方法:本系统综述按照Cochrane和PRISMA指南进行,并在开放科学框架(DOI:XXX)注册。检索于2024年4月在EMBASE、PubMed和Scopus中进行。搜索词包括手部和手腕损伤、镜像疗法、疼痛、活动范围、力量和功能。描述性综合用于总结干预措施和结果的数据。采用Cochrane RoB 2工具进行质量评价。结果:样本范围为22 ~ 40人,共220人。五项研究将镜像疗法与积极运动相结合,并让比较组在相同的时间内进行积极运动。镜像治疗干预每次20 - 75分钟,每周2 - 5次,持续3-8周。在大多数研究中,镜像疗法干预减轻了疼痛,改善了活动范围、力量和功能。在20%-75%的研究中,镜像治疗组在疼痛、活动范围和功能方面比对照组有更大的改善。7项研究的风险评估结果为1项高质量研究、4项中等质量研究和2项低质量研究。结论:中等质量的证据表明,镜像疗法干预可能有效地减轻疼痛,改善手和手腕肌肉骨骼损伤的活动范围、力量和功能。进一步的研究需要更大规模的试验和更均匀的干预措施。
{"title":"Effectiveness of mirror therapy to treat musculoskeletal injuries of the hand and wrist: A systematic review","authors":"Stephanie Reischl PhD ,&nbsp;Rochelle Furtado PhD ,&nbsp;Joy MacDermid PhD ,&nbsp;Ruby Grewal MD ,&nbsp;Siobhan Schabrun PhD ,&nbsp;Ana Luisa Trejos PhD","doi":"10.1016/j.jht.2025.04.013","DOIUrl":"10.1016/j.jht.2025.04.013","url":null,"abstract":"<div><h3>Background</h3><div>Mirror therapy is an effective intervention for improving outcomes when an affected extremity has severe movement restrictions or pain.</div></div><div><h3>Purpose</h3><div>To investigate the effects of mirror therapy interventions on musculoskeletal injuries of the hand/wrist.</div></div><div><h3>Study Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>This systematic review was conducted in accordance with Cochrane and PRISMA guidelines and registered with Open Science Framework (DOI:<em>XXX</em>). The search was conducted in EMBASE, PubMed, and Scopus in April 2024. Search terms included hand and wrist injuries, mirror therapy, pain, range of motion, strength, and function. Descriptive synthesis was used to summarize the data for interventions and outcomes. The Cochrane RoB 2 tool was used for quality assessment.</div></div><div><h3>Results</h3><div>Samples ranged from 22 to 40 participants with a total of 220 participants. Five studies combined mirror therapy with active exercise and had comparator groups performing active exercises for the same duration. Mirror therapy intervention ranged from 20 to 75 minutes per session, two to five times a week for 3-8<!--> <!-->weeks. Mirror therapy interventions reduced pain, improved range of motion, strength, and function in most studies. Greater improvements for the mirror therapy groups than the comparator group were reported for pain, range of motion, and function in 20%-75% of the studies. Risk assessment for the seven studies resulted in one high, four moderate, and two low quality studies.</div></div><div><h3>Conclusions</h3><div>Moderate quality evidence suggests that mirror therapy interventions may be effective at reducing pain, improving range of motion, strength and function for musculoskeletal hand and wrist injuries. Further investigation is warranted with larger trials with more homogenous interventions.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"39 1","pages":"Pages 168-177"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294349","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}
引用次数: 0
Therapy-led model of care for simple, diagnostic-defined pediatric hand fractures can maximize service access and improve consumer outcomes: An implementation study of value-based healthcare using mixed-method design 治疗主导的简单、诊断定义的小儿手部骨折护理模式可以最大限度地提供服务并改善消费者结果:使用混合方法设计的基于价值的医疗保健实施研究。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-07-07 DOI: 10.1016/j.jht.2025.05.006
Katherine Dalton BOccThy (Hons I), MHM , Sarah Lyall-Watson BOccThy (Hons I) , Anna Young BOccThy , Stuart Bade MBBS, FRACS , Megan Simons PhD, BOccThy (Hons I)

Background

Pediatric upper limb fractures place high demand on emergency and specialist medical services.

Purpose

Allied health professionals (ie, therapists) are increasingly becoming sole providers for care of these conditions; however, evidence for the effectiveness, experiences, and outcomes within the pediatric population is lacking.

Study Design

This quality improvement study used mixed-methods design, informed by the RE-AIM and Consolidated Framework for Implementation Research.

