Pub Date : 2024-10-01DOI: 10.1016/j.jht.2024.02.008
Brynhild Krog Eriksen OT MsC, Tone Vaksvik OT PhD
Background
Knowledge of specific activity limitations due to cold hypersensitivity is sparse.
Purpose
To explore activity limitations caused by cold hypersensitivity and the associated environmental factors in patients with hand injuries.
Study design
Descriptive study.
Methods
Seventy-seven patients with multiple tissue hand injuries described activity limitations related to cold hypersensitivity in questionnaires six and/or 12 months after surgery. To characterize the activity limitations, we performed a quantitative content analysis applying the International classification of functioning and health (ICF).
Results
The respondents described on average 3.6 cold related activity limitations in leisure and/or work. The activities were most frequently (n) assigned to the ICF domains d920 Recreation and leisure (95), d440 Fine hand use (77), and d850 Remunerative employment (39). The most common related environmental factors were Products and technology for e140 Culture, recreation and sport (79) and for e135 Employment (71), respectively, and e225 Climate (71). Gloves were both a facilitator and a barrier for activity performance.
Conclusion
The impact of cold hypersensitivity on activity was related to both the activity and the environment. The results call for clinical interventions and product development, for example of gloves, to help patients solve their cold related activity limitations.
{"title":"Activity limitations related to cold hypersensitivity in patients with hand injuries","authors":"Brynhild Krog Eriksen OT MsC, Tone Vaksvik OT PhD","doi":"10.1016/j.jht.2024.02.008","DOIUrl":"10.1016/j.jht.2024.02.008","url":null,"abstract":"<div><h3>Background</h3><div>Knowledge of specific activity limitations due to cold hypersensitivity is sparse.</div></div><div><h3>Purpose</h3><div>To explore activity limitations caused by cold hypersensitivity and the associated environmental factors in patients with hand injuries.</div></div><div><h3>Study design</h3><div>Descriptive study.</div></div><div><h3>Methods</h3><div>Seventy-seven patients with multiple tissue hand injuries described activity limitations related to cold hypersensitivity in questionnaires six and/or 12 months after surgery. To characterize the activity limitations, we performed a quantitative content analysis applying the International classification of functioning and health (ICF).</div></div><div><h3>Results</h3><div>The respondents described on average 3.6 cold related activity limitations in leisure and/or work. The activities were most frequently (<em>n</em>) assigned to the ICF domains <em>d920 Recreation and leisure</em> (95), <em>d440 Fine hand use</em> (77), and <em>d850 Remunerative employment</em> (39). The most common related environmental factors were <em>Products and technology for e140 Culture, recreation and sport</em> (79) and for <em>e135 Employment</em> (71), respectively, and <em>e225 Climate</em> (71). Gloves were both a facilitator and a barrier for activity performance.</div></div><div><h3>Conclusion</h3><div>The impact of cold hypersensitivity on activity was related to both the activity and the environment. The results call for clinical interventions and product development, for example of gloves, to help patients solve their cold related activity limitations.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 544-554"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carpal tunnel syndrome (CTS) is the most common mononeuropathy in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients.
Purpose
This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the median nerve and pain in mild-to-moderate CTS patients.
Study Design
This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1.
Methods
Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample t-tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's d effect size was used to assess the intervention's magnitude.
Results
Both ESWT and LLLT groups showed significant improvements in CSA (p = 0.002) and pain (p < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy.
Conclusion
The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction.
{"title":"A randomized clinical trial on the changing of median nerve cross-sectional area and pain after extracorporeal shock wave and low-level laser therapy added to conventional physical therapy in patients with mild-to-moderate carpal tunnel syndrome","authors":"Amirhossein Ghasemi , Gholam Reza Olyaei , Hossein Bagheri , Mohammad Reza Hadian , Shohreh Jalaei , Khadijeh Otadi , Kazem Malmir","doi":"10.1016/j.jht.2023.12.009","DOIUrl":"10.1016/j.jht.2023.12.009","url":null,"abstract":"<div><h3>Background</h3><div><span>Carpal tunnel syndrome (CTS) is the most common </span>mononeuropathy<span> in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients.</span></div></div><div><h3>Purpose</h3><div><span>This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the </span>median nerve and pain in mild-to-moderate CTS patients.</div></div><div><h3>Study Design</h3><div>This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1.</div></div><div><h3>Methods</h3><div>Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample <em>t</em>-tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's <em>d</em> effect size was used to assess the intervention's magnitude.</div></div><div><h3>Results</h3><div>Both ESWT and LLLT groups showed significant improvements in CSA (<em>p</em> = 0.002) and pain (<em>p</em> < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy.</div></div><div><h3>Conclusion</h3><div>The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 555-562"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567632","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jht.2023.12.004
Dave Parsons , Rachel Ross , Celeste Glasgow , Luke Robinson , Luke McCarron , Lisa O’Brien
Background
Identifying the factors influencing engagement in research capacity and culture (RCC) in hand therapy practice is essential to inform strategies to support contributions to high-quality research and its implementation in clinical practice. However, the RCC of clinicians providing hand therapy services in Australia has not been investigated.
