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  • Is grip strength associated with hand dexterity and functional capabilities?

    Handgrip strength and upper limb functional performance measures in people over 18 years old: Analysis of relationships and influencing factors. Pérez-Parra, J. E., et al. (2024). Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Grip strength - Dexterity and Functional performance This cross-sectional study assessed the relationship between grip strength and hand dexterity/function. A total of 162 participants between the age of 18 and over 80 were included. Grip strength was assessed through a Camry digital dynamometry. Hand dexterity and function was assessed through the Box and Block test, Nine-Hole Peg Test, and Jebsen-Taylor Hand Function Test. Grip strength was found to decline with age, with greater strength in men compared to women across all age groups. The results also showed that there were small to moderate correlations between grip strength and hand function/dexterity tests. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, grip strength is a valuable indicator of upper limb muscle strength and functional performance in individuals over the age of 18. In addition, there is a growing body of evidence showing that grip strength is useful in screening for frailty/cognitive decline in middle-aged and older people. Grip strength can also predict upper limb maximum lifting capacity and mortality  in middle-aged people. URL : https://doi.org/10.1016/j.jht.2023.05.009 Abstract Background: Handgrip strength is a common, simple, and inexpensive method to measure muscle strength. On the other hand, the functional performance measurement involves a usual task which implies repeating elements between the individuals’ interaction and the environment. This is fundamental for projecting their results to daily life situation. Purpose: To explore the relationship between grip strength and measures of functional performance of the upper limbs (ULs) in people over 18 years of age, and to determine the influence of sociodemographic and anthropometric variables on the relationship. Study Design: A cross-sectional study was conducted under the analytical empirical approach, using linear associations between handgrip strength and functional performance measurement tests (correspondence analysis). Methods: Three hundred sixty-two male and female individuals between 18 and 91 years of age from 4 Colombian cities participated. The grip strength of both ULs measured with a digital dynamometry was associated with the Box and Block Test (BBT, manual dexterity), Nine-Hole Peg Test (NHPT, daily living tasks), and Jebsen-Taylor Hand Function Test (JJT, ability to grasp, pick up, and place). Multiple linear regression analyzes were performed to assess possible explanatory factors of a sociodemographic and anthropometric order. Results: A significant association was found between the grip strength of dominant and non-dominant ULs with all functional performance tests (ρ > 0.27 and p < .001), except for the writing and simulated feeding subtests of the JJT (ρ ≤ 0.16). An interactive effect of age was found in the relationship between grip strength and the 3 functional performance tests. Conclusions: These results support the association between grip strength with the NHPT, JJT, and BBT measures and the interactive effect of age on the performance of all tests. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Can we tell who is likely to develop post-traumatic elbow stiffness?

    Risk factors for the occurrence and progression of posttraumatic elbow stiffness: A case-control study of 688 cases. Qian, Y., Yu, S., Shi, Y., Huang, H. and Fan, C. (2020) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Post-traumatic elbow stiffness - Risk factors This retrospective case-control study aimed at identifying risk factors associated with post-traumatic elbow stiffness. The study included 688 participants and analyzed factors such as age, muscle strength, injury mechanism, immobilisation time, number of surgeries, alcohol, and smoking habits. Results indicated that factors like age, muscle strength, and injury mechanism played a role in elbow stiffness occurrence. Prolonged cast immobilisation time, multiple surgeries, and alcohol abuse were associated with stiffness and progression. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, younger age, lower levels of strength, longer immobilisation time, a greater number of surgeries, alcohol abuse, and smoking habits contributed to a higher risk of post-traumatic elbow stiffness. If you are interested in advising your patients about whether they are likely to regain a functional elbow range with surgery, you can have a look at this synopsis and use the prediction tool at the link below. URL : https://doi.org/10.3389/fmed.2020.604056 Abstract Background: Elbow stiffness is a severe complication after trauma. Surgical or conservative treatments may be ineffective for restoring functional elbow motion. We aim to evaluate intrinsic and extrinsic factors for the occurrence and severity of elbow stiffness. Methods: This retrospective case–control study included mild/moderate stiffness, severe stiffness, and non-stiffness groups between January 2011 and December 2017 at a single orthopedic center. Multivariable logistic regression analysis and subgroup analysis were used to evaluate age, gender, body mass index, muscle strength, fracture type and site, injury mechanism, immobilization time, elbow dysfunction time, multiple surgeries, nerve symptoms, physical therapy, smoking and alcohol abuse, and dominant hand of stiff elbow as potential risk factors for the occurrence and severity of elbow stiffness. Results: There were 461 patients in the stiffness group and 227 patients in the non-stiffness group. The odds ratios (ORs) of the age, muscle strength, and injury mechanism were 0.960, 0.333, and 0.216 for the occurrence of elbow stiffness. In subgroup evaluation, increased cast immobilization time might be a risk factor for patients receiving conservative therapies (OR = 2.02; p = 0.014). In the evaluation on factors for progression of elbow stiffness, “multiple surgeries” might be a risk factor in surgical treatment by subgroup analysis (OR = 1.943; p = 0.026). Nevertheless, alcohol abuse might increase severity of elbow stiffness in conservatively treated patients (OR = 3.082; p = 0.025). Conclusion: Increased cast immobilization time in the conservative therapy might be a risk factor for stiffness occurrence. Multiple surgeries might be risk factors for stiffness progression. Alcohol abuse potentially increased stiffness severity after conservative treatment. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Do you need to provide patients with splinting following Dupuytren surgery?

    Comparison of hand therapy with or without splinting postfasciectomy for Dupuytren's contracture: Systematic review and meta-analysis. Karam, M., Kahlar, N., Abul, A., Rahman, S. and Pinder, R. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Dupuytren – Splinting post surgery This systematic review and meta-analysis assessed the effect of hand therapy alone versus hand therapy plus splinting post fasciectomy for Dupuytren’s surgery. The analysis included primary outcome measures such as total active flexion and extension and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, alongside secondary outcome measures like pain intensity, grip strength, global perceived effect, and patient satisfaction. The meta-analysis of three randomised controlled trials and one retrospective study for a total of 295 participants, showed no significant differences between hand therapy alone vs hand therapy plus splinting groups in terms of primary and secondary outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, following surgical intervention for Dupuytren's contracture, it appears that splinting does not offer any added functional benefit compared to hand therapy alone. While splinting may still be considered for patients who develop an extension deficit postoperatively, its routine use may not significantly improve outcomes. Nevertheless, in the conservative treatment of Dupuytren's contractures, splinting may be beneficial . URL : https://doi.org/10.1055%2Fs-0041-1725221 Abstract This study aimed to compare the outcomes of hand therapy alone versus additional splinting post fasciectomy for Dupuytren's contracture patients. A systematic review and meta-analysis were conducted, and a search was performed identifying all relevant studies comparing the two groups. Primary outcome measures included Total active flexion and extension (TAF and TAE) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary outcome measures included pain intensity, grip strength, and global perceived effect and patients' satisfaction. A random effects model was used for the analysis. Four RCTs were identified enrolling 295 patients. There were no significant differences between hand therapy and splintage groups in terms of all outcomes (both primary and secondary). Splintage offers no added functional benefit to hand therapy alone for post fasciectomy patients with Dupuytren's contracture, however, orthotic regimes may still be applied on an intention to treat basis in those patients who develop an extension deficit postoperatively. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Is greater social deprivation associated with worse outcomes following rotator cuff repair?