Methods

Six diagnostically defined, simple pediatric hand injuries (ie, soft tissue; minimally displaced or angulated fractures) were redirected at the time of referral to therapy-led care. Quantitative and qualitative data were collected, including consumer codesigned value-based healthcare outcome measures (function, pain, and patient experience); a patient-reported outcome measure (PROMIS Pediatric Upper Extremity Short Form 8a); health service delivery performance measures (eg, time to appointment, cost of staffing); and workforce stakeholder survey (feasibility and acceptability). Descriptive or inferential statistics were applied to quantitative data and content analysis to qualitative data.

Results

The therapy-led clinic absorbed 20% of the overall new occasions of service to the orthopedic medical fracture clinic with a median wait time of 9 days (IQR = 5), seeing 97 new patients. Patient-reported measures were collected for 3 months. Fifty-three percent (n = 30/57) of eligible families completed the value-based healthcare outcome measures at clinical healing (eg, 4-6 weeks post injury), with all measures exceeding expected performance for function, pain, and health service experience. There was a higher virtual care follow-up in therapy-led vs medical care (82% vs 9%, respectively). Workforce stakeholders indicated a high willingness to continue the therapy-led clinic if adequate workforce resourcing was available.

Conclusions

The application of therapist-led care in pediatric acute hand injuries is safe, effective, and of high value. This model, and the effectiveness of using value-based health care and implementation science frameworks in quality improvement, has high potential for scale and spread within other healthcare settings.
背景:小儿上肢骨折对急诊和专科医疗服务的需求很高。目的:联合医疗专业人员(即治疗师)正日益成为治疗这些疾病的唯一提供者;然而,在儿科人群中缺乏有效性、经验和结果的证据。研究设计:本质量改进研究采用混合方法设计,参考RE-AIM和实施研究综合框架。方法:6例诊断明确的小儿手部单纯性损伤(即软组织损伤;轻度移位或成角骨折)在转介到治疗主导护理时被重定向。收集定量和定性数据,包括消费者共同设计的基于价值的医疗保健结果测量(功能、疼痛和患者体验);患者报告的结果测量(PROMIS小儿上肢短表8a);保健服务提供绩效措施(如预约时间、人员配备费用);劳动力利益相关者调查(可行性和可接受性)。定量资料采用描述性或推断性统计,定性资料采用内容分析。结果:治疗主导门诊吸收了骨科内科骨折门诊整体新增服务病例的20%,中位候诊时间为9天(IQR = 5),新增患者97例。收集患者报告的测量数据3个月。53% (n = 30/57)符合条件的家庭在临床愈合时(例如,受伤后4-6周)完成了基于价值的医疗保健结果测量,所有测量在功能、疼痛和健康服务体验方面的表现都超过了预期。与医疗护理相比,治疗主导的虚拟护理随访率更高(分别为82%和9%)。劳动力利益相关者表示,如果有足够的劳动力资源,他们非常愿意继续以治疗为主导的诊所。结论:在小儿急性手外伤中应用治疗师主导的护理是安全、有效的,具有较高的应用价值。这种模式,以及在质量改进中使用基于价值的医疗保健和实施科学框架的有效性,在其他医疗保健环境中具有很大的规模和推广潜力。
{"title":"Therapy-led model of care for simple, diagnostic-defined pediatric hand fractures can maximize service access and improve consumer outcomes: An implementation study of value-based healthcare using mixed-method design","authors":"Katherine Dalton BOccThy (Hons I), MHM ,&nbsp;Sarah Lyall-Watson BOccThy (Hons I) ,&nbsp;Anna Young BOccThy ,&nbsp;Stuart Bade MBBS, FRACS ,&nbsp;Megan Simons PhD, BOccThy (Hons I)","doi":"10.1016/j.jht.2025.05.006","DOIUrl":"10.1016/j.jht.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric upper limb fractures place high demand on emergency and specialist medical services.</div></div><div><h3>Purpose</h3><div>Allied health professionals (ie, therapists) are increasingly becoming sole providers for care of these conditions; however, evidence for the effectiveness, experiences, and outcomes within the pediatric population is lacking.</div></div><div><h3>Study Design</h3><div>This quality improvement study used mixed-methods design, informed by the RE-AIM and Consolidated Framework for Implementation Research.</div></div><div><h3>Methods</h3><div>Six diagnostically defined, simple pediatric hand injuries (ie, soft tissue; minimally displaced or angulated fractures) were redirected at the time of referral to therapy-led care. Quantitative and qualitative data were collected, including consumer codesigned value-based healthcare outcome measures (function, pain, and patient experience); a patient-reported outcome measure (PROMIS Pediatric Upper Extremity Short Form 8a); health service delivery performance measures (eg, time to appointment, cost of staffing); and workforce stakeholder survey (feasibility and acceptability). Descriptive or inferential statistics were applied to quantitative data and content analysis to qualitative data.</div></div><div><h3>Results</h3><div>The therapy-led clinic absorbed 20% of the overall new occasions of service to the orthopedic medical fracture clinic with a median wait time of 9 days (IQR = 5), seeing 97 new patients. Patient-reported measures were collected for 3 months. Fifty-three percent (<em>n</em> = 30/57) of eligible families completed the value-based healthcare outcome measures at clinical healing (eg, 4-6 weeks post injury), with all measures exceeding expected performance for function, pain, and health service experience. There was a higher virtual care follow-up in therapy-led vs medical care (82% vs 9%, respectively). Workforce stakeholders indicated a high willingness to continue the therapy-led clinic if adequate workforce resourcing was available.</div></div><div><h3>Conclusions</h3><div>The application of therapist-led care in pediatric acute hand injuries is safe, effective, and of high value. This model, and the effectiveness of using value-based health care and implementation science frameworks in quality improvement, has high potential for scale and spread within other healthcare settings.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"39 1","pages":"Pages 224-235"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592967","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}
引用次数: 0
Editorial Board / Masthead / ASHT Officers 编辑委员会/报头/ ASHT官员
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2026-03-03 DOI: 10.1016/S0894-1130(26)00005-0
{"title":"Editorial Board / Masthead / ASHT Officers","authors":"","doi":"10.1016/S0894-1130(26)00005-0","DOIUrl":"10.1016/S0894-1130(26)00005-0","url":null,"abstract":"","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"39 1","pages":"Pages A3-A4"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147417114","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}
引用次数: 0
Development and clinical application of a shoulder external rotation orthosis: A novel approach to post-operative and conservative management 肩外旋矫形器的发展和临床应用:一种新的术后保守治疗方法。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-06-16 DOI: 10.1016/j.jht.2025.05.014
Juliana Larocerie-Salgado OT, MSc, CHT , Kristen MacDonald MScOT, CHT , Samantha H. Lau MSc OT
{"title":"Development and clinical application of a shoulder external rotation orthosis: A novel approach to post-operative and conservative management","authors":"Juliana Larocerie-Salgado OT, MSc, CHT ,&nbsp;Kristen MacDonald MScOT, CHT ,&nbsp;Samantha H. Lau MSc OT","doi":"10.1016/j.jht.2025.05.014","DOIUrl":"10.1016/j.jht.2025.05.014","url":null,"abstract":"","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"39 1","pages":"Pages 275-278"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318751","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}
引用次数: 0
Upper-limb prosthetic requirements from the healthcare providers, end-users and relatives' perspectives 医疗保健提供者、最终用户和家属对上肢假肢的需求。
IF 1.8 4区 医学 Q2 ORTHOPEDICS Pub Date : 2026-01-01 Epub Date: 2025-06-17 DOI: 10.1016/j.jht.2025.04.006
Sofía C. Henao PhD , Simón Cuartas-Escobar MEng , Sara Salazar-Salgado MSc , Ana María Posada-Borrero MD, MSc

