Search Results

Development of a prediction model to determine responders to conservative treatment in people with symptomatic hand osteoarthritis: A secondary analysis of a single-centre, randomised feasibility trial. Magni, N., Rice, D. and McNair, P. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Exercise for hand OA - Prognostic factors This is a prognostic study identifying factors that can predict response to exercise in people with symptomatic hand osteoarthritis (OA). The data utilised were part of a randomised controlled feasibility trial. A total of 59 participants with symptomatic hand OA were included. Participants were randomised to receive advice only, or advice plus either blood flow restriction training or high-intensity training. Participants were defined as responders to treatment at six weeks based on the OMERACT-OARSI criteria (a combination of pain, function, and disease burden outcome), pain (NRS), and function (i.e., FIHOA). The prediction model was moderately accurate and it included the type of treatment, expectations of treatment, and compliance with exercises. More specifically people with positive treatment expectations, who received both exercise and advice, and who had greater compliance with exercises were more likely to be responders. Future studies will need to validate this prediction model on a separate sample of people with symptomatic hand OA. 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, positive expectations, the addition of resistance exercises to advice, and high compliance with the exercise program were more likely to respond to conservative treatment in hand OA. Overall it appears that resistance training is not detrimental in people with hand OA and that several factors contribute to the development of hand OA rather than just biomechanical variables. Open Access URL: https://doi.org/10.1016/j.msksp.2022.102659 Abstract Background: Conservative treatments are beneficial for people with hand osteoarthritis (OA). Objective: It was the purpose of this study to develop and internally validate both a basic model and a more complex model that could predict responders to conservative treatments in people with hand OA. Design: This was a secondary analysis of a single-centre, randomised feasibility study. Methods: Fifty-nine participants (34 responders) with hand osteoarthritis recruited from the general population. Participants were randomised to receive either advice alone, or advice in combination with blood flow restriction training (BFRT), or traditional high intensity training (HIT). Participants underwent supervised hand exercises three times per week for six weeks. The OMERACT-OARSI criteria were utilised to determine responders vs non responders to treatment at the end of six weeks. A basic logistic regression model (treatment type, expectations, adherence) and a more complex logistic regression model (basic model variables plus pain catastrophising and neuropathic pain features) were created. Discrimination ability, and calibration were assessed. Internal model validation through bootstrapping (200 repetitions) was utilised to calculate the prediction model optimism. Results The results showed that the basic model presented with acceptable discrimination (optimism corrected c-statistic: 0.72, 95% CI 0.71–0.73) and calibration (slope = 1.41; intercept = 0.68). The more complex model had better discrimination but poorer calibration. Conclusion: A prediction tool was created to provide an individualised estimate of treatment response in people with hand OA. Future studies will need to validate this model in other groups of patients. Trial registration https://www.anzctr.org.au/- ACTRN12617001270303. 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

Preoperative patient-reported data indicate the risk of prolonged opioid use after hand and upper extremity surgeries. Shipp, M. M., et al. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Opioids - Who will use them post-surgery? This is a retrospective study attempting to identify predictors of opioid use post-hand/upper limb surgery. A total of 2,144 participants were included. Participants were followed up at 3 months after surgery. Several variables including demographic characteristics, mental health, and pain prior to surgery were entered into the prediction model. The results showed that we are currently unable to predict who will start using opioids following hand/upper limb 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, we are unable to predict who will start using opioids following hand and upper limb surgery. Some evidence suggests that in carpal tunnel syndrome, clients who use gabapentinoids prior to surgery have greater odds of starting using opioids post carpal tunnel release. This study, however, showed an association which is not the same as a prediction. URL: https://doi.org/10.1016/j.jhsa.2022.06.026 Abstract Purpose: Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery. Methods: We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve. Results: We included 2,114 patients. In our final model on the 2018–2019 electronic health records and PRD data (n = 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit. Conclusions: We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management. 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 the number of preoperative corticosteroid injections affect clinical and radiographic outcomes of trapeziectomy and suspensionplasty? Thomas, O. J., Hassebrock, J. D., Buckner-Petty, S. A. and Renfree, K. J. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: 1st cmcj OA injections - Do they affect thumb metacarpal subsidence This is a retrospective study assessing the long-term effect of corticosteroid injections on thumb metacarpal subsidence following suspension arthroplasty for thumb OA. A total of 60 participants were included. Of these, 16 received no injection, 19 received one injection, and 25 participants received two or more injections. Thumb metacarpal subsidence was measured at follow-up and compared to baseline measurements. Subsidence simply meant the reduction in space from the base of the metacarpal to the scaphoid. In suspension arthroplasty, this sinking is due to the compression of the suspension arthroplasty created with the tendon. Participants were followed up to 8 years post-surgery. The results showed that there was no difference in thumb metacarpal subsidence between those who receive no pre-operative cortisone injection or several cortisone injections. 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 number of cortisone injections prior to suspension arthroplasty does not affect thumb metacarpal subsidence after surgery. However, we need to keep in mind that cortisone injections 3 months prior to trapeziectomy increase the odds of complications, including infections. Considering that the effectiveness of cortisone injections for 1st cmcj OA is not superior to placebo, their use may be questionable. URL: https://doi.org/10.1016/j.jhsa.2022.06.004 Abstract Purpose: This study aimed to determine whether an increasing number of preoperative corticosteroid injections is associated with greater radiographic subsidence of the thumb metacarpal at long-term follow-up after abductor pollicis longus suspensionplasty, secondary to steroid-induced pathologic weakening of capsuloligamentous restraints surrounding the thumb carpometacarpophalangeal joint and greater extension of the lunate, but neither affect patient-reported outcomes nor revision rates. Methods: A retrospective chart review was performed of patients who underwent primary trapeziectomy and abductor pollicis longus suspensionplasty by a single surgeon over a 10-year period. The number of preoperative corticosteroid injections in the trapeziometacarpal joint was documented, and patients were separated into 4 subgroups: 0, 1, 2, or 3 or more injections. Preoperative and final radiographs were evaluated for a change in the distance between the base of the thumb metacarpal and the distal pole of the scaphoid as a measure of thumb metacarpal subsidence and radiolunate angle as a measure of nondissociative carpal instability, which has been reported as a complication after basal joint arthroplasty. Additionally, the final patient-reported outcomes (Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and revision rates were also assessed. Results: Of a total of 60 patients with an average age of 64 years that were included in the study, 16 (26.7%) received 0, 19 (31.7%) received 1, 12 (20%) received 2, and 13 (21.7%) received 3+ preoperative injections. The median postoperative follow-up was 92 months. The mean distance between the base of the thumb metacarpal and the distal pole of the scaphoid decreased by 2 mm, and the mean radiolunate angle increased by 4° across the entire cohort. When comparing subgroups, no differences were observed in either parameter or the final Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores. Conclusions: This study demonstrates no apparent detrimental effect of an increased number of preoperative corticosteroid injections on radiographic thumb metacarpal subsidence, increase in extension of radiolunate angle (nondissociative carpal instability), patient-reported outcomes, or revision rates at an average of almost 8 years after trapeziectomy and abductor pollicis longus suspensionplasty. 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

Neglect-like symptoms and their relationships with other clinical features in people with hand osteoarthritis: An exploratory study. Magni, N., Collier, J., Rice, D., and McNair, P. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence Topic: Neglect-like symptoms - Hand osteoarthritis This is an exploratory study (cross-sectional study) assessing the presence of neglect-like symptoms in people with hand OA and their association with a series of pain characteristics and psychological variables. A total of 105 participants were included in the study. Hand OA was diagnosed through the American College of Rheumatology (ACR) criteria and confirmed through an x-ray. The presence of neglect-like symptoms was assessed through a questionnaire (see figure below) asking whether the painful limb feels "dead", or "not being part of their body". Several associations were explored including pain duration (years), and mental health issues. The results showed that 60% of people with symptomatic hand OA presented with neglect-like symptoms. Whilst controlling for several other variables (e.g. age, pain intensity, mental health), the duration of pain was associated with the presence of these symptoms. In other words, if people had experienced pain for 20 years, they had 300% greater odds of presenting with these symptoms compared to somebody with one-year pain duration. Even just having pain for 5 years increased the odds by 50% compared to a one-year pain duration (see graph below). 