    Neighborhood socioeconomic disadvantages influence outcomes following rotator cuff repair in the non-medicaid population “socioeconomic impact on RC outcomes”. Sprowls, G. R., et al. (2024) Level of Evidence: 2 Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence study Topic: Rotator cuff repair - Effect of social deprivation This retrospective study explored how neighborhood socioeconomic disparities, measured by the Area Deprivation Index (ADI), impacted outcomes following rotator cuff repair surgery. A retrospective review of 287 patients from 2015 to 2020 revealed a significant association between ADI and 2-year American Shoulder and Elbow Surgeons (ASES) scores. In particular, patients from more disadvantaged neighborhoods had worse initial and final ASES scores at 2 years. However, all patients showed a similar overall improvement from pre-operatively to post-operatively. Despite surgery being beneficial, patients from disadvantaged neighborhoods had poorer outcomes. Factors contributing to this included delayed care access and limited resources. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, patients from neighborhoods with higher socioeconomic disparities may have inferior preoperative shoulder function and potentially worse final outcomes at 2 years post rotator cuff repair. These findings are consistent with previous research showing that greater social deprivation is associated with greater osteoarthritis burden, worse recovery from hand surgery, and worse signs/symptoms for untreated cubital tunnel syndrome. URL: https://doi.org/10.1016/j.jse.2024.03.002 Abstract Background: Prior investigations have utilized various surrogate markers of socioeconomic status to assess how healthcare disparities impact outcomes after rotator cuff repair (RCR). When taken as individual markers, these factors have inconsistent associations. Medicaid insurance status is an accessible marker that has recently been correlated with less optimal outcomes after RCR. Socioeconomic disparities exist within the non-Medicaid population as well and are arguably more difficult to characterize. The Area Deprivation Index (ADI) uses seventeen socioeconomic variables to establish a spectrum of neighborhood healthcare disparity. The purpose of this study was to determine the influence of neighborhood socioeconomic disadvantages, quantified by ADI, on 2-year patient reported outcome scores following RCR in the non-Medicaid population. Methods: A retrospective review of patients who underwent RCR from 2015-2020 was performed. All procedures were performed by a group of seven surgeons at a large academic center. Patient demographics and comorbidities were collected from charts. Rotator cuff tear size was assessed from arthroscopic pictures. ADI scores were calculated based on patients’ home addresses using the Neighborhood Atlas tool. The primary outcome measure was American Shoulder and Elbow Surgeons (ASES) score with minimum follow-up of two years. A linear regression analysis with covariate control for age and patient comorbidities was performed. Results: There were 287 patients with a mean age of 60.11 years. The linear regression model between ADI and two-year ASES score was significant (p = .02). When controlling for both age and patient comorbidities, every 0.9-point reduction in ADI resulted in a 1-point increase in the ASES score (P = 0.03). Patients with an ADI of 8, 9, or 10 had lower mean two-year ASES scores than those with an ADI of 1 (87.08 vs 93.19, p = .04), but both groups had similar change from preoperative ASES score (40.17 vs 32.88, p =.12). The change in ASES score at two-years in our study surpassed all established MCID values irrespective of ADI. Conclusion: Patients with greater levels of disparity in their home neighborhoods have worse final ASES scores at two years, but patients significantly improve from their preoperative state regardless of social disadvantages. This is the first study to the authors’ knowledge that examines ADI and outcomes following RCR. Providers should be aware that patients with higher ADI scores may have inferior preoperative shoulder function. The results of this study support the utilization of primary rotator cuff repair in applicable tears regardless of socioeconomic status. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Can you use a simple clam shell splint for metacarpal fractures (II to V) that are managed conservatively?

    Functional hand-based splint in the treatment of metacarpal fractures. Oxley, P. J. and Fin Hodge, W. (2023) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Metacarpal fracture - Clam shell This retrospective study assessed the effectiveness of a hand-based functional splint in treating metacarpal fractures (II to V) not requiring surgical fixation. A total of 33 participants were included in the study. The splint provided to these people was a simple clam shell for the metacarpals (see picture below). Most people did not have to take time off work, as shown in the table below. Overall, the splint duration was four weeks. In addition, fracture reduction maintained without severe adverse events. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the use of a hand-based functional splint appears to be appropriate in the treatment of non-operative metacarpal fractures. The benefits of such approach include early return to pre-injury activities with a low risk of adverse events. These findings are in line with results from a recent study looking at return to sport in professional NFL players with metacarpal fracture, where the average time off was three weeks with some people returning as early as a few days post injury. URL: https://doi.org/10.1177/22925503211042867 Abstract Background: Post-treatment stiffness remains a significant hurdle following treatment for displaced or minimally displaced metacarpal fractures. Treatment goals should focus on a stable and acceptable reduction, minimal patient morbidity, and optimal mobility. Methods: A retrospective review of all non-operative metacarpal fractures over a five-month period at a tertiary center hand clinic treated with a hand-based splint were reviewed for radiologic and clinical stability. The splint allowed metacarpophalngeal joint, interphalangeal joint, and radiocarpal joint motion. Data collected included age, handedness, type and location of fracture, occupation, and ability to continue working. Radiologic images were reviewed by a radiologist not otherwise involved in patient care. Results: Thirty-three patients were reviewed with a total of 39 fractures of the second, third, fourth, and fifth metacarpals. Nine patients had nondominant hand fractures while 24 were dominant hand injuries. Twenty out of 24 patients employed pre-injury were able to continue working without missing any days. Three patients were lost to the final follow-up. The average splint duration was 24 days. Twenty-seven of 30 patients showed no change in alignment from start of splinting to end, while three showed some change but remained within non-operative criteria. Conclusion: A hand-based functional splint for metacarpal fractures allows for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment. It can be applied to any non-operative fracture of the second through the fifth metacarpal. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • When are surgeons more likely to release FDS slip for trigger finger?

