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.
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.
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.
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.
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: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: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.
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: The objective of this study is to undertake a comparative analysis of the values obtained from the Semmes-Weinstein Monofilament Test (SWMT) when conducted with the eyes open, eyes closed, and in a noisy environment, in a sample of healthy individuals. Methods: The SWMT was applied to 70 healthy individuals with a mean age of 29.0 +/- 10.51 years under three conditions: eyes open, eyes closed, and in a noisy environment. The first, second, and fifth fingertips of the subjects were evaluated, with the dominant and non-dominant hands being considered separately. The evaluations conducted with the eyes open and eyes closed were carried out in a quiet environment. The evaluation conducted with the individual's eyes open was performed with a screen. In the test conducted in a noisy environment, the participants' eyes were kept open. Results: The median SWMT values were #2.83 for all tested distal phalanx palmar surfaces in both dominant and non-dominant hands. It was determined that the tests performed with eyes closed on the thumb of the dominant hand gave better results than the tests performed with eyes open (p < 0.01). No statistically significant differences were detected between noisy and quiet testing conditions across the tested sites. Discussion: Visual deprivation can enhance tactile detection in healthy individuals. We highlight the significance of visual input in tactile assessments and propose that visual manipulation may serve as a promising approach in somatosensory re-education.
Aim:The ability of advanced practice allied health-led clinics to comprehensively manage acute upper limb trauma has limited evaluation. This study aimed to evaluate the safety, requirement for specialist escalation, patient satisfaction, and patient outcomes of an allied health-led upper limb fracture clinic. Methods:Eligible outpatients referred to Orthopaedics with acute upper limb fractures were diverted to and managed by the allied health led Advanced Practice Hand Clinic (APHC) between August 2020 and August 2022. Patients were excluded if they did not complete treatment, were referred with chronic conditions, or simple fractures not requiring specialist care. Demographic, diagnostic, service delivery, patient satisfaction and clinical outcome data were collected as part of usual care. Descriptive statistics were used to analyse the data. Results:Three hundred and twelve patients were eligible, aged median (IQR) 23 (13-47) years, 38% female, and 28% were clinical scaphoid fractures. Wait time for care was 7 (4-11) days. No adverse events were noted. Most (n = 289, 93%) patients completed APHC treatment, with most (88%, 254/289) not requiring orthopaedic consultation. Few (7%, 23/312) patients were returned for orthopaedic management. QuickDASH scores were significantly improved at discharge (4.6 (0-9.1)) compared to initial appointment (48.9 (31.8-57.3), p < 0.001, n = 72). Most patients (98%-100%) were satisfied with wait times, seeing a hand therapist, and with their treatment received. Conclusion:The APHC safely managed patients with acute upper limb trauma in lieu of Fracture Clinic, reduced reliance on Orthopaedic services, provided good functional outcomes and achieved high levels of patient satisfaction.
Background:Hand injuries can significantly impair individuals' ability to engage in essential daily and social activities, necessitating valid and culturally relevant tools to assess participation limitations. The Participation Behaviour Questionnaire (PBQ), originally developed in Persian and grounded in the International Classification of Functioning, Disability and Health (ICF), was designed to evaluate the extent of participation restrictions following hand and upper limb injuries. Purpose:This study aimed to translate and cross-culturally adapt the PBQ for use among Canadian English-speaking individuals with hand injuries and assess its content validity within a Canadian clinical context. Methods:The PBQ was adapted according to Beaton's five-step guideline for the cross-cultural translation of self-report measures. Cognitive interviews were conducted with 15 patients and 22 healthcare professionals, including physiotherapists, hand therapists, surgeons, and rehabilitation researchers, using think-aloud and semi-structured methods to examine item clarity, consistency of interpretation, and cultural appropriateness. Findings:Cognitive interviews with 15 patients and 22 experts revealed 25 items requiring revision, with 88% of concerns related to clarity and comprehension. Overall, clarity issues were identified in 22 of the 37 items, resulting in 18 substantive revisions. For example, the item "I feel I have lost my autonomy" was revised to "I feel I have lost my independence in daily tasks" to improve clarity. Commonly misunderstood terms included "public transport" and "voluntary job," which were refined using culturally contextual examples. Cultural and contextual factors also influenced how participants interpreted items such as "My use of public transport" (12%) and "Engagement in voluntary work" (20%). Implications:The English-adapted PBQ demonstrated evidence of content validity based on participant feedback regarding clarity, relevance, and comprehensibility. The 18 substantive revisions enhanced cultural and linguistic appropriateness by addressing clarity in 22 of 37 items, refining ambiguous terminology, and incorporating Canadian-contextual examples where necessary. These findings represent an initial step in the overall validation process; in this pre-psychometric, single-center Canadian-English study, additional research is required to assess the instrument's psychometric properties, including construct validity, reliability, and responsiveness.
Introduction Handedness and hemispheric dominance are thought to influence manual performance, especially dexterity and grip strength, which underpin daily and occupational function. We investigated the effects of handedness and hemispheric dominance (inferred from a neurobehavioral inventory) on dexterity and grip strength, focusing on whether balanced hemispheric dominance confers advantages in mixed-handed/ambidextrous individuals. Methods This cross-sectional study included 182 adults (aged 19-50 years) who completed the Edinburgh Handedness Inventory to identify hand dominance and a neurobehavioral inventory to assess hemispheric dominance. Grip strength was measured using Constant 14,192-709E and Saehan Pinch Gauge SH5005, while dexterity was evaluated with the Purdue Pegboard Test. Statistical analyses were performed using SPSS 16, with significance set at P < 0.05. Results Right-handed participants exhibited significantly higher dexterity in the right hand (P < 0.001), while left-handed individuals showed greater grip strength in both hands, with marginal significance in the right hand (P = 0.046). Mixed-handed/ambidextrous individuals showed significantly higher assembly dexterity scores (P < 0.001). Interhemispheric balance was marginally associated with improved assembly dexterity (P = 0.05), suggesting its role in enhancing motor coordination. Conclusion Hand dominance and hemispheric dominance significantly influence motor performance. Balanced hemispheric function in mixed-handed/ambidextrous individuals enhances complex coordination tasks, highlighting potential benefits for rehabilitation strategies. Future research should explore these relationships using neuroimaging techniques and include a broader demographic range to further investigate underlying neural mechanisms.
