Hand Therapy最新文献

Introduction: Wrist range of motion (ROM) supports coordinated upper-limb function during self-feeding. Wrist restriction may induce proximal compensation, yet the kinematic consequences of discrete wrist positions remain underexplored.

Methods: Ten healthy young women performed a standardized eating task under four wrist positions: free (FP), palmar-flexed (PFP; 20°), intermediate (IP; 0°), and dorsiflexed (DFP; 20°). Upper-limb kinematics were recorded with a wearable IMU system (100 Hz). Discrete outcomes included maximum/minimum joint angles and event-based angles at the end of scooping and mouth reaching. Parametric data were analyzed using repeated-measures ANOVA with Dunnett comparisons versus FP; non-parametric data used Friedman tests with Bonferroni correction (η²). Statistical Parametric Mapping (SPM) was applied to time-normalized waveforms to localize condition effects across the movement cycle.

Results: Wrist position systematically altered kinematics. Compared with FP, PFP produced the largest deviations, including reduced maximum elbow flexion (108 ± 8° vs 124 ± 8°) and forearm supination (68 ± 12° vs 93 ± 12°; η² up to 0.44). At mouth reaching, PFP similarly reduced elbow flexion (108 ± 8° vs 123 ± 9°) and supination (67 ± 12° vs 93 ± 12°) and shifted wrist posture toward palmar flexion. IP and DFP showed smaller departures from FP. SPM indicated the largest effects mainly during late transport/mouth reaching for elbow flexion and supination, and near movement initiation/termination for wrist radial/ulnar deviation.

Conclusion: Non-neutral wrist positioning-particularly palmar flexion-disrupts self-feeding coordination and elicits proximal compensation. Findings may inform orthosis positioning and exercise progression; confirmation in patient cohorts is warranted.

Introduction: Orthotic fabrication is a widely used option of the conservative management of carpometacarpal (CMC) osteoarthritis, where conventional low-temperature thermoplastic orthosis requires in-person expertise and adjustments, which limit access to care. Advances in 3D printing and smartphone-based scanning offer opportunities for remote orthosis fabrication. However, the feasibility, accuracy, and patient outcomes compared with traditional methods remain unclear.

Methods: This randomized crossover pilot trial will compare remote 3D-printed orthoses, fabricated using a novel heat re-shapable polycaprolactone (PCL), with conventionally fabricated thermoplastic orthoses in 40 hands with early-stage CMC osteoarthritis. Each participant will receive both interventions in a random order, separated by a 1-week washout period. Outcomes include pain (measured using the Numerical Rating Scale), function (assessed using the QuickDASH), adherence, satisfaction, and clinical utility (evaluated using the QUEST and qualitative interviews). Technical parameters (fabrication time, material properties, weight, and need for adjustments) and the feasibility of smartphone versus high-precision photogrammetry scanning will also be evaluated.

Results: As a pilot study, outcomes will focus on feasibility benchmarks (recruitment, retention, adherence) and variability estimates to inform sample size calculations for a definitive trial. Preliminary comparisons of pain, function, and satisfaction between orthosis types, as well as the usability of smartphone scanning and the adaptability of heat re-shapable PCL, will be reported.

Discussion/conclusion: This study will provide the first clinical evidence on the feasibility and patient-centred utility of remote orthosis fabrication using an innovative heat re-shapable 3D printing material. Findings will inform whether digital workflows can extend access to hand therapy and support larger-scale trials to evaluate clinical effectiveness and long-term outcomes.

Thermoplastic splinting is an intervention widely used by occupational therapists to manage upper limb impairments in adults with acquired brain injury (ABI). A key therapeutic goal of splinting within this population is to maintain passive range of movement (PROM). Despite its clinical prevalence, there is limited research evidence evaluating the effectiveness of thermoplastic splinting, particularly in the long-term management of people with severe ABI.