    A comparison of patient characteristics and outcomes between patients receiving flexor digitorum superficialis slip excision or isolated A1 pulley release for trigger finger. Fisher, M. M., et al. (2024) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Trigger finger - FDS slip excision This retrospective study compared patient characteristics and outcomes between those receiving flexor digitorum superficialis (FDS) slip excision or isolated A1 Pulley release for trigger finger. It was hypothesised that patients undergoing A1 pulley release with FDS slip excision may have a higher comorbidity burden. A total of 48 patients who underwent A1 pulley release with FDS slip excision and 144 controls were included in the study. Several factors such as ethnicity, BMI, comorbidities, and postoperative characteristics were accounted for as confounders for the data analysis. The results showed that patients with multiple trigger fingers or preoperative pipj contracture were more likely to require FDS slip excision. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, patients with multiple trigger fingers or a preoperative pipj flexion contracture are more likely to undergo FDS slip excision in addition to A1 pulley release for trigger finger. This may be useful to know if we are seeing these patient prior to surgery. Thus, we could let them know that this additional release will occur, and recovery may be a bit longer compared to less complex cases. In terms of conservative treatment for trigger finger, it appears that mcpj blocks or RME splints could be utilised. If you would like to read more about trigger finger, have a look at the database on this topic. URL: https://doi.org/10.1016/j.jhsa.2024.02.003 Abstract Purpose: Resection of the radial or ulnar slip of the flexor digitorum superficialis (FDS) tendon is a known treatment option for persistent trigger finger. Risk factors for undergoing FDS slip excision are unclear. We hypothesized that patients who underwent A1 pulley release with FDS slip excision secondary to persistent triggering would have a higher comorbidity burden compared to those receiving A1 pulley release alone. Methods: We identified all adult patients who underwent A1 pulley release with FDS slip excision because of persistent triggering either intraoperatively or postoperatively from 2018 to 2023. We selected a 3:1 age- and sex-matched control group who underwent isolated A1 pulley release. Charts were retrospectively reviewed for demographics, selected comorbidities, trigger finger history, and postoperative course. We performed multivariable logistic regression to assess the probability of FDS slip excision after adjusting for several variables that were significant in bivariate comparisons. Results: We identified 48 patients who underwent A1 pulley release with FDS slip excision and 144 controls. Our multivariable model showed that patients with additional trigger fingers and a preoperative proximal interphalangeal (PIP) joint contracture were significantly more likely to undergo FDS slip excision. Conclusions: Patients who underwent A1 pulley release with FDS slip excision were significantly more likely to have multiple trigger fingers or a preoperative PIP joint contracture. Clinicians should counsel patients with these risk factors regarding the potential for FDS slip excision in addition to A1 pulley release to alleviate triggering of the affected digit. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Are patients with Dupuytren more likely to die within 5 yrs of diagnosis compared to matched controls?