Introduction:The radial artery forearm flap (RAFF) is a versatile free tissue transfer used for many clinical presentations. RAFF donor sites typically require a split-thickness skin graft (STSG) for closure. Whilst early rehabilitation of RAFF donor site(s) following STSG commonly involves wrist immobilisation, best practice for this immobilisation procedure remains unknown. Purpose of the Study:The purpose of this study was to systematically 'map' wrist immobilisation methods post-STSG of the RAFF wound and explore the impact of immobilisation methods on donor site morbidity. Methods:A scoping review was completed. Literature searching was conducted from database inception to February 1, 2024 in PubMed, Medline, Cochrane, CINAHL, Embase, Web of Science. Title/abstract screening was conducted by one researcher, full text screening was conducted by two researchers independently. Data extraction included number of participants, participant age and gender, wrist immobilisation details and reported donor site complications. Critical appraisal of articles was not completed. Results:Thirty-seven studies were included in the review. Thermoplastic orthoses (TPO) or 'splinting' (n = 22) and plaster casts (n = 8) were the most frequent immobilisation methods reported with 7 days (n = 15) the most frequent immobilisation period. Detail regarding type of TPO material and location/design of the splint/cast was limited. Frequent donor site morbidities included graft complications (n = 18), changes in sensation (n = 9) and infection (n = 7). Conclusion:Best practice wrist immobilisation procedure for RAFF donor site following STSG cannot be concluded at this time. Additional prospective research is recommended to evaluate the association between wrist immobilisation and donor site morbidity for this complex procedure.
İntroduction:In hand injuries involving thumb impairment, rehabilitation must be conducted meticulously as it is essential for restoring hand function and facilitating return to daily life and work. The aim of this study is to investigate the effects of prescribing mobile games as home exercises on recovery outcomes in patients with thumb involvement due to thumb injuries and/or carpal tunnel syndrome. Method:This randomized controlled trial included 31 patients who were randomly assigned to either the routine rehabilitation (RR) group or the mobile game (MG) group. The primary outcome measure was functional status, assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire. Secondary outcomes included hand function evaluated with the Duruöz Hand Index (DHI), activity-related pain assessed using the Visual Analog Scale (VAS), range of motion (ROM) measured with a goniometer, edema assessed with a tape measure, and adherence to home exercises monitored using a home exercise tracking form. Results:In both groups, statistically significant improvements were observed in all parameters after treatment compared to baseline (p < 0.05); however, no differences were found in the primary outcome measure (p > 0.05). In the between-group comparison, a significant difference in favor of the MG group was observed only for total active motion of the metacarpophalangeal joint and adherence to home exercises (p < 0.05). Conclusion:Mobile game-assisted home exercises appear feasible for patients with thumb involvement. While MCP joint motion improved significantly, no differences were found in pain or function. Further research is needed to confirm clinical relevance.
Introduction:There is a lack of studies on the optimal duration and carry-over effect of superficial heat treatment to increase joint range of motion.This study aims to determine the optimal treatment duration of Fluidotherapy® and Hot Pack in improving wrist and finger active range of motion (AROM) and investigate possible carry-over effects. Methods:The study used a single-site, multi-arm quasi-experimental design. Participants aged 21-80 years with distal radius fracture or fracture and/or soft tissue injuries involving the finger or thumb were assigned consecutively to one of six groups of 10, 15 or 20 min Fluidotherapy® or Hot Pack treatment.All participants had goniometric assessment of their wrist or finger joint AROM adjacent to the injury site and were asked to rate the joint flexibility: (i) prior to treatment; (ii) immediately after treatment; and (iii) after 20 min of AROM mobilisation post-heat treatment. Subjects were asked to rate their joint flexibility again 2 h after the study visit, via telephone. Results were analysed using the Kruskal-Wallis test of association with significance P < 0.05. Results:Participants who had 10 and 20 min Fluidotherapy® and 10 and 15 min Hot Pack treatment showed significant wrist flexion and extension AROM increase immediately after treatment. Participants who had 15 and 20 min Fluidotherapy®, and 15 and 20 min Hot Pack treatment showed further increase in wrist AROM after 20 min of mobilization. Participants with finger injuries in all the treatment groups showed no significant changes in MCPJ or PIPJ AROM immediately and 20 min after treatment.Participants in all treatment groups reported significantly increased wrist flexibility while participants who had 15 min Fluidotherapy® and 20 min Hot pack reported significantly increased MCPJ or PIPJ flexibility, compared to baseline, immediately, 20 min and 2 h after treatment. Discussion:Although there were significant improvements in wrist extension and flexion AROM after 10 or 20 min of Fluidotherapy® and after 10 or 15 min of Hot Pack application, the improvement may not be considered clinically significant. Participants report of significantly improved wrist flexibility in all treatment groups and increased MCPJ and DIPJ flexibility in 2 groups immediately, 20 min, and 2 h after treatments demonstrated the potential of these 2 modalities as pain management adjuncts for pre-conditioning prior to mobilisation.
