Hand Therapy最新文献

Background: An ageing population and increasing chronic health disorders explain the predicted rise in hand surgeries. Preoperative care has the potential to optimise patients' psychological and physical status, making it a promising area for enhancing surgical outcomes. Despite its established use in other surgical specialties, preoperative therapy in hand surgery remains underexplored.

Objective: This study uses an anonymous survey to gather therapists' opinions on the hand procedure whose outcomes benefit most from preoperative therapy. The research focuses on five common elective hand procedures: Carpal Tunnel Release (CTR); Cubital Tunnel Release (CuTR); Dupuytren's Fasciectomy (DF); Trapeziectomy (TZ); and Trigger Finger Release (TFR).

Method: British Association of Hand Therapy members were targeted in an online survey. Thirty-seven respondents (5% response rate) participated over 3 months. Questions explored how preoperative therapy improves surgical outcomes, the efficacy of postoperative therapy, and the importance of patient compliance postoperatively.

Results: TZ emerged as the procedure with the highest potential for preoperative therapy benefit, TZ and DF as top procedures for postoperative therapy requirements and importance of patient engagement and compliance. CTR had contradictory responses, while TFR and CuTR received the fewest endorsements for preoperative therapy benefits.

Conclusion: The survey offers insight into hand therapists' perspectives on preoperative therapy. TZ and DF stand out as having significant potential for optimisation. Uncertainty surrounding efficacy of therapy on Dupuytren's Disease indicates the necessity for further research. Education is considered an essential preoperative component. The small sample size warrants caution when interpreting results.

Introduction: Hand allotransplantation is a treatment option available for individuals who have suffered a traumatic upper extremity injury. To date, there is not an industry-standard recognized measurement tool to assess post-hand allotransplantation functional performance. A commonly used observational functional assessment tool is the Carroll Upper Extremity Function Test (UEFT). This study explored therapists' perceptions of the Carroll UEFT applicability to measure functional outcomes post-hand allotransplantation.

Methods: The study employed a qualitative phenomenological approach with in-depth, semi-structured interviews with five occupational therapists and two physical therapists representing five hand transplant centers in the United States. Braun and Clarke's six-phase thematic analysis approach was utilized for data analysis.

Results: The findings generated four themes: (1) scoring is too vague and subjectivity prevails, (2) questionable reliability of the scores, (3) translates to real-life functional tasks, and (4) outcomes affecting decisions.

Conclusion: The study identified limitations of the Carroll UEFT as applied to a targeted population, hand transplant recipients. The scoring is too vague and subjectivity prevails theme was the most resonant theme generated from the participants, with a call for standardization of the assessment. This theme was followed by questionable reliability of the scores, which identifies concerns regarding the reliability of the Carroll UEFT. Rehabilitation services associated with hand allotransplantations can incorporate the findings of this study and collaborate to identify and navigate the transition to an evaluation tool with strong psychometrics for best practice in the assessment of functional outcomes for hand-transplant recipients.

Introduction: Hand use recovery after a distal radius fracture (DRF) depends on whether the injured hand is dominant or not, which can affect laterality and influence functional outcomes. This study aimed to investigate how the injured side impacts changes in laterality and its relationship to functional outcome, aiming to contribute to the development of future hand therapy strategies.

Methods: Patients with DRF were prospectively recruited. Triaxial accelerometers were wrist-mounted to collect data at 1, 4, 8, and 12 weeks postoperatively and examine the laterality index (LI), total hand use time, and total vector magnitude. Correlations between LI and functional outcomes were assessed at each time point.

Results: 42 patients participated in this study. Among them, 19 and 23 had injured dominant (DI) and injured non-dominant (non-DI) hands, respectively. The LI showed a faster restoration of symmetry in the DI group than in the non-DI group at 8 and 12 weeks postoperatively. Moderate correlations between LI and functional outcomes were observed in wrist joints and grip strength in the DI and non-DI groups, respectively, at all time points.

Discussion: The change in LI in the DI group was considered recovery, as it was identical to the symmetry observed in healthy adults. Additionally, the non-DI group was considered to have adapted to a pattern of predominant use of the dominant hand. The correlation between LI and some functional outcomes appeared to depend on hand use patterns, specifically whether the injured hand was dominant or not. These findings underscore the importance of tailoring interventions.

Introduction: Evaluation of maximum grip strength (MGS) is commonly conducted to guide intervention planning and evaluate treatment outcomes for individuals with hand or upper limb impairments. While the hydraulic Jamar dynamometer is recognised as the gold standard measurement instrument, it has several limitations and there has not been a consensus on whether alternative instruments can replace or complement it. This study aimed to determine whether a new electronic rehabilitation device, the GripAble, is a reliable and valid instrument for measuring the MGS of healthy adults when compared to the gold standard hydraulic Jamar dynamometer. It also sought to compare the user's experience when using the two instruments.

