Hand Therapy Research Articles

Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists

BackgroundWhile the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. PurposeThis study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. Study DesignThis was a consensus paper via the modified Delphi approach. MethodsA modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist’s research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. ResultsThe expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient’s unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. ConclusionsThe findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.

Practitioners in the hand therapy field report a need for increased structured education opportunities

Practitioners in the hand therapy field report a need for increased structured education opportunities

THE EFFECTIVENESS OF CORRECTION OF HAND MOTILITY BY MEANS OF PHYSICAL THERAPY, OCCUPATION THERAPY (HAND THERAPY) IN THE REHABILITATION PROCESS OF MILITARY SERVANTS WITH THE CONSEQUENCES OF GUNSHOT POLYSTRUCTURAL FOREARM BONE FRACTURES

Aim: to evaluate the effectiveness of the developed program of hand therapy on the parameters of upper limb motility in wounded military servants with the consequences of a gunshot polystructural forearm bones fracture in the post-immobilization period
 Materials and methods. 49 military servants with the consequences of a gunshot polystructural forearm bone fractures were examined. The control group (23 persons) underwent rehabilitation according to general polyclinic principles. The main group (26 persons) underwent rehabilitation using tools and principles of hand therapy (therapeutic exercises and functional training for the wrist and fingers, forearm, shoulder, all joints of the upper limb, exercises on the mechanotherapeutic table MAPS THERAPY; Proprioceptive Neuromuscular Facilitation, massage of the upper limbs; kinesiological taping; orthotics) lasting 1 month. The effectiveness of the program was evaluated by the functioning of the upper limb when performing the Action Research Arm Test and dexterity by the Nine-hole peg test.
 Results. In the injured persons with the consequences of a gunshot polystructural fracture of the bones of the forearm in the post-immobilization period, deterioration of the motility of the upper limb according to the Action Research Arm Test and dexterity according to the Nine-hole peg test, which are factors of disruption of the normal functioning of the upper limb, were determined. After the rehabilitation intervention, all examined persons showed an improvement in motility according to the Action Research Arm Test in the control group by 14.7%, in the main group by 35.4%, according to the Nine-hole peg test - by 61.8% and 22.3%, respectively. According to all studied parameters, the patients of both groups showed a statistically significantly better result compared to the initial data (p<0.05), however, the subjects of the main group showed a better result than the patients of the control group (p<0.05).
 Conclusions. The hand therapy program demonstrated a statistically significantly better effect (p<0.05) on all studied indicators of upper limb motility compared to the polyclinic rehabilitation program, which confirms the need for the use of specialized rehabilitation directions in patients with upper limb injuries that take into account the anatomical and physiological features of the hand and its role in activities of daily living.

Photobiomodulation and Growth Factors in Dentistry: A Systematic Review

Photobiomodulation, or Low-Level Laser Therapy, is a therapeutic technique that can be applied in tissue regenerative surgery. By stimulating the cellular compartment, photobiomodulation promotes cell proliferation, enabling tissue restoration after dental extractions, periodontal surgical treatments, or the management of traumatic oral injuries. On the other hand, Platelet-Rich Plasma (PRP) or Platelet-Rich Fibrin (PRF) therapy is particularly effective in providing a source of growth factors that enhance tissue healing. Authors carried out a Systematic Review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Web of Science (WoS), Scopus, and Cochrane Library databases, using the combination of the following keywords: (“low laser therapy”) AND (“growth factors”) AND (dent* OR oral) and (“photobiomodulation”) AND (“growth factors”) AND (dent* OR oral). A total of 10 publications were deemed eligible for qualitative analysis. The evidence analyzed confirms that the use of photobiomodulation and PRP/PRF (alone or in combination) can stimulate tissue regeneration, allowing for a reduction in postoperative inflammation, wound healing, and new tissue formation. Moreover, these effects are strictly dependent on the intrinsic characteristics of the individual patient, the needs, and the clinical assessment of the practitioner who will appropriately direct the treatment. Furthermore, it is necessary to investigate with evidence-based methodologies (Evidence-based Medicine, EBM) which types of patients and/or lesions are more susceptible to treatment with these tools, as well as to understand the best ways of using (alone or in combination) these important and cutting-edge therapeutic options.

