Journal of Hand Therapy最新文献

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.

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.

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: 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.