Method: Clinical splinting records were retrospectively reviewed for 25 adults with severe ABI receiving care in a long term care (LTC) facility, ranging from 2 to 33 years post-injury. Eleven participants wore bilateral splints, resulting in a total of 36 splint records being evaluated. Goniometric measurements of upper limb joints were compared to determine changes in joint PROM over a 12-months period.

Results: At baseline, 26% of joints presented with contractures. Over the 12-months period, only one additional contracture was identified. PROM was maintained in 94% of joints reviewed over a 12-months period in a long-term care (LTC) setting. Of those persons with PROM losses, 6/9 had sustained a hypoxic ABI.

Discussion: The findings of this retrospective study suggest that static thermoplastic splinting may be beneficial in the long-term management of adults with severe ABI by maintaining PROM and preventing or slowing the progression of contractures. Additionally, thermoplastic splinting may prevent or reduce the severity of secondary complications associated with contracture, such as skin breakdown, muscle stiffness and reduced ease of care.

Introduction: Intra-articular steroid injection for thumb carpometacarpal joint (CMCJ) osteoarthritis (OA) is routinely offered with evidence of its short-term effectiveness only. One of the factors for reduced effectiveness could be the lack of accuracy of the intra-articular injection. Therefore, this scoping review sought to examine the accuracy of thumb CMCJ injection and examine if clinical effectiveness improves with accuracy by using image guidance.

Method: A literature search was undertaken using databases Medline, Emcare, AMED and CINAHL, along with Google Scholar and reference searching. All studies on adults examining accuracy of thumb CMCJ injection and image-guided injections published in English up to the end of 2023 were selected.

Results: 15 studies met the inclusion criteria. Cadaver studies observed lower accuracy rate of landmark-based injection particularly in presence of thumb CMCJ arthritis. Studies on patients observed an accuracy rate of around 50% with landmark-based injection. Fluoroscopy-guided injection was observed to be more accurate (near 100%) than ultrasound guidance. Clinical effectiveness of accurate intra-articular injection was observed to last from 3 months (DASH 26.7 for intra-articular vs 37.5 for extra-articular, p < 0.05 and VAS score for intra-articular 26.5 vs 39.0 for extra-articular, p < 0.05) up to 6 months (15%-10/66 patients reporting pain relief). Some studies observed accuracy of landmark-based thumb CMCJ injection increased with experience of the clinician.

Conclusion: Accuracy of landmark-based thumb CMCJ injection is indeterminate. However, there is lack of robust evidence to support use of image guidance to improve accuracy and clinical effectiveness of steroid injection for thumb CMCJ and warrants further research.

Introduction: The Problematic Experience of Therapy Scale (PETS) identifies barriers to home-based exercise programs but has not been validated in hand therapy populations. This study aimed to translate the extended PETS into Swedish and evaluate its content and construct validity in patients undergoing early sensory relearning following peripheral nerve injury.

Methods: The PETS was translated into Swedish (PETS-Swe) following established cross-cultural adaptation guidelines. Fifty-three patients with peripheral nerve injuries completed the PETS-Swe four weeks into a home-based sensory relearning program. Exercise adherence was monitored using a daily exercise diary. Content validity was assessed through expert review (face validity) and patient ratings of item relevance, clarity, and ambiguity. Item-level (I-CVI) and scale-level (SCVI) content validity indices were calculated, alongside modified kappa statistics for interrater agreement. Construct validity was examined using Spearman's correlation between PETS-Swe scores and reported exercise frequency.

Results: Translation revealed no major discrepancies. Most items demonstrated high content validity (I-CVI and S-CVI >0.8), though lower relevance scores were observed in the technical subscale (I-CVI: 0.65-0.69). Interrater agreement was good to excellent across all items (K >0.74 for items 1-17; K = 0.6-0.74 for items 18-20). Expert reviewers confirmed strong face validity. Moderate negative correlations were found between PETS-Swe scores and exercise adherence (rho = -0.40 to exercise log; -0.57 to diary), supporting construct validity.

