Background Patient-reported outcome measures (PROMs) are widely recommended to evaluate function and participation among individuals with upper limb musculoskeletal conditions. There is scarce evidence about the use of PROMs in physiotherapy practice in India. We aimed to understand how physiotherapists use PROMs in patients with upper limb musculoskeletal conditions in Tamil Nadu, India. Methods A sequential explanatory mixed-methods study was conducted. An online survey was completed by 158 physiotherapists, followed by semistructured interviews with 12 participants to explore experiences and perceptions in depth. Results The mean age of the participants (n = 158) was 31.8 years. Twelve participants were interviewed (median age 35 years). Participants predominantly treated shoulder conditions and relied mainly on impairment-based assessments such as pain (76%), range of motion (70%), and muscle strength (59%). While 38% of the survey participants reported rarely or never using PROMs, all interview participants reported occasional use. Most survey participants were familiar with pain scales and unfamiliar with PROMs. Lack of time, knowledge, confidence in selecting and administering PROMs, and the non-availability of PROMs in Tamil were commonly reported barriers. Patient-related challenges such as literacy, language, and cooperation emerged in interviews. Availability of PROMs, therapist training, and workplace policies were the reported facilitators. Conclusions Our findings indicate that the use of PROMs and familiarity with them are reportedly low among physiotherapists in Tamil Nadu. Larger surveys are needed to guide policy, education, and professional practice to facilitate PROM use by physiotherapists in India.
Background The triangular fibrocartilage complex (TFCC) is essential for distal radioulnar joint (DRUJ) stability and wrist load distribution, with injuries often leading to pain and functional impairment. Management strategies can include hand therapy interventions such as stability training, pain management, and functional retraining, often supported by orthotic devices. The WristWidget® has been proposed as a specialized orthosis providing circumferential compression to enhance DRUJ stability, reduce pain, and improve grip strength and weight-bearing tolerance. Purpose To critically evaluate the evidence for the WristWidget® as a conservative treatment option following TFCC injury, considering biomechanical benefits, clinical outcomes, and practical limitations. Study design Literature review. Methods A comprehensive search was undertaken in Medline, CINAHL Complete, Scopus, Cochrane Library, and Web of Science using terms related to “WristWidget,” “wrist orthosis,” and “TFCC injury.” Studies were included if they investigated clinical or functional outcomes associated with WristWidget® use following TFCC injury. Results From 140 identified studies, three met inclusion criteria. Findings indicate short-term improvements in weight-bearing capacity and function, particularly in patients with DRUJ instability. Biomechanical benefits appear linked to increased joint compression and stabilization. However, studies were limited by small sample sizes, non-randomised designs, and lack of long-term follow-up, restricting generalisability. Conclusion Preliminary evidence suggests that the WristWidget® may provide short-term improvements in pain and function after TFCC injury. Nevertheless, current evidence is constrained by methodological limitations, and its long-term efficacy remains unclear. Further controlled studies are required to better establish its clinical efficacy and guide its optimal use in patients' daily tasks.
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.