How should we treat painful sensitivity in the hand? An international e-Delphi study

BackgroundEvidence synthesis suggests allodynia resulting from neuropathic pain has few interventions with clear effectiveness. As research continues to build this needed evidence base, expert consensus recommendations can address the conflicting approaches within current hand therapy practice. PurposeThis study aimed to develop consensus recommendations for the clinical management of allodynia from an international panel of hand therapists. Study DesignThis was an international e-Delphi survey study. MethodsWe recruited international hand rehabilitation experts to participate in an e-Delphi survey. Consensus was defined as 75% or more of participants agreeing with a recommendation, and at least 3 rounds of consensus building were anticipated. Experts were identified from 21 countries, and clinical vignettes describing a spectrum of patients with painful sensitivity in the hand were provided to elicit treatment recommendations. Initial recommendations were summarized, and consensus sought for clinical practice recommendations. ResultsSixty-eight participants were invited, with 44 more added through peer nominations. Fifty-four participants from 19 countries completed the initial survey and were invited to participate in all subsequent rounds. Over 900 treatment suggestions were provided from the initial vignettes across domains, including sensory, physical, and functional interventions, education, and cortical representation techniques: 46 ultimately reached consensus. However, important discrepancies in justification (eg, why allodynia should be covered) and implementation of techniques (eg, desensitization, sensory reeducation) were identified as the consensus exercise progressed. ConclusionsExperts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and “top-down” approaches; this is highly aligned with contemporary theories, such as the Neuromatrix Model of Pain. However, consensus was not reached on the justification and implementation of some of these approaches, reflecting the lack of a taxonomy and supporting evidence for tactile stimulation approaches in the current literature. Trials directly comparing the effectiveness of these approaches are needed.

Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness

BackgroundVideo consultation was implemented as a new service in a hospital hand therapy setting. PurposeTo describe the first year’s practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. Study DesignIterative design including economic evaluation. MethodsUsing the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients’ municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. ResultsOf 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. ConclusionsThe results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.

Do current upper limb orthotic classification systems help clinicians choose and design effective orthoses? A scoping review with expert interviews

BackgroundOrthosis (orthotic) fabrication is an essential part of the treatment plan for many upper extremity conditions. PurposeWe aim to comprehensively identify the current body of evidence about the purpose, structure, scope, and application of available orthotic classification systems. Our secondary aim was to know if the current classification systems can be used as a decision guide for clinicians. Study DesignA scoping review. MethodsA scoping review of research studies identified through data-based and gray literature was conducted to determine studies that addressed classification systems of the orthosis (orthotic) in the hand and upper limb. Two investigators screened study titles and abstracts and did the data extraction. To do a comprehensive review, all the hand therapy associations were contacted and asked to share their specific orthosis classification system. To answer our second aim, we discussed our findings with the experts in a panel. ResultsTwelve different classification systems were identified, which were developed with different aims. Five classification systems classified orthosis based on their function (n = 5, 50%); one based on therapeutic goals and proposed a decision algorithm. Two of the proposed systems were aimed at helping in decision-making or offering an algorithm for therapists to help them choose the proper orthosis. The expert panel process identified that the current classification systems could not help clinicians select proper orthosis for their patients. ConclusionsThere are different classification systems which were developed with various aims. However, none of those can help clinicians make informed decisions about appropriate orthosis choices for their patients.

Preliminary Results from a Six-Week Home-Based Evaluation of a Rehabilitation Device for Hand and Wrist Therapy After Stroke.

