Journal of Hand Therapy最新文献

Background

A hand-related disorder (HRD) has a more significant impact on participation in everyday life for patients with a weak sense of coherence (SOC) compared to those with a strong SOC. Therefore, understanding how patients with a weak SOC manage the conditions of everyday life after a hand operation is of clinical interest.

Purpose

This study aimed to explore how patients with a weak SOC experience and manage the conditions of everyday life after an operation for an HRD.

Study Design

A qualitative design with a hermeneutic approach.

Methods

An in-depth interview was conducted with each of eight adults—five women and three men—with an HRD and a weak SOC (SOC-13 score <52). Participants with varying HRDs were interviewed once between six and 13 weeks after the hand operation. Data were analyzed based on a hermeneutic approach.

Results

The analyses resulted in five themes: even more conditions to handle, challenges in everyday life, managing everyday life, different expectations, and the influence of information on everyday life. The lives of most participants were significantly impacted: they experienced a range of difficulties managing their activities and roles after their operation. The participants felt uncertain about managing everyday life and the future and expressed unfulfilled expectations for different reasons. All wanted individualized information about what to expect.

Conclusions

Participants had several conditions in life that challenged their everyday lives, and the HRD made their everyday lives even more challenging. The extent to which they felt affected appeared to relate to their perception of their presurgery activities. They had several strategies to manage everyday life but used these to varying extent. Their expectations about the outcome had both positive and negative effects on their ability to manage everyday life, and individually adapted information was requested about what to expect and how to cope with everyday life after the surgery.

Background: 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.

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.

Study design: Cross-sectional observational clinical measurement study.

Methods: 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.