Purpose
This study aimed to measure RCC among hand therapists in Australia to identify perceived barriers, motivators, and skills related to undertaking research.
Study Design
Cross-sectional survey.
Methods
All Australian Hand Therapy Association members were invited to complete the RCC tool, which includes three domains: i) individual, ii) professional group (team), and iii) organization.
Results
One hundred twenty-two therapists (13.6% response rate) completed the survey. Survey findings indicate that the RCC of hand therapists in Australia is relatively low across all RCC domains, with scores on these items being either moderate or low. The findings from this study suggest that the areas or skills that respondents felt most confident with were more closely aligned to the clinical skills required as evidence-based practitioners, compared to other skills more closely aligned with the clinician-researchers, such as data analysis or writing proposals.
Conclusions
Hand therapists in Australia may not possess the research experience or skills required to confidently complete a range of research-related activities. Future support strategies should focus on improving hand therapist knowledge and confidence regarding common research tasks and provide funding and mentoring for additional hand therapist clinician-researcher roles.
{"title":"Research capacity and culture among hand therapists in Australia: A cross-sectional survey","authors":"Dave Parsons , Rachel Ross , Celeste Glasgow , Luke Robinson , Luke McCarron , Lisa O’Brien","doi":"10.1016/j.jht.2023.12.004","DOIUrl":"10.1016/j.jht.2023.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Identifying the factors influencing engagement in research capacity and culture (RCC) in hand therapy practice is essential to inform strategies to support contributions to high-quality research and its implementation in clinical practice. However, the RCC of clinicians providing hand therapy services in Australia has not been investigated.</div></div><div><h3>Purpose</h3><div>This study aimed to measure RCC among hand therapists in Australia to identify perceived barriers, motivators, and skills related to undertaking research.</div></div><div><h3>Study Design</h3><div>Cross-sectional survey.</div></div><div><h3>Methods</h3><div>All Australian Hand Therapy Association members were invited to complete the RCC tool, which includes three domains: i) individual, ii) professional group (team), and iii) organization.</div></div><div><h3>Results</h3><div>One hundred twenty-two therapists (13.6% response rate) completed the survey. Survey findings indicate that the RCC of hand therapists in Australia is relatively low across all RCC domains, with scores on these items being either moderate or low. The findings from this study suggest that the areas or skills that respondents felt most confident with were more closely aligned to the clinical skills required as evidence-based practitioners, compared to other skills more closely aligned with the clinician-researchers, such as data analysis or writing proposals.</div></div><div><h3>Conclusions</h3><div>Hand therapists in Australia may not possess the research experience or skills required to confidently complete a range of research-related activities. Future support strategies should focus on improving hand therapist knowledge and confidence regarding common research tasks and provide funding and mentoring for additional hand therapist clinician-researcher roles.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 662-669"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139657208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jht.2023.12.007
Jason L. Judkins PhD, DSc, OTR/L, CHT , Vy T. Nguyen PhD , Melissa D. Richardson , Tanja C. Roy PhD
Background
Upper extremity musculoskeletal injuries are common with active-duty Army Soldiers and result in increased limited duty days. Patient satisfaction and surgery rates improve with direct access to occupational therapy in the civilian community.
Purpose
Examine the amount of time from initial evaluation following an upper extremity musculoskeletal injury (MSKI) to return to full duty plus occupational therapy (OT) utilization in Army Soldiers.
Study Design
Retrospective observational.