While many robot-aided solutions have been proposed for the rehabilitation of the distal segment of the upper limb, very few take into account the synergy between the wrist and fingers to allow them to train simultaneously in a home environment. WiGlove is a passive robotic orthosis designed to address this need. This wearable, wireless device enables stroke survivors to perform flexion/extension exercises of both the wrist and fingers while performing ADL or playing therapeutic computer games. As a part of its user-centred design process, this paper presents a case study of a 6-week feasibility evaluation of the WiGlove conducted at a stroke survivor's home without assistance from the therapists. The participant trained with the device for an average of 48 minutes a day and showed a noticeable reduction in the spasticity of the fingers and improved performance in the box and block test. He expressed satisfaction with its usability and suitability for the home environment. These results show overwhelmingly positive outcomes in terms of its acceptance, usability and effectiveness in offering home-based rehabilitation of the wrist and fingers.

A Wearable Device for Upper Limb Rehabilitation and Assistance Based on Fluid Actuators and Myoelectric Control

Wearable exoskeleton solutions for upper limb rehabilitation or assistance, particularly for the hand area, have become increasingly attractive to researchers, proving to be effective over time in treating hand movement impairments following various neurological diseases. Our aim in the present work is to design a wearable exoskeleton device for active hand rehabilitation/assist control based on myoelectric signal (EMG) capture from forearm muscles, which is easy to wear by the user, comfortable, lightweight, and relatively inexpensive to make. The actuators use two different lengths to increase biocompatibility with the anatomy of the hand, and PneuNets fluid actuators are used. Their design to meet force and bending requirements was based on finite element numerical simulations, and the actuators were designed based on a clear design methodology to achieve the best possible quality. Tests on healthy subjects show that the EMG-based control strategy meets the needs of rehabilitation/assistive hand therapy, finding a comfortable and easy-to-use device. Future directions will focus on developing the device to meet rehabilitation needs for the entire upper limb and integrating the device into virtual reality (VR) through immersive devices.

How should we define and assess painful sensitivity in the hand? An international e-Delphi study

BackgroundPainful sensitivity in the hand is commonly seen with neuropathic pain, interfering with daily activities including rehabilitation. However, there are currently several terms used to describe the problem and a lack of guidance on what assessments should be used. PurposeTo gather expert opinion a) identifying current and common terminology used in hand therapy, b) developing a consensus definition of hypersensitivity, and c) developing consensus guidance on how to best assess allodynia. Study designInternational e-Delphi survey study. MethodsWe conducted an e-Delphi consensus study drawing on international experts in hand rehabilitation. We planned up to four rounds of consensus-seeking, defining consensus as 75% or more of participants agreeing with a definition or recommendation. Experts were identified from 21 countries, with the nomination of other experts encouraged for ‘snowball sampling’. The first round included clinical vignettes describing ‘painful sensitivity of the hand’ and asked participants to describe how they would assess each case. Definitions for hypersensitivity, tactile hyperesthesia, and allodynia were also requested. ResultsWe invited 68 participants: 44 more were added through nominations. Sixty-three agreed to participate and were sent the round one survey; 54 participants from 19 countries completed this survey and were invited to participate in all subsequent rounds. No two definitions of hypersensitivity were the same, while 87% of the definitions for allodynia and 78% for tactile hyperesthesia were concordant with a published taxonomy. Over 700 assessment items were proposed in round one: ultimately 38 items representing eight distinct constructs reached a consensus for assessing allodynia. ConclusionsTherapists definitions were consistent with an existing taxonomy for allodynia. Although hypersensitivity conceptualizations varied regarding the qualities of stimulus and response, a working definition was reached. Recommended assessments were relatively consistent internationally, holistic, and reflected a potential link between allodynia and central sensitization.