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, a large proportion of clients with hand OA (60%) present with symptoms such as "dead" feelings in their painful limb. These symptoms are associated with a longer duration of pain. The prevalence of neglect-like symptoms reported in this study is similar to the prevalence reported in a previous hand OA study (50%). It is important to ask our clients whether they have any of these symptoms as they are often unwilling to mention it due to fear of being judged mentally ill. We can reassure them that they are not alone and that these "weird" feelings are very common among people with symptomatic hand OA. URL: https://doi.org/10.1016/j.msksp.2022.102662 Abstract Background Symptomatic hand osteoarthritis (OA) is a debilitating condition. Body schema impairments such as neglect-like symptoms have been previously reported in people with symptomatic hand OA, however, little is known about their clinical importance, or relationships with other clinical features. Objectives The aim of this cross-sectional study was to assess the prevalence of neglect-like symptoms in painful hand OA and their association with measures of depression, pain catastrophising, sleep quality, function, pain interference and pain duration whilst controlling for important covariates. Design Secondary analysis of cross-sectional study. Methods Logistic regression with age, sex, and worst pain intensity as covariates were utilised to assess differences between participants with and without neglect-like symptoms. Results A total of 121 participants were recruited. Sixty-one percent of participants presented with neglect-like symptoms. Participants with longer pain duration had greater odds of presenting with neglect-like symptoms (OR: 1.10 95%CI: 1.01 to 1.19; p = 0.012). No difference was observed for depression, pain catastrophising, sleep quality, function, or pain interference. Conclusions A large proportion of participants with symptomatic hand OA reported neglect-like symptoms, the presence of which was associated with longer pain duration. 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

Predicting clinically relevant patient-reported symptom improvement after carpal tunnel release: A machine learning approach. Hoogendam, L., et al. (2022) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Carpal tunnel release - Prognostic model This is a machine learning study aiming to develop and validate a prediction model to determine who would report a clinical relevant improvement at six months post carpal tunnel release. A total of 2,119 participants were included in the study. Participants defined as responders to surgery were those who reported a reduction of 0.8 points out of 5 (20% improvement) on the Boston Carpal Tunnel Questionnaire (BCTQ) at six months post carpal tunnel release. Variables utilised as predictors included the baseline BCTQ score, hand function (VAS), treatment expectations, and depression. The results showed that the prediction model, which is available as a free online tool, had a moderate ability to discriminate who would benefit from carpal tunnel release at six months. This model performed equally well when it was validated on another group of patients (n = 397) whose data was not utilised to develop the model. 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, this online tool may help predict whether surgery for carpal tunnel syndrome is likely to improve our clients' symptoms at six months. Currently, conservative interventions for carpal tunnel syndrome, which appear to be backed by evidence, include cortisone injections, and/or a combination of education, exercise, and night splinting. If you would like to know who is more likely to respond to a cortisone injection for carpal tunnel syndrome read this synopsis. Alternatively, you can have a look at the whole CTS database. URL: https://doi.org/10.1227/neu.0000000000001749 Abstract BACKGROUND: Symptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering a carpal tunnel release (CTR). OBJECTIVE: To predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR. METHODS: We split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire-symptom severity scale were classified as "improved." Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397). RESULTS: A gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81. CONCLUSION: We developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR. 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 is the effect of vitamin C on finger stiffness after distal radius fracture? A double-blind, placebo-controlled randomized trial. Özkan, S., Teunis, T., Ring, D. C. and Chen, N. C. (2019) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: Radius fracture - effect of vitamin C on stiffness and pain This is a double-blind randomised controlled study assessing the effect of vitamin C on pain and finger stiffness following surgical management of distal radius fracture. A total of 134 participants were randomised to a daily dose of either vitamin C (500mg) or placebo pills for 42 days following their distal radius fracture. The effectiveness of vitamin C was assessed through finger range of movement (distance from the palmar crease for all fingers) and pain (NRS 0 to 10) at 6 weeks and 6 months. The results showed no difference in range of movement or pain between the vitamin C and placebo group. 