Methods
Electronic health records and profiles from 18,206 US active-duty Army soldiers with MSKI and OT evaluation between 2017–2018 were examined. Repeated measures generalized estimating equations provided the rate ratios (RRs) for OT healthcare utilization (total number of OT evaluations and treatment visits) by days to first OT evaluation and limited duty profile (total days on profile).
Results
Soldiers were on average 32.0 (SD = 8.9) y/o, predominantly senior enlisted (45.7%), white (58.0%), male (81.4%), 10.0 (SD = 8.4) years of service, and high school or less educated (51.3%). There were 22,617 UE MSKIs with an OT evaluation and 4936 UE MSKIs with profiles. Compared with UE MSKIs with an OT evaluation on the same day, there was a significant increase in rates of OT utilization for 1–7 days (RR: 1.4, 95% CI: 1.3, 1.5), 8–14 days (RR: 1.3, 95% CI: 1.2, 1.4), 15–30 days (RR: 1.4, 95% CI: 1.3, 1.5), 31–60 days (RR: 1.5, 95% CI: 1.4, 1.6), and +60 days later (RR: 1.6, 95% CI: 1.5, 1.7). Similar differences in rates for limited duty profiles were found.
Conclusion
A greater number of days between diagnosis of UE MSKI and OT evaluation results in greater rates of OT utilization and longer temporary profile. Results suggest that earlier intervention by OT may decrease recovery and healthcare utilization of soldiers.
{"title":"Association between availability of direct access to army occupational therapy with return to duty in active-duty soldiers","authors":"Jason L. Judkins PhD, DSc, OTR/L, CHT , Vy T. Nguyen PhD , Melissa D. Richardson , Tanja C. Roy PhD","doi":"10.1016/j.jht.2023.12.007","DOIUrl":"10.1016/j.jht.2023.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Upper extremity musculoskeletal injuries are common with active-duty Army Soldiers and result in increased limited duty days. Patient satisfaction and surgery rates improve with direct access to occupational therapy in the civilian community.</div></div><div><h3>Purpose</h3><div>Examine the amount of time from initial evaluation following an upper extremity musculoskeletal injury (MSKI) to return to full duty plus occupational therapy (OT) utilization in Army Soldiers.</div></div><div><h3>Study Design</h3><div>Retrospective observational.</div></div><div><h3>Methods</h3><div>Electronic health records and profiles from 18,206 US active-duty Army soldiers with MSKI and OT evaluation between 2017–2018 were examined. Repeated measures generalized estimating equations provided the rate ratios (RRs) for OT healthcare utilization (total number of OT evaluations and treatment visits) by days to first OT evaluation and limited duty profile (total days on profile).</div></div><div><h3>Results</h3><div>Soldiers were on average 32.0 (<em>SD</em> = 8.9) y/o, predominantly senior enlisted (45.7%), white (58.0%), male (81.4%), 10.0 (<em>SD</em> = 8.4) years of service, and high school or less educated (51.3%). There were 22,617 UE MSKIs with an OT evaluation and 4936 UE MSKIs with profiles. Compared with UE MSKIs with an OT evaluation on the same day, there was a significant increase in rates of OT utilization for 1–7 days (RR: 1.4, 95% CI: 1.3, 1.5), 8–14 days (RR: 1.3, 95% CI: 1.2, 1.4), 15–30 days (RR: 1.4, 95% CI: 1.3, 1.5), 31–60 days (RR: 1.5, 95% CI: 1.4, 1.6), and +60 days later (RR: 1.6, 95% CI: 1.5, 1.7). Similar differences in rates for limited duty profiles were found.</div></div><div><h3>Conclusion</h3><div>A greater number of days between diagnosis of UE MSKI and OT evaluation results in greater rates of OT utilization and longer temporary profile. Results suggest that earlier intervention by OT may decrease recovery and healthcare utilization of soldiers.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 670-676"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698864","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jht.2023.12.012
Zixian Yang , Charlene Xue Lin Ong , Jackson Kian Hong Jiang
Background
Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion.
Purpose
To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option.
Study design
Retrospective cohort.
Methods
We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles.
Results
Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8–21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses.
Conclusion
We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained.