    Mortality in patients with Dupuytren’s disease in the first 5 years after diagnosis: A population-based survival analysis. van den Berge, B. A., et al. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Dupuytren – Mortality risk This retrospective study assessed the relationship between Dupuytren’s disease and mortality rates. A total of 2,600 participants with Dupuytren and more than 15,000 controls were included in the study. The survival analysis was completed whilst controlling for factors such as smoking and diabetes. The results suggested that people with Dupuytren presented with a reduced mortality risk compared to controls without the disease. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, people with Dupuytren’s do not appear to have a higher mortality rate at five years of diagnosis compared to healthy controls whilst controlling for lifestyle confounders. This is in contrast to previous research showing increased mortality in this group of people. In terms of therapeutic interventions, we have splinting and more invasive options to deal with this condition. URL: https://doi.org/10.1177/17531934241235546 Abstract Previous studies suggest that Dupuytren’s disease is associated with increased mortality, but most studies failed to account for important confounders. In this population-based cohort study, general practitioners’ (GP) data were linked to Statistics Netherlands to register all-cause and disease-specific mortality. Patients with Dupuytren’s disease were identified using the corresponding diagnosis code and assessing free-text fields from GP consultations. Multiple imputations were performed to estimate missing values of covariates, followed by 1:7 propensity score matching to balance cases with controls on confounding factors. A frailty proportional hazard model was used to compare mortality between both groups. Out of 209,966 individuals, 2561 patients with Dupuytren’s disease were identified and matched to at least four controls. After a median follow-up of 5 years, mortality was found to be actually reduced in patients with Dupuytren’s disease. There was no difference in mortality secondary to cancer or cardiovascular disease. Future studies with longer average follow-up using longitudinal data should clarify these associations in the longer term. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Does surgery for scaphoid non union lead to good outcomes in patients with low levels of symptoms pre-operatively?

    Should we always perform scaphoid nonunion surgery in patients with minor preoperative symptoms? Cohen, A., Reijman, M., Selles, R. W., Hovius, S. E. R. and Colaris, J. W. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Scaphoid non-union - Conservative management This retrospective study assessed the outcomes of surgical treatment for scaphoid non-union fractures in patients with minor preoperative symptoms. A total of 35 patients with scaphoid non-union at three months post injury (assessed through x-ray, CT, or MRI) were included. These participants presented with low levels of symptoms and their post-surgical recovery was measured at around one year post surgery. The results showed that 40% of patients had improved functional outcomes at follow up and that 30% were not satisfied with the outcome of surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the potential downsides of surgical intervention for people with scaphoid non-union with low levels of symptoms, include the risk of worse functional outcomes, reoperations, and wrist osteoarthritis. Patient satisfaction post-surgery is not guaranteed and understanding the trade-offs of surgery may be crucial to optimise treatment outcomes and patient experience. Keep in mind that greater symptoms in people with scaphoid waist fractures appear to be associated with greater levels of depression. URL: https://doi.org/10.1177/17531934241235530 Abstract The objective of this study was to assess the downsides of surgical treatment of scaphoid fracture nonunion in patients with minor preoperative symptoms. Patients were classified with minor symptoms based on the Patient-Rated Hand/Wrist Evaluation questionnaire. Of the 35 included patients, most patients encountered problems with patient-specific activities; 9% reported worse postoperative functional outcomes, 34% were not satisfied with the treatment and 9% were reoperated. The risk of a worse functional outcome after surgery with the need for further operations and the chance of developing wrist osteoarthritis, along with the possibility of poor patient satisfaction and ongoing daily functional impairment, should be considered during preoperative counselling. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • What splints for post-traumatic elbow stiffness?