A description of the barriers, facilitators, and experiences of hand therapists in providing remote (tele) rehabilitation: An interpretive description approach

BackgroundTelerehabilitation is increasingly being used to meet the rehabilitation needs of situations where face-to-face therapy is not possible. Nevertheless, reports on barriers and facilitators of implementing this method from the perspective of therapists still need to be made available. PurposeTo investigate the experiences of hand therapists when implementing telerehabilitation, examining the difficulties, barriers, and facilitators encountered during its implementation. Study DesignQualitative study. MethodsThis study used a purposive sampling method to recruit therapists with varying experiences in telerehabilitation and conducted semi-structured interviews. Data collection and analysis continued iteratively until thematic saturation was achieved. A total of 14 therapists were interviewed via Zoom. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The process of interpretive description guided interviews and analysis of the interviews to identify key barriers and facilitators in providing telerehabilitation. Results/DiscussionSix main themes and 10 corresponding sub-themes were constructed concerning facilitators and barriers to telerehabilitation: factors related to the patient, therapy, therapists, injury, technology, and policy. Therapists implemented different coping strategies in their interventions and measurements to facilitate treatment. However, some interventions, such as orthotic fabrication, could not be done online. Educating therapists, providing a standard method, and integrating with in-person rehabilitation can overcome the barriers to telerehabilitation in hand therapy. ConclusionsTechnology was the main facilitator and, on the other hand, a barrier to providing online hand therapy interventions. Therapists generally reported high satisfaction and usability of this method. Despite all barriers, telerehabilitation can be implemented as a part of hand therapy interventions alongside face-to-face therapy as a hybrid method. The barriers and facilitators experienced and raised by therapists can be added to what is already known regarding telerehabilitation in hand therapy. They might be applied to guide therapeutic procedures and upcoming studies.

Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand

BackgroundRange of motion (ROM) is an outcome measure commonly used when treating acute and chronic hand injuries and conditions. Increased adoption of telehealth service provision in hand therapy practice, influenced by the advent of COVID-19, has led to the need for a valid and reliable approach to measure the range of motion of the digits of the hand when providing hand therapy services using telehealth. PurposeTo determine if performing manual goniometry during a livestream teleconsultation is reliable and clinically useful to measure the range of motion of the fifth digit when providing hand therapy services using telehealth. Study DesignClinical measurement, repeated-measures study. MethodsAccording to a measurement protocol, 12 independent raters (who currently provide hand therapy services) each obtained several screen-based goniometric range of motion measurements of the fifth digit at 2-time points. Raters were surveyed on the clinical utility of the telehealth-based goniometry approach. Measures of relative and absolute reliability were calculated to evaluate test-retest and inter-rater reliability. Free-text responses were analyzed using content analysis. ResultsInter-rater reliability was excellent for all flexion and extension measures (intraclass correlation coefficient [ICC] ≥ 0.89) but poor for the arc of motion (ICC ≤ 0.67). Test-retest reliability was poor (ICC ≤ 0.43). No statistically significant differences between test and retest measurements were observed (P ≥ 0.24). The overall coefficient of variation indicated good precision (14.69%). Measurement error (≤6.07º) and limits of agreement (≤6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations. ConclusionsThis study suggests that performing manual goniometry during a livestream teleconsultation is unreliable for measuring the range of motion of the fifth digit. However, when combined with patient-reported and functional outcomes, this approach may be suitable to facilitate a range of motion assessment for certain functions of telehealth service provision in hand therapy practice.

What Factors Influence Variability in Thumb Carpometacarpal Arthroplasty Care? A Survey of ASSH Members.

The purpose of this study was to gather information regarding current practices in the care of carpometacarpal (CMC) arthroplasty including the use of hand therapy, immobilization, and surgical technique, and to determine which factors influence these patterns. We conducted a survey from February 24, 2022, through March 26, 2022, of 3648 currently practicing members of the American Society for Surgery of the Hand. We developed an 11-item questionnaire that contained questions about surgical technique, immobilization, and postoperative therapy utilization. Results were analyzed using chi-square analysis and a Bonferroni correction was applied to account for multiple comparisons. Statistical significance was set at a P-value of less than .05. A total of 811 hand surgeons completed the survey (22% response rate). Surgeons who are employed by the same medical center as their hand therapist use more in-person hand therapy than surgeons with other types of business relationships. Surgeons with more than 25 years of experience are less likely to recommend therapy routinely, more likely to use ligament reconstruction and tendon interposition, and less likely to be an employee of the same medical center as their hand therapist. The length of immobilization and the time at which hand therapy began were related to surgical technique. Variability in hand therapy usage after CMC arthroplasty is at least partially explained by business relationships with hand therapists and surgeon experience. Variability in the length of immobilization and the beginning of hand therapy postoperatively was more associated with surgical technique.

