Journal of Hand Therapy最新文献

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.

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.

Background: Metacarpophalangeal joint blocking orthoses are used for managing trigger finger, with limited intervention evidence for relative motion orthoses.

Purpose: This 6-week trial evaluated the effectiveness of metacarpophalangeal joint blocking and relative motion orthoses for managing trigger finger severity, function, occupational performance/satisfaction, and orthosis wearability.

Study design: Randomized comparative trial, ClinicalTrials.gov (NCT05763017).

Methods: Thirty-six participants with no prior trigger finger intervention and ≥ 21 years old were randomly assigned to the relative motion or metacarpophalangeal joint blocking orthosis (neutral metacarpophalangeal joint) groups. The primary author screened for eligibility and fabricated the orthoses. Week-1 and week-6 Therapist A assessed stages of stenosing tenosynovitis, number of triggering events in 10 active fists (NTE), visual analog scales for pain, orthosis comfort and satisfaction (wearability), Disabilities of the Arm, Shoulder and Hand, and Canadian Occupational Performance Measure. Week-3 Therapist B administered orthosis wearability visual analog scales. The relative motion pencil test determined orthosis design, relative motion extension or flexion, and metacarpophalangeal joint differential. Mixed-effects ANOVA was used to compare week-1 and week-6 outcomes. Cohen's f was used to measure the effect size.

Results: Thirty-five participants completed this trial. Between week-1 and week-6, both groups demonstrated significant differences with large effect size in stages of stenosing tenosynovitis (f=1.21), NTE (f=1.07), pain at rest (f=0.36), pain during activity (f=0.76), Disabilities of the Arm, Shoulder and Hand (f=1.19), Canadian Occupational Performance Measure performance (f=1.12) and satisfaction (f=1.14). No superior effect was noted between orthosis groups. Wearability for both groups was 7/10 at rest and 4/10 during activity. The pencil test yielded 15/18 relative motion extension orthoses and 20-25˚ metacarpophalangeal differential.

Conclusions: Symptom severity, pain, hand function, and orthosis wearability outcomes support interchangeable use of relative motion and metacarpophalangeal joint blocking orthoses for managing trigger finger.

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 18years 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.

Background: In terms of different scapula-focused interventions included in the treatment for restoration of altered biomechanics and diminished motor control in rotator cuff injuries, evidence supporting the superiority of any method is limited.

Purpose: The aim was to investigate the effectiveness of scapula-focused interventions primarily on pain and function under the subtitle of rotator cuff injuries, and to synthesize evidence in order to inform clinical practice by compiling the current literature.

Study design: Literature synthesis, systemic review.

Methods: PubMed, Cochrane, Scopus, Proquest, Pedro, and Google Scholar databases were searched based on December 2024 using the determined search strategy. PEDro scale for methodological quality and revised Cochrane risk-of-bias tool for risk-of-bias assessment were used. Studies obtained were evaluated independently by two researchers in terms of title, abstract, and full text.

Results: A total of 743 articles were identified from database searches. Eleven studies (565 participants/age range 20-66) of moderate-to-high quality, rated 5-9 according to the PEDro quality assessment, were included. In conservative rehabilitation of rotator cuff pathologies, scapular stabilization exercises showed a large effect size in reducing pain (Cohen's d = 2.07) and a large effect size in improving function (Cohen's d = 2.35). In postoperative rehabilitation of rotator cuff pathologies, scapular training exercises showed the greatest effect in improving function (Cohen's d = 1.58), while the combination of scapular training exercises and scapular manual interventions showed the greatest effect in reducing pain (Cohen's d = 1.18). Scapular stabilization exercises were also found to have a large effect size for shoulder abduction range of motion (Cohen's d = 2.07).

Conclusions: It is concluded that additional scapular training exercises, and a combination of the scapular training exercises and scapular manual interventions create a significant difference in pain, function, and range of motion in individuals with postoperative rotator cuff injuries; whereas additional scapular stabilization exercises create a significant difference in pain and function in a conservatively treated rotator cuff patient.

Background: People with stroke commonly experience upper limb impairments. Transcutaneous electrical nerve stimulation is a noninvasive approach that delivers electrical signals to stimulate nerves.

Purpose: To evaluate the effectiveness of transcutaneous electrical nerve stimulation, with or without concurrent rehabilitation interventions, compared with passive or active controls, on upper limb motor recovery, spasticity, strength, range of motion, and dexterity post-stroke, and to identify optimal transcutaneous electrical nerve stimulation parameters.

Study design: Systematic review and meta-analysis.

Methods: A systematic search was conducted in PubMed, Scopus, MEDLINE, PEDro, REHABDATA, CINAHL, and EMBASE from inception to August 2024. Eligible studies were randomized controlled trials involving adults with stroke who received transcutaneous electrical nerve stimulation to the upper limb, alone or with rehabilitation interventions. Comparators included passive controls (eg, sham) or active controls (eg, conventional therapy). Studies assessed upper limb outcomes, including motor recovery, spasticity, strength, range of motion, or dexterity. Data were synthesized using Comprehensive Meta-Analysis Version 4. Study quality was assessed using the PEDro scale.

Results: Ten RCTs involving 744 post-stroke participants (mean age 61; 63% male) met inclusion criteria. Meta-analysis showed small, non-significant effects of TENS on functional recovery (SMD = 0.21, 95% CI: -0.15 to 0.57, p = 0.26; I² = 81%) and spasticity (SMD = 0.05, 95% CI: -0.35 to 0.44, p = 0.82; I² = 77%). Some studies reported significant improvements in strength, range of motion, and dexterity when TENS was combined with rehabilitation, though between-group differences were often not significant. Results for activities of daily living and quality of life were inconsistent and generally non-significant.

Conclusions: Transcutaneous electrical nerve stimulation alone shows limited effectiveness for upper limb recovery post-stroke. Combined with rehabilitation, it may offer additional benefits. Transcutaneous electrical nerve stimulation parameters should be individualized. More trials are needed to determine optimal applications in stroke rehabilitation.

Background: There is a lack of clear guidelines on best practices for managing pain after carpal tunnel release (CTR) using opioids and non-opioids.

Purpose: The purpose of this review is to present the available evidence specific to the use of opioids and non-opioids to manage pain following CTR.

Study design: Systematic review.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for searching MEDLINE, Cochrane Central Register of Controlled Trials, Excerpta Medica Database, and Web of Science databases for English language using the keywords carpal tunnel, wrist surgery, and postoperative pain. Randomized controlled trials and cohort studies that compared the pharmacological use of oral opioids and non-opioids and patient-reported pain outcomes were included.

Results: Initially, 2861 articles were identified. After applying predefined inclusion and exclusion criteria and conducting full-text screening, five randomized controlled trials totaling 691 patients were included. A comparative synthesis of these trials revealed that reported pain scores and mean pill consumption did not differ significantly between patients prescribed opioids vs non-opioids.

Conclusions: Based on this limited review of five studies, the use of non-opioids, such as acetaminophen or ibuprofen, is not inferior to opioids for management of pain following CTR. Most authors recommend a multimodal analgesic approach combining acetaminophen and ibuprofen.

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.