{"title":"The use of non-invasive skin traction orthosis in managing phalangeal fractures","authors":"Zixian Yang , Charlene Xue Lin Ong , Jackson Kian Hong Jiang","doi":"10.1016/j.jht.2023.12.012","DOIUrl":"10.1016/j.jht.2023.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion.</div></div><div><h3>Purpose</h3><div>To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option.</div></div><div><h3>Study design</h3><div>Retrospective cohort.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles.</div></div><div><h3>Results</h3><div>Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8–21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (<em>p</em> = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses.</div></div><div><h3>Conclusion</h3><div>We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 609-615"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731038","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jht.2023.12.002
Patrick Krastman MD , Gerald Kraan MD, PhD , Yara E. van Kooij MSc, PT , Sita M.A. Bierma-Zeinstra PhD , Jos Runhaar PhD , Hand-Wrist Diagnostic Study group
Background
Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited.
Purpose
To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints.
Study Design
An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed.
Methods
In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario.
Results
Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain.
Conclusions
This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).
背景：在评估腕部不适时，病史采集和体格检查的循证实践非常有限：目的：为腕部未分化症状患者的临床评估制定一套推荐的诊断测试：研究设计：根据德尔菲研究的实施和报告建议，进行了一项电子德尔菲研究：在这项电子德尔菲研究中，邀请了一个全国性多学科专家小组，根据几种病例情景，为腕部主诉未分化患者（年龄≥18 岁）的概率诊断列出诊断测试清单。我们设计了四种不同的病例，并将其提交给专家组成员，这些病例在患者年龄（35 岁 vs 65 岁）、病变部位（桡侧 vs 尺侧）和病程（6 周 vs 10 周）方面各不相同。在连续几轮中，专家们被要求对所列出的诊断测试的重要性进行评分。最后，专家们被要求对每个病例推荐的诊断测试进行排序：综合所有结果，建议对所有病例进行以下诊断测试：询问是否发生过外伤、询问如何引起主诉、询问主诉的定位、评估活动范围、评估是否存在肿胀、评估左右肿胀的差异、评估腕部畸形或位置变化以及触诊疼痛最剧烈的部位：这是第一项科学研究，在这项研究中，临床专家建议在评估未分化的腕部不适患者时进行诊断性测试，这些患者的年龄（35 岁与 65 岁）、部位（桡侧与尺侧）和持续时间（6 周与 10 周）各不相同。
{"title":"Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study","authors":"Patrick Krastman MD , Gerald Kraan MD, PhD , Yara E. van Kooij MSc, PT , Sita M.A. Bierma-Zeinstra PhD , Jos Runhaar PhD , Hand-Wrist Diagnostic Study group","doi":"10.1016/j.jht.2023.12.002","DOIUrl":"10.1016/j.jht.2023.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited.</div></div><div><h3>Purpose</h3><div>To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints.</div></div><div><h3>Study Design</h3><div>An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed.</div></div><div><h3>Methods</h3><div>In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario.</div></div><div><h3>Results</h3><div>Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain.</div></div><div><h3>Conclusions</h3><div>This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 591-600"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jht.2023.12.018
Sally E. Yates BHlthSci, MPhty, MSc (Hand Therapy), CHT , Joanne V. Glinsky BAppSci (Physiotherapy), MHlthSc, PhD , Melissa J. Hirth B(OT), MSc (Hand & Upper Limb Rehab), Dip Business, PhD , Joel T. Fuller BPhty (Hon), PhD
Background
Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking.
Purpose
This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions.
Study design
Systematic review.
Methods
A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation.
Results
Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren’s release for improving total active extension (mean difference [MD] −2.8°, 95% confidence interval [CI]: −9.6° to 4.0°, p = 0.84), total active flexion (MD −5.8°, 95% CI: −12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: −2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: −0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD −16.7°, 95% CI: −20.1° to −13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion.
Conclusion
The addition of an extension orthosis following procedures to manage Dupuytren’s contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion.