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, 500mg of vitamin C taken daily for 40-50 days post distal radius fracture does not appear to reduce stiffness or improve pain. However, previous research suggests that this dosage of vitamin C reduces the risk of developing CRPS following a distal radius fracture. If you would like to know how to predict whether somebody can be classified as having CRPS at 4 months post-hand or wrist fracture, have a look at this synopsis. I would also suggest looking at what hand therapists in the UK have done to reduce the incidence of CRPS following a distal radius fracture. Open Access URL: https://doi.org/10.1097/corr.0000000000000807 Abstract Background: It is proposed that vitamin C administration can reduce disproportionate pain and stiffness after distal radius fracture; however, randomized trials that tested this hypothesis have had inconsistent results. Questions/purposes: (1) Is administering vitamin C after distal radius fracture associated with better ROM, patient-reported upper extremity function, and pain scores? (2) What factors are associated with post-fracture finger stiffness and worse upper extremity function? Methods: This is a double-blind, randomized, placebo-controlled, noncrossover study. Between August 2014 and July 2017, we approached 204 consecutive patients, of which 195 were eligible, and 134 chose to participate. Participants were randomized to receive once-daily 500 mg vitamin C (67 participants) or placebo (67 participants) within 2 weeks after distal radius fracture. All patients received usual care at the discretion of their surgeon. The mean age of participants was 49 ± 17 years, 99 patients (74%) were women, and 83 (62%) were treated nonoperatively. The primary outcome was the distance between the fingertip and distal palmar crease 6 weeks after fracture. This measure is easy to obtain and previously has been shown to correlate with aggregate ROM of all finger joints. The secondary outcomes were total active finger motion, total active thumb motion, upper extremity-specific limitations, and pain intensity. An a priori power analysis suggested 126 patients would provide 80% power to detect a difference of 2 cm (SD 4.0) fingertip distance to palmar crease with α set at 0.05 using a two-tailed Student's t-test. Accounting for 5% lost to followup, we included 134 patients. All analyses were intention-to-treat. Ten participants of the intervention group and five of the placebo group were lost to followup. Their missing data were addressed by multiple imputation, after which we performed linear regression analysis for our outcome variables. Results: Administration of vitamin C was not associated with ROM, function, or pain scores at 6 weeks (distance to palmar crease: β -0.23; 95% CI -1.7 to 1.2; p = 0.754; finger ROM: β 4.9; 95% CI, -40 to 50; p = 0.829; thumb ROM: β 0.98; 95% CI, -18 to 20; p = 0.918, Patient-Reported Outcomes Measurement Information System [PROMIS] score: β 0.32; 95% CI, -2.6 to 3.2; p = 0.828; pain score: β -0.62; 95% CI, -0.62 to 0.89; p = 0.729) nor at 6 months (PROMIS score: β -0.21; 95% CI, -3.7 to 3.3; p = 0.904; pain score: β 0.31; 95% CI, -0.74 to 1.4; p = 0.559). At 6 weeks, we found that more finger stiffness was mildly associated with greater age (β -1.5; 95% CI, -2.8 to -0.083; p = 0.038). Thumb stiffness was mildly associated with greater age (β -0.72; 95% CI, -1.3 to -0.18; p = 0.009) and strongly associated with operative treatment (β -32; 95% CI, -50 to -13; p = 0.001). Greater pain interference was modestly associated with greater functional limitations at 6 weeks (β -0.32; 95% CI, -0.52 to -0.12; p = 0.002) and 6 months (β -0.36; 95% CI, -0.60 to -0.11; p = 0.004). Conclusions: Vitamin C does not seem to facilitate recovery after distal radius fracture, but amelioration of maladaptation to nociception (pain interference) merits greater attention. Level of Evidence Level I, therapeutic study. 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

A modified-delphi study establishing consensus in the therapeutic management of posttraumatic elbow stiffness. Whitten, M., Silfies, S. P., Grampurohit, N. and Fedorczyk, J. M. (2022) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Therapeutic Topic: Post-traumatic elbow stiffness - Treatment This is an expert consensus on the conservative management of elbow stiffness. A group of certified hand therapists, both occupational therapists and hand therapists, were involved in two discussion rounds. Overall, the majority of hand therapists agreed that scar tissue management followed by some form of stretching and splinting were the best options to improve elbow stiffness. The type of range of movement interventions included stretching, sustained positioning in extension/flexion, functional activities, or resisted exercises (e.g. resistance training). 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, expert hand therapists suggest that scar treatment (post-surgical), splinting (e.g. static progressive) and active range of movement, in several forms, are beneficial to improve elbow stiffness. This consensus is in line with previous evidence showing that stretching or resistance training improves range of movement. Overall, exercise appears to be useful for elbow stiffness and a regime of static stretching appears to be equally effective as muscle energy techniques (e.g. PNF) in improving range of movement. URL: https://doi.org/10.1016/j.jht.2021.11.002 Abstract Study Design : Web-based modified Delphi study. Background : Therapy is widely considered the first choice of treatment for posttraumatic stiffness of the elbow since loss of motion is a common sequela following traumatic elbow injuries. There is high variability in practice patterns for the management of the posttraumatic elbow. Purpose : The aim of this study is to identify the current therapeutic management of posttraumatic elbow stiffness using