Background

Upper-limb amputation negatively impacts people’s quality of life because replicating the hand anatomy and its multiple functions is complex. This difficulty has caused prosthesis rejection rates to be as high as 50%, mainly due to a lack of function, comfort, and control.

Purpose

This study aimed to define upper-limb prosthesis design requirements from the perspectives of health providers, end-users, and close relatives.

Methods

Semistructured interviews were conducted with three types of stakeholders: 11 healthcare providers, 10 end-users with unilateral upper-limb amputation, and 10 close relatives. The questions included characteristics for prosthetic design and the capability to conduct activities of daily living (ADL) with different types of prostheses. This study forms part of a project focused on the design of a myoelectric upper limb prosthesis. The presented information pertains to the needs definition stage of the Design Thinking process, specifically, the Data, Information, Knowledge, and Wisdom scheme, aiming to outline the gathered insights and key findings descriptively.

Results

The three groups agreed that the most critical characteristic of a prosthesis was comfort, followed by maintenance and low weight. Cost was the requirement with the most remarkable difference in perception among stakeholders. Differences in the perception of the capability of conducting activities of daily living (ie, transport, housework, personal care and grooming) were found between the end-users and their relatives. These results and previous research provide relevant information for device design, mainly related to critical challenges and user requirements. These considerations may help to improve user satisfaction and reduce device abandonment rates.

