Journal of Hand Therapy最新文献

Background: Although exercise is known to be important in treating scleroderma patients, studies on the methods by which exercise should be performed are limited.

Purpose: This study aimed to compare the effects of physiotherapist-guided telerehabilitation and independent home-based exercise treatments for hand rehabilitation in patients with scleroderma.

Study design: Randomized controlled trial.

Methods: Patients diagnosed with scleroderma were randomized into two groups. While patients in the telerehabilitation group did their exercises under the supervision of a physiotherapist using the Zoom application, patients in the home-based exercise group did the exercises in the brochure given to them on their own. The treatment of both groups was 3 days a week for 8 weeks and included similar exercises. Hand mobility, thumb mobility, finger motion, gross and pinch grip strength, pain intensity, hand functions, health status, and quality of life of the patients were evaluated before and after treatment.

Results: Thirty-four patients were included in the study. No significant difference was detected between the groups due to baseline evaluation. After 8-week treatment, telerehabilitation group demonstrated better hand mobility (p = 0.010, d = -0.31; p = 0.015, d = -0.17), thumb mobility (p < 0.001, d = 0.54; p < 0.001, d = 0.48), finger motion (p = 0.005, d = -0.35; p = 0.005, d = -0.41), gross grip strength (p < 0.001, d = 0.52; p = 0.007, d = 0.35), and triple (p = 0.002, d = 0.76; p = 0.011, d = 0.62) and lateral pinch grip strength (p = 0.008, d = 0.09; p = 0.024, d = 0.17) scores for right and left hands, respectively.

Conclusions: The present research indicated that physiotherapist-guided telerehabilitation is more effective than self-management in hand rehabilitation in patients with scleroderma. Based on these findings, physiotherapist-guided telerehabilitation is a quality practice that has the potential to increase hand mobility and grip strength in patients with scleroderma.

Background: Numerous conservative treatment options are available to manage carpal tunnel syndrome (CTS). It is unclear how hand therapists currently manage CTS and whether practice patterns have changed over time.

Purpose: This study aimed to (1) document how hand therapists manage CTS and (2) identify possible changes in treatment patterns over a 15-year window.

Study design: Cross-sectional.

Methods: An online survey was distributed among all members of the Australian Hand Therapy Association. Findings were compared with a nearly identical survey conducted 15 years earlier, and with clinical guidelines, and recent clinical trials and reviews.

Results: The 10 most commonly used noninvasive management options were explanation and advice, splinting, home exercise prescription, nerve gliding exercises involving proximal joints (ie, elbow, shoulder, or neck) and distal joints (ie, hand and wrist), ergonomic advice, advice regarding sitting and standing posture, tendon gliding exercises, and active wrist and finger exercises. Although these interventions also constituted the 10 most common interventions in the previous survey, meaningful differences were observed. Compared to 15 years ago, the main changes included an increase in the use of neurodynamic exercises involving proximal joints (+19.9 %pt) and distal joints (+10.7 %pt), and heat (+10.7 %pt), whereas tendon gliding exercises (-8.5 %pt) and therapeutic ultrasound (-6.2 %pt) were the main modalities that were performed less frequently. Apart from ergonomic and postural advice, commonly performed interventions (eg, explanation and advice, splinting, and neurodynamic exercises) were in line with the literature. Overall, Australian hand therapists often used a more active (exercise-based) approach compared with the guidelines and an approach that typically involved the arm rather than only the hand and wrist.

Conclusions: Australian hand therapists use a wide range of interventions to manage CTS, with some noteworthy changes in treatment patterns over the preceding 15 years. Their approach is mostly supported by the literature.

Background: Although the use of telemedicine has persisted in hand surgery and therapy practices beyond the COVID-19 pandemic, there remains a need for simple, validated means of remotely measuring finger joint range of motion for integration in fast-paced virtual clinics. We propose on-screen measurement, a technique previously validated in the elbow, which involves holding a goniometer up to the telemedicine appointment screen.

Purpose: This study aimed to determine the reliability and concurrent validity of on-screen measurements relative to the gold standard, in-person goniometry. Congruence of management plans established at virtual and in-person appointments was as a secondary aim.

Study design: Prospective Reliability and Agreement (Concurrent Validity) Study.

Methods: Patients with Dupuytren's disease assessed virtually and in-person were recruited from one surgeon's practice. Virtual and in-person measurements in maximal passive extension, time between appointments and treatment plans made at each visit were extracted from patients' charts. In-person assessors were blinded to previous telemedicine-based measurements and, after a 2-week washout period, the original assessor and two additional assessors re-measured joints from screenshots captured at telemedicine appointment. Descriptive and statistical analyses were used to evaluate inter-rater and intra-rater reliability as well as concurrent validity.

Results: Fifty-four eligible patients (191 joints; 102 digits) attended telemedicine and in-person appointments at a median of 31 days apart. Inter-rater and intra-rater reliability were excellent (intraclass correlation coefficient >0.96). The absolute mean difference between on-screen and in-person measurements was 8˚, with 61.7% of on-screen measurements falling within 10˚ of in-person measurements. Management plans made at the telemedicine appointment were congruent with those carried out in-person in 96.3% of cases.

Conclusions: On-screen measurement is highly reliable with concurrent validity that compares to similar photography-based measurement studies. Our results suggest on-screen measurement may be a useful tool for initial consultation and triaging of patients with flexion contractures.