Discussion: The Swedish version of the extended PETS is a valid tool for identifying barriers to home-based sensory relearning in patients with peripheral nerve injuries undergoing hand therapy.

Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered across a range of healthcare settings. Uncertainty exists regarding optimal management and how this is reflected in care provision through clinical guidelines and pathways. We aimed to identify existing UK-based clinical guidelines and pathways and examine their quality.

Methods: For this review, we searched MEDLINE, PubMed, Embase, CINAHL, ProQuest, Scopus, Web of Science, Google, The National Grey Literature Collection, TRIP, and the National Institute for Health and Care Excellence and undertook targeted outreach and engagement activities with healthcare professional networks. We included clinical practice guidelines and pathways for NTWD published after 2010. The AGREE II tool was used to assess guideline quality based on the domains of topic selection, best practice identification, data collection, and rigor of analysis.

Results: Of 7017 records identified, 15 eligible clinical guidelines and pathways for NTWD management were eligible and included. De Quervain's tenosynovitis and ganglion cyst were most frequently covered while other NTWD had few or no guidelines or pathways. Variation in the composition and nomenclature of sources was found. Quality assessment using the AGREE II tool identified variability and overall unsatisfactory quality.

Conclusion: There is a lack of high-quality clinical guidelines and pathways for NTWD within the UK healthcare system indicating an obstacle to improvements in healthcare delivery.

Introduction: Skin involvement is a clinically relevant but insufficiently quantified feature of Dupuytren's disease (DD). The Cutometer® MPA 580 offers an objective method to assess skin biomechanics, yet its reliability on healthy and DD-affected hands has not been examined using a hand-specific protocol.

Methods: In this cross-sectional study, two observers performed Cutometer® measurements on 31 DD-affected and 30 healthy hands using a standardized hand protocol. In DD patients, measurement sites were classified on skin involvement (fused vs non-fused). Reliability was assessed using ICC (2, 1), SEM, reproducibility coefficient (RC), and within-subject coefficient of variation (WSCV). Agreement was evaluated with Bland-Altman analysis. Differences between fused and non-fused sites were analysed for Uf (R0) and Ua/Uf (R2).

Results: Uf (R0) showed good intra-observer reliability on palmar regions in both healthy and DD hands. Reliability decreased on anatomically restricted areas, particularly along the ulnar side of the fourth digit, and inter-observer reliability was consistently lower. Ua/Uf (R2) showed acceptable intra-observer reliability for one observer, while inter-observer agreement remained poor. Absolute errors were smallest on the palm and highest in stiff or curved regions. Fused sites demonstrated lower maximal deformation (Uf) than non-fused skin, although interpretation is limited by the absence of precise anatomical site recording.

Conclusion: Using a hand-specific protocol, the Cutometer® provides reliable within-observer measurements on palmar skin, while digit measurements are less consistent. Differences between fused and non-fused skin support construct validity. Further standardization is recommended to support clinical and longitudinal use in hand evaluation.

Background: Hand injuries are treated by specialized hand surgeons and certified hand therapists (CHTs) for optimal care. Hand surgeons refer upper extremity patients to CHTs and work closely together. Hand surgeons and CHTs must collaborate effectively to optimize best practice and functional outcomes.

Purpose: To assess the perceived quality of collaboration between CHTs and orthopedic hand surgeons. In addition, to identify common characteristics within the working relationship that support an effective collaboration to facilitate optimal patient care.

Methods: This study utilized a constructivist-interpretive approach through purposive sampling of 10 practicing CHTs with frequent communication with hand surgeons. A 30-min, virtual, semistructured interview identified current CHT perceptions regarding hand surgeon collaboration. Interviews were transcribed via Zoom and confirmed via member checking. Initial codebook was developed with subsequent collaborative thematic analysis. Results: Themes emerged related to common reasons therapists reach out to hand surgeon, common obstacles faced when communicating, and elements of an ideal hand surgeon collaboration. Themes included: let's chat, what it's not, and help me help you! The participants defined an ideal hand surgeon collaboration as mutually respectful, interactive and face-to-face, frequent, and ongoing with opportunities for clinical advancement and collaboration to promote optimal patient outcomes.