Conclusions

All stakeholders prioritize comfort in upper-limb prostheses, though perceptions of cost diverge sharply depending on financial responsibility. Integrating users’ ADL requirements could enhance independence. Tailoring designs to end-users' diverse needs, addressing family impacts, and mitigating external abandonment factors (eg, unrealistic expectations, training gaps, and accessory shortages) are critical to reducing device abandonment and improving rehabilitation outcomes.
背景:上肢截肢对人的生活质量有负面影响,因为复制手部解剖结构及其多种功能是复杂的。这一困难导致假体排斥率高达50%,主要是由于缺乏功能、舒适度和控制。目的:本研究旨在从医疗服务提供者、最终使用者和近亲属的角度定义上肢假肢的设计要求。方法:对三种类型的利益相关者进行半结构化访谈:11名医疗保健提供者,10名单侧上肢截肢的最终用户和10名近亲。问题包括假体设计的特点和使用不同类型的假体进行日常生活活动的能力。这项研究是一个专注于设计肌电上肢假体的项目的一部分。所呈现的信息属于设计思维过程的需求定义阶段,特别是数据、信息、知识和智慧方案,旨在描述地概述收集到的见解和关键发现。结果:三组患者一致认为义肢最重要的特征是舒适性,其次是可维护性和轻重量。成本是利益相关者之间感知差异最显著的要求。在进行日常生活活动(即交通、家务、个人护理和修饰)的能力的感知上,最终用户与其亲属之间存在差异。这些结果和之前的研究为设备设计提供了相关信息,主要涉及关键挑战和用户需求。这些考虑可能有助于提高用户满意度和降低设备弃用率。结论:所有利益相关者都优先考虑上肢假肢的舒适性,尽管对成本的看法因经济责任而有很大差异。整合用户的ADL需求可以增强独立性。根据最终用户的不同需求定制设计,解决家庭影响,减少外部放弃因素(如不切实际的期望、培训差距和配件短缺)对于减少设备放弃和改善康复效果至关重要。
{"title":"Upper-limb prosthetic requirements from the healthcare providers, end-users and relatives' perspectives","authors":"Sofía C. Henao PhD ,&nbsp;Simón Cuartas-Escobar MEng ,&nbsp;Sara Salazar-Salgado MSc ,&nbsp;Ana María Posada-Borrero MD, MSc","doi":"10.1016/j.jht.2025.04.006","DOIUrl":"10.1016/j.jht.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Upper-limb amputation negatively impacts people’s quality of life because replicating the hand anatomy and its multiple functions is complex. This difficulty has caused prosthesis rejection rates to be as high as 50%, mainly due to a lack of function, comfort, and control.</div></div><div><h3>Purpose</h3><div>This study aimed to define upper-limb prosthesis design requirements from the perspectives of health providers, end-users, and close relatives.</div></div><div><h3>Methods</h3><div>Semistructured interviews were conducted with three types of stakeholders: 11 healthcare providers, 10 end-users with unilateral upper-limb amputation, and 10 close relatives. The questions included characteristics for prosthetic design and the capability to conduct activities of daily living (ADL) with different types of prostheses. This study forms part of a project focused on the design of a myoelectric upper limb prosthesis. The presented information pertains to the needs definition stage of the Design Thinking process, specifically, the Data, Information, Knowledge, and Wisdom scheme, aiming to outline the gathered insights and key findings descriptively.</div></div><div><h3>Results</h3><div>The three groups agreed that the most critical characteristic of a prosthesis was comfort, followed by maintenance and low weight. Cost was the requirement with the most remarkable difference in perception among stakeholders. Differences in the perception of the capability of conducting activities of daily living (ie, transport, housework, personal care and grooming) were found between the end-users and their relatives. These results and previous research provide relevant information for device design, mainly related to critical challenges and user requirements. These considerations may help to improve user satisfaction and reduce device abandonment rates.</div></div><div><h3>Conclusions</h3><div>All stakeholders prioritize comfort in upper-limb prostheses, though perceptions of cost diverge sharply depending on financial responsibility. Integrating users’ ADL requirements could enhance independence. Tailoring designs to end-users' diverse needs, addressing family impacts, and mitigating external abandonment factors (eg, unrealistic expectations, training gaps, and accessory shortages) are critical to reducing device abandonment and improving rehabilitation outcomes.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"39 1","pages":"Pages 147-155"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327697","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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