Methods: Fifty-five healthy adults completed two MGS assessments ten minutes apart using a standardised protocol. Test-retest and inter-instrument reliability were evaluated using intraclass correlation coefficient. Concurrent validity was established using a Bland-Altman plot. Relationship and level of agreement between measurements on the two devices were evaluated. Participants' user experience was explored through a quantitative survey.

Results: The GripAble was found to have excellent test-retest reliability (ICC = 0.971-0.975) and good-to-excellent inter-instrument reliability (ICC = 0.898-0.922) with the Jamar dynamometer. Its measurement output is equivalent to approximately 63.3% of that of the Jamar dynamometer. The mean difference value between the measurements on the two devices was 9.44 kg (SD = 4.47). Users preferred the GripAble.

Discussion: While the GripAble is a reliable MGS assessment instrument, it should not be used interchangeably with the Jamar dynamometer for repeated measurements of the same individual owing to the differences in their readings.

Introduction: Distal radius fractures (DRF) are common injuries seen by therapists. Patient Reported Outcomes Measures (PROMs) are a way to measure recovery, yet previous research suggests PROM utilisation is low amongst therapists. This study looks at current use of condition specific PROMs amongst UK therapists treating patients with DRF and explores possible barriers and facilitators to their use.

Methods: An online anonymised cross-sectional survey hosted on Qualtrics software was distributed to UK physiotherapists, occupational therapists, and therapy technicians via special interest groups and social media. Analysis was carried out on Excel and Qualtrics Software.

Results: There were 60 responses to the survey. For therapists who use PROMs the Quick-Disabilities of the Arm, Shoulder and Hand questionnaire, and Patient Reported Wrist Evaluation were the most used, but many therapists reported never using a PROM. Barriers identified included not having enough time in a therapy session, already collecting generic PROMs, and current PROMs did not add to their clinical reasoning. Therapists reported current condition specific PROMs did not capture the psychosocial impact of a DRF or help to assess return to full function.

Conclusion: NHS managers should explore opportunities to collect generic PROMs in a way that has the least impact on clinician time. The development of a Core Outcome Set for hand and wrist trauma may help therapists to identify a toolkit of PROMs to measure different aspects of recovery from this injury but further research is needed to understand the utility of PROMs over individualised therapist assessment.

Background: Work-related musculoskeletal disorders (WRMD) may be associated with various individual, physical, biomechanical, or psychosocial/organisational risk factors. Self-report questionnaires have increasingly been used to assess patients' perceptions of injury impact. QuickDASH is a widely used outcome measurement questionnaire but is seldom applied to WRMD.

Objective: To evaluate the construct validity of the Brazilian version of the QuickDASH (QD-Br) in patients with WRMD affecting the upper limbs, hypothesising a moderate correlation with fatigue, ergonomic, and functional questionnaires.

Methods: Workers of a tertiary hospital, such as healthcare professionals and support staff employees with WRMD in the upper limbs and neck were included. The outcome measures were QD-Br, the Numerical Pain Scale (NPS), Isometric Handgrip Strength (GS), Isokinetic Force of Bilateral Shoulder Elevation in the Scapular Plane (ISOAbd), Functional Impairment Test - Hand and Neck/Shoulder/Arm (FIT-HaNSA), and: Patient-Specific Functional Scale (PSFS-Br), Neck Disability Index (NDI-Br), Work Ability Index (WAI-Br), Need for Recovery Scale (NFR-Br), and Quick Exposure Checklist (QEC-Br). Spearman's Correlation Coefficient (ρ) was calculated to determine the direction and strength of associations.

Results: The sample was 70% female, 63% reporting chronic symptoms. The shoulder was the joint most frequently reported. QD-Br showed moderate positive correlations with NDI-Br and NPS and moderate but negative correlations with WAI-Br and PSFS-Br. It presented weak and positive correlations with NFR-Br, weak and negative correlations with GS, ISOAbd, and FIT-HaNSA, and no correlation with QEC-Br.

Conclusion: QD-Br demonstrated evidence of construct validity for assessing workers with upper limb complaints, effectively reflecting their dysfunctions and symptoms.

Introduction: Cubital Tunnel Syndrome (CuTS) is a common condition of the elbow that is often treated with surgical decompression of the ulnar nerve but evidence for optimal management is unclear. A previous Cochrane review from 2016 identified very limited evidence to guide conservative management, in particular, night splints. The aim of this systematic review was to update the evidence related to the effectiveness of night splints in the treatment of CuTS.

Methods: We conducted an electronic search on January 15th 2025 of the MEDLINE, Embase, Emcare and CINAHL databases from the last 30 years, using a pre-defined protocol. Risk of bias was assessed using the RoB2 and ROBINS-I tools, with certainty assessed using GRADE.