Conclusions: By intentionally facilitating effective working relationships with hand surgeons, CHTs can promote the practice of occupational therapy, further define the role of CHTs in the healthcare realm and make lasting functional improvements for hand and upper extremity patients receiving skilled occupational therapy services.

Introduction: Neurogenic Thoracic Outlet Syndrome (NTOS) is a complex condition that can be encountered in musculoskeletal and hand therapy services. Rehabilitation is recognised as the primary treatment for NTOS however, detail on rehabilitation components are poorly described. This scoping review aimed to identify and describe the physical assessment and rehabilitation components alongside clinical reasoning strategies that may aid therapists in the conservative management of adults with NTOS.

Methods: Four databases (MEDLINE, EMBASE, CINAHL and Cochrane) were searched, utilising the PRISMA-ScR guidelines. The Template for Intervention Description and Replication (TIDieR) checklist was used to organise data regarding rehabilitation interventions for NTOS.

Results: Twenty-Nine out of 1381 studies identified, met the eligibility criteria. NTOS Provocation tests (16/18 89%) were the most frequently described assessment components, followed by palpation of pertinent structures (11/18 61%) and assessment of posture (10/18 56%). 'Decompressing the thoracic outlet' was the main aim encountered for rehabilitation programmes. Exercise (17/19 90%) was the most frequent rehabilitation intervention identified, with stretching (n = 15), strengthening (n = 14) and neural mobility (n = 7) exercises being most prevalent. The Scalenes and Pectoralis muscles (n = 10) were the main targets for stretching whilst the Scapula (n = 9), Trapezius and Serratus Anterior muscles (n = 5) were the main targets for strengthening exercises. Other interventions identified included, posture improvement (n = 13), manual therapy (n = 10), adjuncts (n = 8) and activity modification (n = 7).

Discussion: The reporting of rehabilitation techniques for NTOS is generally poor, particularly regarding treatment intensity. There is an essential need for a standardised and reproducible rehabilitation intervention for NTOS to be developed.

Introduction: Peripheral nerve injuries can lead to paralysis, sensory loss, chronic pain, and profound psychological and vocational consequences. Recent UK guidelines recommend biopsychosocial rehabilitation, yet qualitative evidence suggest gaps in service provision. This study explored current rehabilitation and perceived barriers among therapists treating adults with peripheral nerve injuries.

Methods: A cross-sectional online survey was distributed to UK physiotherapists and occupational therapists experienced in upper and lower limb peripheral nerve injury rehabilitation. Questions captured demographics, treatment strategies before and after reinnervation, access to psychological support, and perceived organisational barriers. Descriptive analysis was undertaken.

Results: Fifty-three respondents (60% physiotherapists, 40% occupational therapists) completed the survey; 70% had more than 10 years' experience. Ninety eight percent of respondents treated adults with upper limb nerve injuries. Motor and sensory interventions (active and passive range of motion, splinting, strength training, and functional activity) were reported as "always/frequently" used by >80% of respondents. Over a quarter of respondents (28%) occasionally/rarely used pain neuroscience education. Other specific psychological interventions including cognitive behavioural techniques and mindfulness were rarely used (<30% always/frequently). Over half respondents reported no outpatient access to clinical psychology. Organisational barriers included limited time, funding, skilled staff, and absence of local guidelines. However, 83% believed therapists could deliver more psychologically informed care.

Conclusions: UK rehabilitation for adults with peripheral nerve injuries remains predominantly biomedical, with limited integration of psychologically informed care and limited access to Clinical Psychology. Addressing systemic barriers and evaluating digital or hybrid models may enable more biopsychosocial, patient-centred care.