Development of a clinical hand rehabilitation guideline for second to fifth metacarpal fracture rehabilitation: A Delphi method

Abstract

Introduction: Metacarpal fractures are viewed as minor injuries, potentially leading to reduced hand function and productivity, especially in working-age people. The study aimed to develop and finalise a second to fifth metacarpal fractures clinical hand rehabilitation guideline. Methods: A three-round eDelphi method, employing REDCap questionnaires and informed by a previous clinical hand rehabilitation guideline, facilitated expert consensus. Experience and qualifications guided expert selection. Consensus was defined as 75% or more experts selecting four or five on a Likert scale or ‘yes’ in ‘yes/no’ questions. Open-ended responses were incorporated, following Conducting and Reporting of Delphi Studies recommendations. Results: Fifteen experts specialising in hand injury management, including orthopaedic surgeons, occupational therapists and physiotherapists, were invited to participate, with attrition of one expert in three rounds. In Round 1, 10 (28.5%), Round 2, 6 (18%) and Round 3, 16 (36%) guideline statements were accepted. Consensus was reached for including grasp types in rehabilitation; activities of daily living (ADLs) types under light, medium and heavy categories; time when early active mobilisation should commence and splint types after conservative management, K-wires and surgical fixation. Conclusion: The finalised clinical hand rehabilitation guideline based on the Occupational Therapy Intervention Process Model (OTIPM) framework may benefit occupation return.