Hand Therapy最新文献

Objectives: There is a shortage of clinical tools integrating the individual journey through healthcare, as care providers frequently use diverse Patient Reported Outcome Measures (PROMs) that cannot be easily aggregated. The use of a single PROM from primary care into tertiary care would enable a more cohesive journey. The MSK-HQ has the potential to be used in this way but requires validation within the hand therapy population. Our hypothesis is that the concurrent validity and responsiveness of the Musculoskeletal Health Questionnaire (MSK-HQ), is non-inferior to the QuickDASH.

Methods: 382 individual outcome measures were reviewed spanning a period of 1 year from 07/2022 until 08/2023. Individual demographic information including; sex, age, ethnicity, chronicity, referral source, and borough were collected. Receiver operating characteristic (ROC) curves assessed the ability of the average 4-months change in both MSK-HQ and QuickDASH to distinguish between individuals who showed improvement and those who did not, based on global change scores, calculating MCID.

Results: Spearman's correlation between the global change anchor and MSK-HQ was 0.53 (95% CI: 0.45-0.60), and between the global change anchor and QuickDASH was 0.55 (95% CI: 0.48-0.62). The MSK-HQ demonstrated a strong ability to discriminate between Hand Therapy individuals reporting global improvement versus no improvement, with an area under the curve (AUC) of 0.82 (95% CI: 0.77-0.86), comparable to the QuickDASH, which had an AUC of 0.83 (95% CI: 0.79-0.88). The interpretability of a significant improvement in the MSK-HQ was 4.5 points of change.

Statistical significance/conclusion: The analysis validated our hypothesis and revealed no statistically significant difference in sensitivity or improvement in reporting change scores, indicating that the MSK-HQ is non-inferior to the established benchmark, QuickDASH, and is therefore suitable for use in Hand Therapy.

The intrinsic muscles of the hand are essential for precise functional movements of the fingers and thumb; for example, when playing an instrument or using a smartphone. Intrinsic muscle strength can be assessed using a variety of methods and there are many widely used clinical assessments for hand dexterity. However, there is no clinical assessment that isolates the intrinsic muscles of the hand to evaluate their functional capability and reflects the use of the hands with modern technology. The authors propose The Keyboard Intrinsic Test (KIT) as a modern assessment of intrinsic hand function using a standard laptop keyboard.

Introduction: Distal radius fractures (DRFs) are the most common adult fracture in the UK, and patients seek online information to support recovery. The quality of such information varies, including in artificial intelligence (AI) generated summaries. This study explored the use of a generative AI model (Gemini) for information searching and synthesis of patient information on DRF recovery.

Methods: Seven health information questions were co-developed with patients, hand therapists, and surgeons. Each question was searched in Google using three terms: 'distal radius fracture', 'wrist fracture', and 'broken wrist'. For each AI Overview, the summary and cited sources were exported. Citations were screened for relevance and checked for accurate representation in the AI summary. Trustworthiness was rated using a National Institutes of Health (NIH) framework. AI summaries were compared with four UK guidelines on DRF management and rehabilitation.

Results: Across all searches, 277 citations were identified; 37% were irrelevant. Of relevant citations, 57% (n = 99) were highly trustworthy, 40% (n = 70) moderately, and 3% (n = 6) low. Core messages aligned with UK guidelines, but AI summaries often gave fixed recovery timeframes.

Discussion: Google's AI Overview produced generally accurate, trustworthy DRF recovery information. However, variable source relevance, differing complexity by search term, and fixed timeframes highlight the need for clinicians to understand the online content patients encounter. Terminology influenced tone, 'distal radius fracture' yielded technical summaries, 'wrist fracture' mixed technical and practical advice, 'broken wrist' offered more lay-friendly guidance. Awareness of these differences can support personalised advice and bridge gaps between AI-generated content and evidence-based practice.

Introduction: Grip strength (GS) is a crucial indicator of hand function; however, its reliable assessment in individuals with severe hand dysfunction remains a clinical challenge. This study evaluated the intra-rater reliability of GS and grip pressure (GP) using the Jamar dynamometer and a modified sphygmomanometer (ModSp) in patients with complex bilateral hand dysfunction. Secondary objectives included determining the correlation between the instruments and exploring patient preferences.

Method: Fifty-two individuals with severe bilateral hand dysfunction due to systemic sclerosis were assessed as a representative model. A standardized measurement protocol was followed for both instruments. Intra-rater reliability was analyzed using intraclass correlation coefficients (ICCs), and linear regression was used to derive conversion formulas. Patient preferences were recorded using standardized open-ended questions and analyzed via thematic content analysis.