    Mobilizing orthoses in the management of post-traumatic elbow contractures: A survey of Australian hand therapy practice. Sim, G., Fleming, J. and Glasgow, C. (2021) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: Elbow stiffness - Splinting This is survey of Australian Hand Therapists regarding the use of splints for the management of post-traumatic elbow stiffness. A total of 60 participants completed the entire survey. The results showed that splinting options were mainly utilised for extension deficits and that static progressive splints were the most common option selected. In addition, hand therapists highlighted how the first three months were key to recover as much range of movement as possible. Therapists considered factors like effectiveness and ease of use when selecting splints. The wearing time advised varied from 6 to 12 hrs per day. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, splinting for managing elbow extension deficits, are commonly utilised by hand therapists in Australia for post-traumatic contractures. Static progressive splints are the ones often selected as the favorite option. Recommended dosage varied from 6 to 12 hours. Considering the negative repercussions associate with elbow range of movement limitations in the long term, any intervention that has the potential to positively impact these impairments is worth a try. Remember that the longer the time since elbow injury, the less likely we are to make a change. URL: https://doi.org/10.1016/j.jht.2019.12.014 Abstract Study Design: Mixed-methods survey. Introduction Elbow stiffness and contractures often develop after trauma. There is a lack of evidence on mobilizing orthoses and the factors guiding orthotic prescription. Purpose of study: To investigate hand therapists' orthotic preferences for varying extension and flexion deficits, and describe the factors affecting orthotic choice for post-traumatic elbow contractures. Methods: 103 members responded to the electronic survey via the Australian Hand Therapy Association mailing list. Five post-surgical scenarios were used to gather information regarding orthotic preferences, reasons and orthotic protocol: (1) week 8 with 55° extension deficit; (2) week 12 with 30° extension deficit; (3) week 12 with 55° extension deficit; (4) week 8 with flexion limited to 100°; (5) week 12 with limited flexion. Results: Most responders (89.9%) used mobilizing orthoses, predominantly for extension (88.5%). Orthotic preferences for scenarios 1 to 5 were (1) serial static (78.3%); (2) custom-made three-point static progressive (38.8%); (3) custom-made turnbuckle static progressive (33.8%); (4) “no orthosis” (27.9%); and (5) custom-made hinged (27.1%) and nonhinged (27.1%) dynamic. Choices were based on “effectiveness,” “ease for patients to apply and wear,” and “ease of fabrication/previous experience/comfortable with design.” The recommended daily dosage for extension was 6 to 12 hour. Discussion: This is the first known study that reflects on the use of mobilizing orthoses in post-traumatic elbows in Australia. Conclusions: Mobilizing orthoses are used routinely for post-traumatic elbows in Australia. Extension deficits are managed with serial static and static progressive orthoses at weeks 8 and 12, respectively. Research is needed to assess whether orthotic intervention before 12 weeks is beneficial in reducing contractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Can you help your clients with weight management if they are overweight?

    Alternative models to support weight loss in chronic musculoskeletal conditions: Effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial. Kim, A., et al. (2024) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: Weight management - Diet This randomised controlled trial assessed the effectiveness of physiotherapists delivering a very low-energy diet (VLED) program alongside exercise for individuals with knee osteoarthritis (OA) and overweight or obesity. A total of 88 participants were randomised into an intervention group (VLED + exercise) and a control group (exercise only) and underwent six videoconference sessions over six months. The results showed that the intervention group significantly lost more weight (8.1%) compared to the control group (1%), with improvements in BMI, waist circumference, pain, function, and global knee improvement. The VLED program was safe and effective, suggesting implications for future care models. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, it is possible to deliver a very low energy diet (VLED) program supplementary to exercise for individuals who are overweight or obese. Anybody interested in adding this to their skill set would need to upgrade their nutritional knowledge, but the benefit of implementing this in our practice are likely to significantly benefit our patients. If you consider for example symptomatic hand OA, it appears that being overweight may contribute to the disease process as well as increasing the risk of developing it, and the risks associated due to cardiovascular risks. URL: https://doi.org/10.1136/bjsports-2023-107793 Abstract Objectives: To determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity. Methods: 88 participants with knee OA and body mass index (BMI) >27 kg/m2 were randomised to either intervention (n=42: VLED including two daily meal replacement products supplementary to control) or control (n=46: exercise). Both interventions were delivered by unblinded physiotherapists via six videoconference sessions over 6 months. The primary outcome was the percentage change in body weight at 6 months, measured by a blinded assessor. Secondary outcomes included BMI, waist circumference, waist-to-hip ratio, self-reported measures of pain, function, satisfaction and perceived global change, and physical performance tests. Results: The intervention group lost a mean (SD) of 8.1% (5.2) body weight compared with 1.0% (3.2) in the control group (mean (95% CI) between-group difference 7.2% (95% CI 5.1 to 9.3), p&lt;0.001), with significantly lower BMI and waist circumference compared with control group at follow-up. 76% of participants in the intervention group achieved ≥5% body weight loss and 37% acheived ≥10%, compared with 12% and 0%, respectively, in the control group. More participants in the intervention group (27/38 (71.1%)) reported global knee improvement than in the control group (20/42 (47.6%)) (p=0.02). There were no between-group differences in any other secondary outcomes. No serious adverse events were reported. Conclusion: A VLED delivered by physiotherapists achieved clinically relevant weight loss and was safe for people with knee OA who were overweight or obese. The results have potential implications for future service models of care for OA and obesity.Trial registration number NIH, US National Library of Medicine, Clinicaltrials.gov NCT04733053 (1 February 2021).Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analysed during the current trial will be made available from the corresponding author on reasonable request. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Can AI discriminate between people with and without pain by looking at their movement and posture?

