BACKGROUND:Orthotic management alone or with hand therapy (+HT) are cornerstones of nonoperative management for thumb carpometacarpal osteoarthritis, yet comparative data are scarce. PURPOSE:To compare outcomes over the course of 12 months for orthotic management alone vs +HT for patients with thumb carpometacarpal arthritis. STUDY DESIGN:Prospective observational. METHODS:We identified patients from our ongoing prospective nonoperative carpometacarpal osteoarthritis registry who elected for treatment with orthotic management alone or +HT from 2019-2023. We collected baseline and 1-, 2-, 6-, and 12-month surveys as well as patient-reported outcome measures. We used bivariate mixed-effect regression analyses to compare continuous variables between groups. RESULTS:A total of 25 orthotic management alone and +41 HT patients were identified. The +HT group had significant improvements in brief Michigan Hand Questionnaire (bMHQ) scores from baseline (mean 67 [SD 12]) at 1 and 2 months (53[5] and 51[8], respectively), and for Patient-Reported Outcomes Measurement Information System Pain Interference scores from baseline (56[2]) at 1 and 2 months (51[6] and 51[5], respectively). The orthotic management alone group had significant improvements in bMHQ scores from baseline (mean 63 [SD 15]) at 2 and 6 months (52[10] and 48[9], respectively), and for Patient-Reported Outcomes Measurement Information System Pain Interference scores from baseline (57[5]) at 2 and 6 months (51[9] and 50[8], respectively). Approximately 12% of patients in both groups received a corticosteroid injection by 12 months. CONCLUSIONS:Patients choosing +HT for initial management of their thumb carpometacarpal arthritis had some earlier benefits than those choosing orthotic management alone. Relatively few patients choosing either of these approaches progressed to corticosteroid injections within 12 months of initiating care. We need larger cohorts with better retention to improve comparisons of carpometacarpal osteoarthritis nonoperative care options.
BACKGROUND:Stiffness of the proximal interphalangeal (PIP) joint is a common complication following trauma or surgery. Recurrence remains a clinical challenge due to persistent tissue contractile activity, and no standardized method exists to predict long-term outcomes. PURPOSE:To evaluate the contraction test as a tool for detecting residual contractile activity in patients with PIP joint flexion contracture treated with an elastic tension digital neoprene orthosis, and to assess its usefulness in predicting recurrence of stiffness to guide therapeutic decisions. STUDY DESIGN:Longitudinal retrospective cohort study. METHODS:Fifty-seven patients with PIP joint flexion contracture were treated with an elastic tension digital neoprene orthosis between July and December 2022. Patients were assigned to wear the orthosis either 20-22 hours or 10-14 hours daily during the first three weeks. Passive range of motion and contraction test values were recorded at baseline and during follow-up for up to six months. Improvements in extension and persistence of contractile activity were analyzed. RESULTS:At baseline, the contraction test was positive in all patients. After three weeks, the mean cumulative gain in passive range of motion was 29° in the longer-wear group and 19° in the shorter-wear group. The contraction test remained positive in 95% of patients at this stage. At the end of follow-up, 49% of patients (28/57) achieved a negative contraction test, and no recurrence was observed among those who continued treatment. Conversely, patients with a persistent positive test (51%) showed a higher risk of recurrence despite improvements in extension. The greatest gains in extension occurred during the first three weeks, followed by stabilization at approximately three and a half months. CONCLUSIONS:The contraction test provides an objective measure of residual contractile activity and is useful for predicting recurrence of PIP joint stiffness after treatment with an elastic tension digital neoprene orthosis. It may support clinical decision-making regarding continuation or discontinuation of orthotic treatment, contributing to more personalized management of contractures.
BACKGROUND:After a stroke, wrist and hand dysfunction usually develops from extended non-use and lack of home-based repetitive training, greatly influencing affect daily living and general quality of life. Wearable mobile and traditional electromyography biofeedback devices as biofeedback-based rehabilitation tools offer an intriguing solution for task-specific training, thereby improving user involvement and functional recovery. PURPOSE:The main aim of this study was to find out how satisfied people with wrist and hand dysfunction who had recently had a stroke were with using a wearable mobile biofeedback device (Pheezee) compared to traditional electromyography biofeedback. STUDY DESIGN:Crossover trial. METHODS:Thirty subacute stroke (male 16 and female 14) participants with wrist and hand dysfunction participated in the study. All participants received 1 week of training using the Pheezee, then 1 week using traditional electromyography biofeedback. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) scale measured user satisfaction. RESULTS:The Mann-Whitney U test applied for between-group comparisons. The wearable mobile biofeedback device demonstrated significantly higher user satisfaction in terms of weight, safety, durability, comfort, simplicity of use, and effectiveness (p < 0.05). However, no significant differences were observed between the two modalities concerning adjustment component (p > 0.05). QUEST 2.0 device subscale total eight items were higher in the Pheezee device group (3.69 ± 0.26) compared to the traditional electromyography biofeedback device group (3.18 ± 0.18) mean and SD respectively, demonstrating a mean difference of 0.52 points (16.3% higher user satisfaction). CONCLUSIONS:Wearable mobile biofeedback devices show promise as supportive tools in stroke rehabilitation and can be feasibly integrated into home-based task-specific training programs. Their ability to raise engagement and adherence to rehabilitation could help stroke survivors have better functional results and quality of life.