Results: Both instruments demonstrated excellent ICCs (0.96-0.98). Strong positive correlations were found between instrument scores (r = 0.88-0.91, p < 0.001), and regression models explained 78-82% of the variance. However, Bland-Altman analysis revealed systematic bias and relatively wide limits of agreement, indicating the methods are not interchangeable. Regarding preferences, 69.2% of participants favored the ModSp, citing greater comfort, better adaptation to deformities, and reduced pain during grasp, while 17.3% preferred the Jamar dynamometer and 13.5% reported no preference.

Conclusion: The Jamar and ModSp devices demonstrated excellent intra-rater reliability for grip assessment in severe hand dysfunction. While strongly correlated, they are not directly interchangeable for precise monitoring. The ModSp offers a practical, patient-centered alternative when standard dynamometry is hindered by physical constraints.

Background: Outcome assessment after claw hand correction is inconsistent, with prior reports relying on heterogeneous combinations of joint-angle measurements, photographs, grip testing, and qualitative functional grading. We developed the Contralateral Hand Function Score (CHFS), a simple contralateral hand-referenced composite measure, and evaluated its reproducibility and construct validity.

Methods: We performed a retrospective study of 51 patients who underwent surgical correction of claw hand between 2009 and 2025. CHFS was calculated as the mean of three equally weighted domains-motion, strength, and function-each expressed as a percentage of the contralateral normal hand. A separate modifier system (CHFS-M) recorded claw-specific contextual determinants of residual impairment but was not included in score calculation. Validation included interobserver reproducibility, interdomain coherence, and predefined known-group comparisons. Cohort characteristics, outcome distribution, and validation metrics were summarized from the study dataset.

Results: Mean age was 41.8 ± 12.6 years and mean follow-up was 18.6 ± 7.2 months. Mean CHFS was 66.2 ± 18.4%, with 24% excellent, 55% good, and 21% poor outcomes. Interobserver reproducibility was excellent for the final CHFS (intraclass correlation coefficient, 0.994) and for all component domains (>0.97). Cronbach's alpha was 0.984 for the three domains and 0.932 for the function subitems. CHFS differed significantly by claw type, contracture status, and surgical technique. The most frequent contextual determinants were diminished workspace (42%), arch reversal (38%), thumb pinch deficit (34%), and flexor digitorum profundus weakness (30%).

Conclusions: CHFS is a simple, reproducible, and clinically interpretable outcome measure for claw hand correction. It provides a practical contralateral-referenced summary of recovery, whereas CHFS-M improves clinical interpretation by documenting residual contextual deficits not captured by the composite score alone.

Level of evidence: Therapeutic Level IV.

Background: Paraffin therapy and hydrotherapy are widely used thermal modalities in hand rehabilitation; however, limited evidence directly compares their immediate effects on finger joint contractures.

Purpose: To compare the immediate effects of paraffin therapy and hydrotherapy on finger contractures.

Methods: Three patients with postoperative or post-traumatic contractures participated. An AB single-case design evaluated the additional effects of paraffin therapy administered after hydrotherapy. Phase A involved hydrotherapy combined with manual therapy, followed by Phase B, comprising paraffin therapy with the same manual therapy. Active flexion and extension angles were measured using a standard goniometer immediately after each session. Participants completed 8 sessions (4 per phase). Time-series data were analyzed using a Bayesian local linear trend (LLT) model. A PND of ≥70% indicated a clinically significant intervention effect.

Results: Improvements in total joint range of motion (ROM) occurred in both phases for all participants. Bayesian analysis revealed that during the paraffin phase (Phase B), additional ROM improvements were noted in two participants compared to Phase A (hydrotherapy). PND values indicated a clinically significant intervention effect (≥70%) for most joints in all participants.

Conclusion: Administering paraffin therapy as a subsequent intervention to hydrotherapy yielded significant additional improvements in active ROM, demonstrating its effectiveness for finger contractures. Additionally, although the fixed-order design limits causal attribution, this study highlights the value of N-of-1 designs combined with Bayesian analysis for data-driven, individualized clinical decision-making in hand rehabilitation.

Introduction: This study set out to explore the experiences of adults receiving treatment in outpatient hand therapy and physiotherapy services in the United Kingdom (UK), specifically in relation to remaining in or returning to work. Motivation for the study included the 2022 UK legislative change that enabled occupational therapists and physiotherapists to issue formal sickness certification (Fit Notes).

Methods: Semi-structured 1:1 qualitative interviews were completed between 2022-2023 at two public hospitals with local ethics approval. Questions examined the impact of the injury/condition on work participation, advice received, and recommendations for supporting future patients. Interview transcripts were analysed using reflective thematic analysis.

Results: Twenty-three interviews were conducted (12 male, age range 24-72 years). Four themes were developed in relation to remaining in or returning to work: (1) individual experience; (2) workplace support; (3) healthcare support; and (4) provision of return-to-work advice and Fit Notes. Themes captured variation in needs depending on condition, employment type, and workplace support. There were strong expectations for therapists to provide work-related guidance.