Immunogenicity of COVID-19 vaccines in lung cancer patients

ObjectivePatients with lung cancer are at increased risk of SARS-CoV-2 infection and severe complications from COVID-19, but information on the efficacy of anti-SARS-CoV-2 vaccine in these patients is scarce. We aimed at evaluating the safety and immunogenicity of COVID-19 vaccines in this population. Patients and methodsThe prospective, nationwide SOLID substudy, enrolled adults with lung cancer who were fully vaccinated against COVID-19. Serum anti-SARS-CoV-2 IgG antibody levels were quantitatively assessed two weeks and six months after receipt of the last dose using a chemiluminescent microparticle immunoassay. Multivariate odds ratios for the association between demographic and clinical factors and seronegativity after vaccination were estimated. Results1973 lung cancer patients were enrolled. Most patients had stage IV disease (66%) and were receiving active cancer treatment (82.7%). No significant differences were found in the probability of being seronegative for anti-SARS-CoV-2 IgG antibodies after full vaccination between patients who were receiving active cancer treatment and those who were not (p = 0.396). The administration of immunotherapy or oral targeted therapy and immunization with mRNA-1273 COVID-19 vaccine were factors independently associated with increased odds of being seropositive after vaccination. From all patients, 1405 received the second dose of vaccine and high levels of antibody titers were observed in 93.6% of patients two weeks after second dose. At six months, multivariate logistic regression analysis showed that performance status ≥ 2 was independently associated with a higher probability of being seronegative after full vaccination with an OR 4.15. On the other hand, received chemotherapy or oral target therapy and vaccination with mRNA-1273 were a factor independently associated with lower odds of being seronegative after full vaccination with an OR 0.52, 0.37 and 0.34, respectively. ConclusionsLung cancer patients can safely achieve a strong immune response against SARS-CoV-2 after full vaccination, regardless of the cancer treatment received. Trial registrationNCT04407143.

Trigger Finger Release: Are Sutures Requiring Removal Necessary?

There is no consensus regarding optimal closure for trigger finger release (TFR) surgery. The purpose of this study was to compare the number of postoperative visits and complications following TFR closure with nonabsorbable sutures versus those following TFR closure with absorbable sutures and skin glue. The hypothesis was that wound closure with absorbable sutures and glue will result in fewer postoperative visits, while having similar complication rates as that with nonabsorbable sutures. A retrospective review identified all patients undergoing open TFR over a 3-year period performed by two hand surgery fellowship-trained hand surgeons who adhered to an identical surgical protocol except for incisional closure. Patients were divided into two groups: a control group with nonabsorbable 4-0 monofilament sutures requiring removal ("suture" group) and a study group with buried absorbable 4-0 monofilament sutures not requiring removal as well as skin glue ("glue" group). The data collected included age, sex, number of postoperative visits, wound complications, infections, antibiotic use, prescribed hand therapy, hospital admission, and reoperation. A total of 305 open TFR surgeries in 278 patients were included in the study, with 155 digits in the "suture" group and 150 in the "glue" group. Both groups were similar in age and sex. The "suture" group had significantly more total postoperative visits (185 vs 42, respectively, P < .001) and postoperative visits within the first 2 weeks (155 vs 10, respectively, P < .001) than the "glue" group. Additional postoperative visits beyond 2 weeks of surgery were similar between the two groups. Three (1.9%) patients in the "suture" group and two (1.3%) patients in the "glue" group developed a superficial surgical site infection within 30 days after surgery. Neither had deep infections requiring hospitalization or reoperation. Both groups required similar rates of postoperative hand therapy. Absorbable sutures afford fewer postoperative visits while having a similar complication rate as nonabsorbable sutures requiring removal. Therapeutic IV.

Conservatively treated distal radius fractures. Who is referred?