{"title":"Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis","authors":"Sally E. Yates BHlthSci, MPhty, MSc (Hand Therapy), CHT , Joanne V. Glinsky BAppSci (Physiotherapy), MHlthSc, PhD , Melissa J. Hirth B(OT), MSc (Hand & Upper Limb Rehab), Dip Business, PhD , Joel T. Fuller BPhty (Hon), PhD","doi":"10.1016/j.jht.2023.12.018","DOIUrl":"10.1016/j.jht.2023.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking.</div></div><div><h3>Purpose</h3><div>This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions.</div></div><div><h3>Study design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation.</div></div><div><h3>Results</h3><div>Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren’s release for improving total active extension (mean difference [MD] −2.8°, 95% confidence interval [CI]: −9.6° to 4.0°, <em>p</em> = 0.84), total active flexion (MD −5.8°, 95% CI: −12.7° to 1.2°, <em>p</em> = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: −2.7 to 3.6, <em>p</em> = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: −0.49 to 0.09, <em>p</em> = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD −16.7°, 95% CI: −20.1° to −13.3°, <em>p</em> < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion.</div></div><div><h3>Conclusion</h3><div>The addition of an extension orthosis following procedures to manage Dupuytren’s contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 495-506"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jht.2023.12.001
Zeal Kadakia , Rafael Paolo Lansang , Pam Ball , Ayse Kuspinar , Sandra VanderKaay , Tara Packham
Background
Composite finger flexion (CFF) is proposed to be a convenient alternative to total active motion (TAM) and total passive motion (TPM). Passive CFF (PCFF) may be useful for early monitoring in post-operative rehabilitation of traumatic hand injuries.
Purpose
To determine whether active and passive CFF are reliable, valid, and responsive measures of hand motion and of higher utility to the tester.
Fifty hand injury patients were recruited from a hospital-based out-patient clinic. TAM, TPM, repeated measures of active CFF (ACFF) and PCFF, self-reported stiffness, patient reported wrist/hand evaluation (PRWHE) scores, and grip strength were recorded. Intraclass correlation coefficients (ICCs) and standard error of measurement were calculated for inter-rater and test-retest reliability. Criterion and construct validity were assessed using correlation coefficients. Responsiveness was explored by calculating correlation coefficients of change scores, effect sizes, and standardized response means. Time taken to measure CFF and TAM/TPM was recorded to consider utility.
Results
The average age of participants was 47 years and 36% were female. Inter-rater and test-retest reliability estimates for ACFF and PCFF were excellent (ICCs = 0.95-98). Standard error of measurement values ranged from 0.21 to 0.33. The correlation coefficient for criterion validity between ACFF and TAM was −0.69; PCFF and TPM was −0.65; and ACFF and PCFF was 0.83. For construct validity, ACFF and TAM were similarly correlated with PRWHE. Correlations between changes in stiffness with ACFF and PCFF were 0.43 and 0.26, respectively. Effect sizes of ACFF and PCFF were small at 0.1 and 0.2. Time taken to measure CFF was much shorter than TAM/TPM.
Conclusions
The results of this study support the use of active and passive CFF as a reliable, valid, and efficient tool in the clinical setting. Further study is required to verify the responsiveness of CFF.
{"title":"Reliability, validity and responsiveness of composite finger flexion in patients with traumatic hand injuries: A clinical measurement study","authors":"Zeal Kadakia , Rafael Paolo Lansang , Pam Ball , Ayse Kuspinar , Sandra VanderKaay , Tara Packham","doi":"10.1016/j.jht.2023.12.001","DOIUrl":"10.1016/j.jht.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Composite finger flexion (CFF) is proposed to be a convenient alternative to total active motion (TAM) and total passive motion (TPM). Passive CFF (PCFF) may be useful for early monitoring in post-operative rehabilitation of traumatic hand injuries.</div></div><div><h3>Purpose</h3><div>To determine whether active and passive CFF are reliable, valid, and responsive measures of hand motion and of higher utility to the tester.</div></div><div><h3>Study Design</h3><div>Cross-sectional observational clinical measurement study.</div></div><div><h3>Methods</h3><div><span>Fifty hand injury patients were recruited from a hospital-based out-patient clinic. TAM, TPM, repeated measures of active CFF (ACFF) and PCFF<span>, self-reported stiffness, patient reported wrist/hand evaluation (PRWHE) scores, and grip strength were recorded. Intraclass correlation coefficients (ICCs) and standard error of measurement were calculated for inter-rater and test-retest reliability. Criterion and </span></span>construct validity<span> were assessed using correlation coefficients. Responsiveness was explored by calculating correlation coefficients of change scores, effect sizes, and standardized response means. Time taken to measure CFF and TAM/TPM was recorded to consider utility.</span></div></div><div><h3>Results</h3><div>The average age of participants was 47 years and 36% were female. Inter-rater and test-retest reliability estimates for ACFF and PCFF were excellent (ICCs = 0.95-98). Standard error of measurement values ranged from 0.21 to 0.33. The correlation coefficient for criterion validity between ACFF and TAM was −0.69; PCFF and TPM was −0.65; and ACFF and PCFF was 0.83. For construct validity, ACFF and TAM were similarly correlated with PRWHE. Correlations between changes in stiffness with ACFF and PCFF were 0.43 and 0.26, respectively. Effect sizes of ACFF and PCFF were small at 0.1 and 0.2. Time taken to measure CFF was much shorter than TAM/TPM.</div></div><div><h3>Conclusions</h3><div>The results of this study support the use of active and passive CFF as a reliable, valid, and efficient tool in the clinical setting. Further study is required to verify the responsiveness of CFF.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 601-608"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567574","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}
It has been suggested that the reduction in subacromial space during arm elevation is one of the potential mechanisms in the etiology of Rotator cuff tendinopathy. While it is known that Kinesio taping reduces the narrowing of the acromiohumeral distance (AHD) during arm elevation, the effect of Dynamic taping remains unknown.