Background: Fibromyalgia is a chronic disorder characterized by widespread pain, fatigue, and other systemic symptoms. While fibromyalgia is associated with generalized musculoskeletal complaints, little is known about its relationship with specific hand disorders that impact function and quality of life.

Purpose: To determine whether fibromyalgia is associated with an increased prevalence of hand diseases-including carpal tunnel syndrome, De Quervain's tenosynovitis, trigger finger, tendinitis, and hand osteoarthritis-and to assess healthcare utilization patterns and surgical intervention.

Study design: Retrospective, population-based, matched case-control study.

Methods: We used electronic health records from Leumit Health Services, an Israeli healthcare provider serving 750,000 enrollees. The study included adults aged 18-90 diagnosed with fibromyalgia between 2002 and 2023, confirmed by board-certified rheumatologists using the 2010 ACR criteria. Controls were matched 5:1 by age, sex, and enrollment year. Hand diseases were diagnosed using ICD-9 codes, which were confirmed by repeated documentation. Surgical interventions and hand-related healthcare utilization were extracted from administrative records. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, with significance determined by p < 0.05 and Benjamini-Hochberg correction.

Results: The study included 9232 fibromyalgia patients and 46,160 controls (mean age 47.6 years; 86.8% female). Fibromyalgia was significantly associated with increased odds of carpal tunnel syndrome (OR 2.98 [2.80-3.16]), trigger finger (OR 1.77), De Quervain's tenosynovitis (OR 1.96), tendinitis (OR 2.16), and hand osteoarthritis (OR 2.99) (all p < 0.001). Fibromyalgia patients also had higher healthcare utilization and surgical procedure rates, including carpal tunnel release (OR 2.57) and trigger finger repair (OR 2.98).

Conclusions: Fibromyalgia is associated with a significantly higher prevalence of hand diseases and related surgical interventions. These findings support the need for early screening and multidisciplinary management of hand pathology in fibromyalgia patients to improve outcomes and prevent disability.

Background: Carpometacarpal osteoarthritis is a common condition that leads to declines in hand dexterity. The Corbett Targeted Coin Test measures dexterity with palm-to-finger translation and proprioceptive target placement, but lacks established norms for the carpometacarpal osteoarthritis population and post carpometacarpal osteoarthritis suture suspension arthroplasty.

Purpose: To determine the Corbett Targeted Coin Test norms for patients with carpometacarpal osteoarthritis that are surgical candidates, as well as Corbett Targeted Coin Test norms and outcomes following carpometacarpal osteoarthritis suture suspension arthroplasty.

Study design: Clinical measurement of a retrospective cohort.

Methods: Subjects were diagnosed with carpometacarpal osteoarthritis, had carpometacarpal suture suspension arthroplasty, and were assessed preoperatively and 12 weeks postoperatively.

Results: Prior to surgery, the patients with carpometacarpal osteoarthritis that were surgical candidates demonstrated a mean Corbett Targeted Coin Test quality of performance score of 53.4 (range 28-90). A total of 31 participants (22 females, nine males) underwent thumb carpometacarpal suture suspension arthroplasty. On average, there were 7.1 therapy visits (range 4-10) and the average age was 66.6years (51-81years). Outcome measures following suture suspension arthroplasty 12weeks postoperatively demonstrated both statistically and clinically significant improvements in pain reduction (Numeric Pain Rating Scale), QuickDASH scores, and Patient-Rated Wrist/Hand Evaluation scores. There was also a clinically significant improvement in grip strength. Corbett Targeted Coin Test scores improved with a mean quality of performance score of 47.3 (range 20-73) but did not correlate with other outcome measures.

Conclusions: Patients with carpometacarpal osteoarthritis had higher quality of performance scores, indicating a slower and/or less accurate dexterity performance compared with the normal population. At 12weeks post suture suspension arthroplasty, the Corbett Targeted Coin Test scores improved 11.4%, and there were statistically and clinically significant improvements in pain reduction (Numeric Pain Rating Scale), QuickDASH, Patient-Rated Wrist/Hand Evaluation, and a clinically significant improvement in grip strength.

Background: Musician's Dystonia is a neurological condition that mainly affects professional players when performing repetitive, finely controlled hand movements necessary for their musical practice.

Purpose: The study in question aims to formulate a rehabilitation treatment protocol for patients with musician's hand dystonia, based on integrated occupational therapy and physiotherapy interventions.

Study design: Case series.

Methods: The description of the treatment protocol will be shown through the presentation of three case reports (a pianist, a saxophonist, and a violinist) who enrolled and attended an intervention program based on four common steps. The outcomes measure used for the assessments were the Disability of the Arm, Shoulder and Hand, the ABILHAND, the Tubiana and Chamagne Scale, the Arm Dystonia Disability Scale, and the Jebsen-Taylor Hand Function Test. The results were then subjected to statistical analysis.

Results: No statistically significant results were obtained; however, clinically significant results were highlighted based on the observation of the raw scores of each musician. Every patient experienced varying degrees of improvement and reported significant gains in motor control, accuracy, sensory discrimination, and musical performance.

Conclusions: The results of the study in question indicate that our rehabilitation program has good chances of effectiveness in improving the musical performance of musicians with focal hand dystonia.