This was a retrospective review of 394 patients with distal radius fractures referred to hand therapy from a fracture clinic service provided by a 24 hr acute medical care facility. Only those fractures treated conservatively with closed reduction and cast immobilisation were included. Age, gender, and the number of treatments received prior to discharge from hand therapy were identified, as well as whether patients received hand therapy treatment alone or if they were referred for specialist opinion. Men with conservatively managed distal radius fractures received significantly less treatment than women (rate ratio 0.67; 95% confidence interval [0.60–0.75]; p &lt; 0.001) and there was a significant difference between the number of treatments received by those who were referred to a specialist and those who were not (p &lt; 0.001). Both genders received an increasing number of treatments with age, with a peak in the number of treatments for patients aged 40–60 years, followed by decline. Global trends of an ageing population signal that the incidence of distal radius fracture will continue to increase. The findings of this study suggest relatively low rehabilitation timeframes and treatment numbers for uncomplicated, conservatively managed fractures. Results give some insight as to which patients are accessing rehabilitation post distal radius fracture but further research is warranted to understand the criteria that trigger referral to hand therapy and how best to provide equitable care for men.

Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review.

Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient's home to objectively measure finger/wrist ROM. Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: "wrist/hand," "rehabilitation," and "telemedicine." Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done. There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments. Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.

The Impact of Upper Limb Injury or Conditions on Daily Occupations: A Qualitative Inquiry

The study aimed to explore six public service users’ perspectives on the impact their upper limb injury or condition has on their everyday lives while receiving occupational therapy intervention at a public hospital in the context of the Northern Cape of South Africa. An interpretivist phenomenological approach was employed. Data was collected using reflexive photography and semi-structured interviews. Three main themes were generated during inductive reasoning, namely the impact on role fulfillment, change in occupational task performance and the factors impacting performance in preferred occupations. Participants confirmed that to present a contextually relevant and responsive service, Occupation-Based Hand Therapy (OBHT) approaches must be considered.

Improving hand therapy delivery during care transitions in multisystem trauma patients

High-quality hand therapy is critical to maximising functional capacity and optimising overall outcomes following hand injuries. Therapy delivery requires clear communication between surgeons and occupational therapists. At Sunnybrook Health Sciences...

Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis?

Thumb carpometacarpal (CMC) osteoarthritis (OA) causes functional disability and an increased health care burden in the aging population. The role of therapy in thumb CMC OA has been minimally analyzed in the literature. We hypothesized that patients treated with therapy for thumb CMC OA would demonstrate reduced rates of surgery for this diagnosis. We queried a national insurance dataset for all patients with an International Classification of Diseases, Ninth Revision, or International Statistical Classification of Diseases, Tenth Revision, code for thumb CMC OA, with a minimum of 2 years of follow-up. A 2:1 propensity-matched cohort of patients with CMC OA who did not receive therapy versus a therapy cohort was created, with a minimum of two sessions of hand therapy for inclusion. The primary outcome was the rate of thumb CMC OA surgery occurring within 2 years of diagnosis; time to surgery and use of thumb CMC injections were secondary outcomes. Multivariable logistic regression analysis was used to identify the risk factors for undergoing surgical treatment. After matching, the therapy cohort comprised 14,548 patients, with a matched group of 28,930 patients who did not undergo therapy. In the overall sample, the rate of surgery within 2 years was 22.5%. Two-year surgical treatment rates were significantly higher for those who did not undergo therapy when compared with those who did (29.3% vs 13.1%). Patients treated with therapy had a significantly longer time to surgery, with no difference in the rate of surgery after one year. In multivariable regression of all included variables, lack of therapy intervention had the highest odds of surgery for thumb CMC OA (odds ratio 4.3). We present the findings of a large insurance database evaluating the association of therapy with rates of surgical treatment for thumb CMC arthritis. On average, those treated with therapy had longer times to surgery, and the 2-year surgery rates for patients diagnosed with thumb CMC arthritis were significantly higher in those who did not undergo therapy treatment. Prognostic II.