Discussion: Being in employment was highly valued by participants for purpose and well-being. Participants placed high trust in therapists' expertise and considered them well suited to provide return-to-work advice and Fit Notes. Clear, written, condition-specific guidance with realistic timeframes was strongly desired to aid communication with employers. Meeting these needs may improve patient confidence and facilitate sustained work participation.

Introduction: Carpometacarpal osteoarthritis (CMC OA) is a common problem in mid-older aged adults. Existing guidelines are ambiguous with respect to materials, design and duration of use of orthoses to manage hand OA. A limitation of studies to date is the low dose (hours per day) of orthosis wearing. This study aimed to evaluate the feasibility of investigating the effectiveness of a soft prefabricated orthosis worn at high dose in conjunction with best practice usual care for CMC OA.

Methods: Study design: Pragmatic, 2-arm parallel-group feasibility RCT. Adults aged ≥40 years with symptomatic CMC OA were randomised to either best practice usual care or usual care in conjunction with a soft neoprene orthosis prescribed to wear 20 h per day, for 4 weeks. A priori feasibility criteria were: (1) enrolment of 30 participants in 4 months; (2) retention >85% at 6 months; (3) intervention adherence on >80% days; (4) interventions acceptable >90% of participants. Outcome measures were collected at baseline, 4 weeks, and 6 months; analysis used descriptive statistics.

Results: Thirty participants were enrolled within 4 months; 97% retained at 6 months. Orthosis wearing achieved ≥20 h on 68% of days. Exercise adherence was 80% on ≥89% of days in both groups. Interventions were acceptable. Clinically significant improvements in pain occurred in both groups.

Discussion: High dose orthosis wearing may be acceptable and feasible for managing CMC OA. Orthosis amendments and a wear target of 18 h are recommended for future investigation of this intervention.

Introduction: Patients with Severe Recessive Dystrophic Epidermolysis Bullosa (RDEB-S) develop hand contractures that progress over time and impact function and quality of life. The role of the Occupational Therapist includes hand assessment and interventions to help maintain function. We developed the Assessment of Hand Contractures in Epidermolysis Bullosa (ACE-EB) to facilitate sensitive and detailed assessment. The purpose of this article is to describe its development and use.

Methods: We undertook a literature search of existing hand assessments and evaluated their use for children with RDEB-S. Most measure contracture recurrence post-operatively and none was sensitive enough to capture emerging contractures seen in children. We developed the ACE-EB by adapting the most relevant existing assessments, to include specific component contracture measurements, a Hand Deformity Grade and a hand surgery Patient Reported Outcome Measure. We explored the validity by surveying clinicians in the field of Epidermolysis Bullosa and we tested the inter-rater reliability.

Results: We describe the development of the ACE-EB. The results of the validity survey showed most respondents agreed that the ACE-EB had sufficiently sensitive grading scales, included relevant aspects of hand assessment and was a useful clinical or research tool. Inter-rater reliability tests showed good strength of agreement.

Discussion: The ACE-EB is a novel clinical tool designed for use with children with RDEB-S. It can be used to monitor changes, track natural history of hand contractures, guide practice and serve as a post-operative outcome measure in children and adults. Further testing of its validity and reliability is required.

Objective: ChatGPT is a popular artificial intelligence (AI) tool used to answer questions on any subject. Given ChatGPT's popularity, it is prudent to investigate its ability to answer common patient questions in the field of hand therapy to better guide patients as they navigate the resources available to them.

Methods: This is a cross-sectional, rater-based comparison study. Four common hand therapy questions were entered into ChatGPT version 3.5. The first five answer tabs that appeared with a Google search for the same four questions were downloaded. Three certified hand therapists blindly graded ChatGPT and Google's answers using Likert scales to assess for answer accuracy (0-6), comprehensiveness (0-3), and conciseness (0-3).

Results: ChatGPT was significantly more accurate, with an estimated marginal mean (EMM) of 5.75 (95% CI: 4.96, 6.54) compared to Google's 3.48 (95% CI: 2.86, 4.10) (p < 0.001). ChatGPT was significantly more complete, with an EMM of 2.50 (95% CI: 2.10, 2.90) compared to Google's 1.48 (95% CI: 1.19, 1.77) (p < 0.001). ChatGPT was significantly more concise, with an EMM of 3.00 (95% CI: 2.66, 3.34) versus 1.60 (95% CI: 1.29, 1.91) for Google (p < 0.001).

Conclusion: ChatGPT is a concise, comprehensive, and accurate alternative to a Google search for people seeking information on hand therapy. The free version of ChatGPT does not update its sourcing past 2019, and the software is known to occasionally present false information. Frequently updated academic websites should therefore remain the primary online medical resource for patients.