Results: We identified only one randomised controlled trial (RCT), with high overall risk of bias, that compared night splints to a control arm of advice only. This under-powered trial with high loss to follow-up found no difference between groups. One additional RCT and three single-arm studies, all at high/serious/critical risk of bias, suggested the majority of patients with mild/moderate CuTS improve with night splinting but it is unclear whether the effect was due to treatment or time. Evidence certainty was very low.

Discussion: We identified a paucity of evidence, of low quality, regarding night splinting. The evidence identified by this review is currently insufficient to determine whether night splints should be recommended for the treatment of CuTS and there is a need for a high-quality research trial comparing night splints to a control intervention.

Introduction: Although post-disaster rehabilitation is increasingly recognized as essential, the role of hand therapy remains underexplored. Following the two devastating earthquakes in Türkiye in 2023, which resulted in over 50,000 deaths and 120,000 injuries, this study presents experiences and practices in post-disaster hand therapy to address the existing knowledge gap.

Objective: This study aims to share post-earthquake hand therapy experiences, highlight patient care challenges, and provide recommendations for future disaster management.

Methods: This retrospective study involves patients who were transported from the disaster area to a tertiary hospital by ambulance. Each patient referred to hand therapy by the hand surgeon was treated and followed up by two hand therapists. The patients had various injuries, including compartment syndrome, fasciotomy, amputations, and fractures. All patients were seen at least once for therapy.

Results: This retrospective study evaluated 24 patients aged 5-63 who were referred to a tertiary centre for hand therapy following the earthquake. All patients were trapped under rubble, with compartment syndrome, amputations, and fractures being the most common injuries. Therapy began on average 3-4 weeks post-disaster. Twelve patients completed treatment, while 10 were lost to follow-up. All patients developed joint limitations and deformities.

Discussion: Our post-disaster hand therapy experiences have shown the necessity of educating the hand therapists and the other healthcare professionals before the disaster, approaching patients within a multidisciplinary framework and planning treatment, and placing emphasis on increasing functional recovery in the long term.

Background: Diabetic Peripheral Neuropathy (DPN) is a prevalent complication of Type 2 Diabetes Mellitus (T2DM), leading to hand function impairments that affect daily activities and quality of life. Despite its significance, no culturally adapted tool exists for assessing hand-related activity limitations in the Malay-speaking population. This study aimed to translate, culturally adapt and validate the Duruöz Hand Index (DHI) for Malaysians with DPN.

Methods: A cross-sectional study was conducted in two phases: (1) translation and cultural adaptation of the DHI into Malay and (2) evaluation of its psychometric properties. Content validity was assessed by a panel of nine experts using the Content Validity Index (CVI). Face validity was evaluated through a pilot test with 10 individuals with DPN. Internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient, ICC) were measured in 30 participants with DPN. Known-group validity was examined by comparing DPN participants with healthy individuals.

Results: The content validity of the Malay-DHI was excellent and face validity confirmed that the Malay-DHI was clear and comprehensible. Internal consistency was strong across all categories (α = 0.84-0.97). Test-retest reliability demonstrated excellent stability (ICC = 0.996-1.000). Known-group validity showed a significant difference between individuals with DPN and healthy individuals (Z = -6.93, p < .001).

Conclusion: The Malay version of the DHI demonstrated strong validity and reliability, making it a culturally relevant and robust tool for assessing hand function in individuals with DPN. This tool may facilitate targeted rehabilitation interventions and improve clinical outcomes.

Background: Restoration of full elbow extension following trauma is difficult and influenced by the injury profile, surgeon preference, patient and environmental factors. The literature suggests that orthotic interventions are effective in improving contractures when movement plateaus despite normal therapeutic interventions. It is not known if extension orthotic intervention is more superior to standard treatment regardless of when it is commenced. The literature lacks patient-reported considerations to contracture management using elbow orthoses.

Methods and analysis: This protocol describes a Phase II double blinded randomised controlled feasibility trial (RCT) and mixed methods study, aimed to examine outcome with extension in an orthotic intervention group (OG) versus control (CG). All participants will undergo six weekly therapy sessions, which include a standardised therapeutic program. OG participants will be provided with an additional extension orthosis and the outcome is assessed according to the change in elbow extension motion after 6 weeks of intervention. Data will be collected via questionnaires, logbooks, feedback forms, and semi-structured interviews at baseline and final assessments for descriptive statistical analysis. Under the guidance of a statistician, all quantitative data will be evaluated using the appropriate parametric or non-parametric analyses to evaluate for systematic differences between groups. Preliminary extension gains are used to determine the final sample size required to achieve adequate power for a full-scaled RCT. Interview data on OG participants will be qualitatively analysed using the "five-factorial dimensions of adherence" framework to identify key differences in the influencers between adherent or non-adherent groups.

Trial registration number: ANZCTR ACTRN12619001402134p.