Purpose
This study aimed to compare the immediate effects of Kinesio taping and Dynamic taping on AHD in individuals with symptomatic Rotator Cuff Tendinopathy.
Study Design
Two group pre-post-test repeated measures design was used.
Methods
Thirty-two participants were randomly assigned to two groups: Kinesio taping group (n = 16) and Dynamic taping group (n = 16). AHD measurements were taken via ultrasound at 0° (rest) and 60° shoulder abduction both before and immediately after taping. Repeated measures ANOVAs were used for statistical analyses.
Results
The study demonstrated that both taping methods led to a significant increase in AHD at both neutral and 60° abduction. However, the increase in AHD with Dynamic taping was statistically greater than with Kinesio taping in both neutral (p < 0.05) and 60° abduction (p < 0.001).
Conclusions
The findings of this study suggest that Dynamic taping techniques may be a more effective approach for improving AHD for symptomatic patients. Therefore, Dynamic taping has the potential to be clinically beneficial before engaging in exercises.
{"title":"Immediate effects of Kinesio taping and Dynamic taping on acromiohumeral distance in individuals with symptomatic rotator cuff tendinopathy","authors":"Meltem Koç PhD , Hüseyin Aydoğmuş MD , Funda Dinç MD , Kılıçhan Bayar PhD , Deran Oskay PhD","doi":"10.1016/j.jht.2023.12.003","DOIUrl":"10.1016/j.jht.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><div>It has been suggested that the reduction in subacromial space during arm elevation is one of the potential mechanisms in the etiology of Rotator cuff tendinopathy. While it is known that Kinesio taping reduces the narrowing of the acromiohumeral distance (AHD) during arm elevation, the effect of Dynamic taping remains unknown.</div></div><div><h3>Purpose</h3><div>This study aimed to compare the immediate effects of Kinesio taping and Dynamic taping on AHD in individuals with symptomatic Rotator Cuff Tendinopathy.</div></div><div><h3>Study Design</h3><div>Two group pre-post-test repeated measures design was used.</div></div><div><h3>Methods</h3><div>Thirty-two participants were randomly assigned to two groups: Kinesio taping group (<em>n</em> = 16) and Dynamic taping group (<em>n</em> = 16). AHD measurements were taken via ultrasound at 0° (rest) and 60° shoulder abduction both before and immediately after taping. Repeated measures ANOVAs were used for statistical analyses.</div></div><div><h3>Results</h3><div>The study demonstrated that both taping methods led to a significant increase in AHD at both neutral and 60° abduction. However, the increase in AHD with Dynamic taping was statistically greater than with Kinesio taping in both neutral (<em>p</em> < 0.05) and 60° abduction (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>The findings of this study suggest that Dynamic taping techniques may be a more effective approach for improving AHD for symptomatic patients. Therefore, Dynamic taping has the potential to be clinically beneficial before engaging in exercises.</div></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 4","pages":"Pages 583-590"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914068","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}
Pub Date : 2024-07-01DOI: 10.1016/j.jht.2023.10.005
Study Design
Clinical measurement.