    Machine learning models for classifying non-specific neck pain using craniocervical posture and movement. Hwang, U.-j., Kwon, O.-y., Kim, J.-h. and Yang, S. (2024) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Artificial intelligence – Persistent pain detection This cross sectional study assessed the ability of machine learning models to classify individuals with and without non-specific neck pain (NSNP) based on craniocervical posture and cervical kinematics during protraction and retraction. The study involved a total of 773 public service office workers and compared the performance of four machine learning algorithms. The results suggest that machine learning algorithms are more suitable for identifying individuals with NSNP than traditional statistical methods. The accuracy achieved with machine learning models reached 73% (Area Under the Curve). It is important to remember that being able to infer the presence of pain or not from movement does not mean that changing that movement will resolve patients' symptoms. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, machine learning models, specifically Random Forest algorithms, have shown promising performance in classifying individuals with non-specific neck pain based on neck posture and cervical kinematics during protraction and retraction. In the future it is possible that we will have computerised systems helping us better assessing our patients and tracking their progress. If you are interested in the use of AI for hand surgery/therapy, have a look at this synopsis. URL: https://doi.org/10.1016/j.msksp.2024.102945 Abstract Objective: Physical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR). Design: Exploratory, cross-sectional design. Setting and participants In total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332). Methods: We set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms–random forest, logistic regression, Extreme Gradient boosting, and support vector machine–were trained. Main outcome measures: Model performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values. Results: The random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715]. Conclusion: ML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

  • Should splinting still be suggested for carpal tunnel syndrome?

    Splinting for carpal tunnel syndrome. Karjalainen, T. V., et al. (2023) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 thumb up) Type of study: Therapeutic Topic: Carpal tunnel syndrome - Splinting This Cochrane review and meta-analysis assessed the effectiveness of splinting for carpal tunnel syndrome (CTS). A total of 29 trials involving 1937 adults with CTS were included. The results showed that short-term splinting may not significantly improve symptoms or hand function compared to no treatment. Night-time splinting may be more beneficial in the short term. It is also still unclear whether splinting reduces the need for surgery and improved quality of life improvements in the long term. Consider that splinting has minimal side effects and it is a relatively cheap option, it could be used as a first line treatment for people with CTS. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, splinting may provide limited to no benefits in reducing symptoms in the short term (< 3 months) and may not improve hand function in the short or long term. Nevertheless, considering its low cost and the minimal side effects associated with its use, it is worth trialing in people with carpal tunnel syndrome. Overall, it appears that night-time splinting may lead to a higher rate of overall improvement in the short term. Have a look at the whole database to get an understanding of where the research is at on this topic. URL: https://doi.org/10.1002/14651858.cd010003.pub2 Abstract BACKGROUND: Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve causing pain and numbness and tingling typically in the thumb, index and middle finger. It sometimes results in muscle wasting, diminished sensitivity and loss of dexterity. Splinting the wrist (with or without the hand) using an orthosis is usually offered to people with mild-to-moderate findings, but its effectiveness remains unclear. OBJECTIVES: To assess the effects (benefits and harms) of splinting for people with CTS. SEARCH METHODS: On 12 December 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL, ClinicalTrials.gov, and WHO ICTRP with no limitations. We checked the reference lists of included studies and relevant systematic reviews for studies. SELECTION CRITERIA: Randomised trials were included if the effect of splinting could be isolated from other treatment modalities. The comparisons included splinting versus no active treatment (or placebo), splinting versus another disease-modifying non-surgical treatment, and comparisons of different splint-wearing regimens. We excluded studies comparing splinting with surgery or one splint design with another. We excluded participants if they had previously undergone surgical release. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, extracted data, assessed study risk of bias and the certainty in the body of evidence for primary outcomes using the GRADE approach, according to standard Cochrane methodology. MAIN RESULTS: We included 29 trials randomising 1937 adults with CTS. The trials ranged from 21 to 234 participants, with mean ages between 42 and 60 years. The mean duration of CTS symptoms was seven weeks to five years. Eight studies with 523 hands compared splinting with no active intervention (no treatment, sham-kinesiology tape or sham-laser); 20 studies compared splinting (or splinting delivered along with another non-surgical intervention) with another non-surgical intervention; and three studies compared different splinting regimens (e.g. night-time only versus full time). Trials were generally at high risk of bias for one or more domains, including lack of blinding (all included studies) and lack of information about randomisation or allocation concealment in 23 studies. For the primary comparison, splinting compared to no active treatment, splinting may provide little or no benefits in symptoms in the short term (< 3 months). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) (scale 1 to 5, higher is worse; minimal clinically important difference (MCID) 1 point) was 0.37 points better with splint (95% confidence interval (CI) 0.82 better to 0.08 worse; 6 studies, 306 participants; low-certainty evidence) compared with no active treatment. Removing studies with high or unclear risk of bias due to lack of randomisation or allocation concealment supported our conclusion of no important effect (mean difference (MD) 0.01 points worse with splint; 95% CI 0.20 better to 0.22 worse; 3 studies, 124 participants). In the long term (> 3 months), we are uncertain about the effect of splinting on symptoms (mean BCTQ SSS 0.64 better with splinting; 95% CI 1.2 better to 0.08 better; 2 studies, 144 participants; very low-certainty evidence). Splinting probably does not improve hand function in the short term and may not improve hand function in the long term. In the short term, the mean BCTQ Functional Status Scale (FSS) (1 to 5, higher is worse; MCID 0.7 points) was 0.24 points better (95% CI 0.44 better to 0.03 better; 6 studies, 306 participants; moderate-certainty evidence) with splinting compared with no active treatment. In the long term, the mean BCTQ FSS was 0.25 points better (95% CI 0.68 better to 0.18 worse; 1 study, 34 participants; low-certainty evidence) with splinting compared with no active treatment. Night-time splinting may result in a higher rate of overall improvement in the short term (risk ratio (RR) 3.86, 95% CI 2.29 to 6.51; 1 study, 80 participants; number needed to treat for an additional beneficial outcome (NNTB) 2, 95% CI 2 to 2; low-certainty evidence).  We are uncertain if splinting decreases referral to surgery, RR 0.47 (95% CI 0.14 to 1.58; 3 studies, 243 participants; very low-certainty evidence).  None of the trials reported health-related quality of life. Low-certainty evidence from one study suggests that splinting may have a higher rate of adverse events, which were transient, but the 95% CIs included no effect. Seven of 40 participants (18%) reported adverse effects in the splinting group and 0 of 40 participants (0%) in the no active treatment group (RR 15.0, 95% CI 0.89 to 254.13; 1 study, 80 participants).  There was low- to moderate-certainty evidence for the other comparisons: splinting may not provide additional benefits in symptoms or hand function when given together with corticosteroid injection (moderate-certainty evidence) or with rehabilitation (low-certainty evidence); nor when compared with corticosteroid (injection or oral; low certainty), exercises (low certainty), kinesiology taping (low certainty), rigid taping (low certainty), platelet-rich plasma (moderate certainty), or extracorporeal shock wave treatment (moderate certainty). Splinting for 12 weeks may not be better than six weeks, but six months of splinting may be better than six weeks of splinting in improving symptoms and function (low-certainty evidence). AUTHORS' CONCLUSIONS: There is insufficient evidence to conclude whether splinting benefits people with CTS. Limited evidence does not exclude small improvements in CTS symptoms and hand function, but they may not be clinically important, and the clinical relevance of small differences with splinting is unclear. Low-certainty evidence suggests that people may have a greater chance of experiencing overall improvement with night-time splints than no treatment. As splinting is a relatively inexpensive intervention with no plausible long-term harms, small effects could justify its use, particularly when patients are not interested in having surgery or injections. It is unclear if a splint is optimally worn full time or at night-time only and whether long-term use is better than short-term use, but low-certainty evidence suggests that the benefits may manifest in the long term. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

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