Background
Many daily living tasks require in-hand manipulation (IHM). There is a gap in standardized assessment tools for measuring IHM. The Corbett Targeted Coin Test (CTCT) was designed to allow measurement of that fine motor skill.
Purpose
1) To evaluate the interrater, test-retest reliability, and validity of the CTCT, and 2) to establish adult norms for the CTCT.
Methods
Reliability and Validity – 30 participants (25 females, age range 21–45) were assessed with the Nine-Hole Peg test and CTCT consecutively by three researchers, then re-evaluated one week later on the CTCT; Reliability was determined using intraclass correlation (ICC2,k) between tests and across testers; Criterion-related validity was determined by comparing scores from nine-hole test and CTCT across testers using ICC2,k. Normative – 190 participants (147 females, age range 20–80) were assessed with the CTCT; mean and standard deviation for participants’ scores were calculated by age groups and gender.
Results
Test-retest reliability: poor for the right hand (ICCs = −0.29 to 0.45), and poor-moderate for the left hand (ICCs = 0.17–0.56). Inter-rater reliability ranged from moderate to excellent (ICCs = 0.60–0.80). The agreement between CTCT scores and Nine-Hole Peg test was poor for the right (ICC = 0.02; 95% CI: [−0.06, 0.14]) and left hands (ICC = 0.06; 95% CI: [−0.08, 0.28]). CTCT normative data: 41–50 age group demonstrated the highest performance while the 71–80 age group demonstrated the lowest performance. Scores between genders were similar.
Discussion
The poor test-retest reliability of CTCT was probably due to practice effect, while interrater reliability indicated that the test can be administered by different testers without compromising the results. The poor validity between tools proves their different constructs.
Conclusions
Use of the CTCT may add another dimension to assessment of dexterity and fine motor skills, specifically, in-hand manipulation, but needs further research on test-retest reliability.
{"title":"The Corbett Targeted Coin Test: Reliability, criterion related validity, and normative data","authors":"","doi":"10.1016/j.jht.2023.10.005","DOIUrl":"10.1016/j.jht.2023.10.005","url":null,"abstract":"<div><h3>Study Design</h3><p>Clinical measurement.</p></div><div><h3>Background</h3><p>Many daily living tasks require in-hand manipulation (IHM). There is a gap in standardized assessment tools for measuring IHM. The Corbett Targeted Coin Test (CTCT) was designed to allow measurement of that fine motor skill.</p></div><div><h3>Purpose</h3><p>1) To evaluate the interrater, test-retest reliability, and validity of the CTCT, and 2) to establish adult norms for the CTCT.</p></div><div><h3>Methods</h3><p>Reliability and Validity – 30 participants (25 females, age range 21–45) were assessed with the Nine-Hole Peg test and CTCT consecutively by three researchers, then re-evaluated one week later on the CTCT; Reliability was determined using intraclass correlation (ICC<sub>2,k</sub>) between tests and across testers; Criterion-related validity was determined by comparing scores from nine-hole test and CTCT across testers using ICC<sub>2,k</sub>. Normative – 190 participants (147 females, age range 20–80) were assessed with the CTCT; mean and standard deviation for participants’ scores were calculated by age groups and gender.</p></div><div><h3>Results</h3><p>Test-retest reliability: poor for the right hand (ICCs = −0.29 to 0.45), and poor-moderate for the left hand (ICCs = 0.17–0.56). Inter-rater reliability ranged from moderate to excellent (ICCs = 0.60–0.80). The agreement between CTCT scores and Nine-Hole Peg test was poor for the right (ICC = 0.02; 95% CI: [−0.06, 0.14]) and left hands (ICC = 0.06; 95% CI: [−0.08, 0.28]). CTCT normative data: 41–50 age group demonstrated the highest performance while the 71–80 age group demonstrated the lowest performance. Scores between genders were similar.</p></div><div><h3>Discussion</h3><p>The poor test-retest reliability of CTCT was probably due to practice effect, while interrater reliability indicated that the test can be administered by different testers without compromising the results. The poor validity between tools proves their different constructs.</p></div><div><h3>Conclusions</h3><p>Use of the CTCT may add another dimension to assessment of dexterity and fine motor skills, specifically, in-hand manipulation, but needs further research on test-retest reliability.</p></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":"37 3","pages":"Pages 371-377"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742749","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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