expert consensus. Methods : This study surveyed experts using a web-based 3 round modified Delphi method. Quantitative data and comments were collected during the first round. Questions with Likert scaling were used to identify consensus (defined as 75% agreement) with each statement and comment boxes enabled open-ended responses to gather expert opinion. Lack of consensus and data from comments guided the second-round of the survey. This process was repeated after Round 2 to develop the Round 3 survey. Consensus was achieved at Round 3 and no further rounds were needed. Results : Round 1 included 34 experts (response rate 20%), not all experts were able to continue through all rounds. Round 2 included 18 experts and Round 3 included 15 experts. Survey items were categorized as follows: examination procedures, therapeutic interventions, orthotic intervention considerations, contributing patient factors, and clinical decisions and rehabilitation challenges. Twenty-five percent of items achieved consensus after Round 1, 30% after Round 2 and 52% after Round 3. Although most participants agreed that orthotic intervention is critical to patient outcomes, there were conflicting thoughts about the orthotic design and wearing schedule. Conclusions : The findings of this web-based modified Delphi study helped to establish a current body of knowledge using expert consensus to guide practice and identify specific questions that can be studied in future clinical studies on posttraumatic elbow stiffness. 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

Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study. Savaş, S. and Aydoğan, Ç. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Therapeutic Topic: Tendon repair - Association between depression and splint wearing This is a prospective study assessing the effect of several variables on splint wearing post-tendon repair. A total of 133 participants with flexor/extensor tendon repair took part in the study. Amongst several variables, depression was assessed through the Beck Depression Inventory. Splint wearing was measured subjectively by asking participants whether they had been wearing the splint as prescribed. The results showed that whilst controlling for several other variables, greater levels of depression were associated with lower odds of splint wearing. Thanks to Chris Edwards for pointing out this paper to me! 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, our clients with depression are less likely to wear a splint following tendon repair (flexors or extensors). This is important as we may be able to provide them with extra encouragement and additional information on the benefits of wearing a splint post-surgery. From previous evidence, we also know that socially deprived clients are likely to get worse outcomes following flexor tendon repair. Being aware of these psychosocial factors may help us be kinder to both our clients and ourselves if splint wearing and outcomes are suboptimal following tendon repair. URL: https://doi.org/10.1016/j.jht.2020.10.005 Abstract INTRODUCTION: Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. PURPOSE OF THE STUDY: This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. STUDY DESIGN: This is a prospective cohort study. METHODS: Two hundred twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 h a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence. RESULTS: One hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01]. CONCLUSIONS: Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence. 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

Nonoperative treatment of lateral epicondylitis: A systematic review and meta-analysis. Lapner, P., et al. (2022) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: Lateral epicondylalgia – Conservative treatment This is a systematic review and meta-analysis assessing the effectiveness of conservative interventions for lateral epicondylalgia. Seventeen randomised controlled trials (RCT) were included. Several types of conservative interventions were assessed and they included physiotherapy, corticosteroid, platelet-rich plasma (PRP), and autologous injections. Pain and function were measured at 6 and 12 months follow-up. All the studies were included in the meta-analysis and they were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which has also been suggested by the Cochrane group for systematic reviews. The results showed that there is low to moderate quality evidence suggesting that corticosteroid injections have a detrimental effect on both pain and function. There is also low to high-quality evidence suggesting that physiotherapy, PRP, and autologous injections do not provide significant improvements. 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, common conservative interventions have negligible effects on tennis elbow pain and function. The sole exception is corticosteroid injections, which appear to significantly worsen outcomes compared to placebo or no intervention. These findings are in line with previous research on corticosteroid and PRP injections. Exercise has small effects and it is hard to differentiate it from placebo effects. The best we can currently do is to avoid clients getting interventions (e.g. corticosteroids), which can worsen their condition and implement the most effective form of intervention: TIME. As a matter of fact, 50% of people with tennis elbow recover after three months and 90% at 12 months without any therapeutic input. During this time we can coach them and avoid them feeding into the nocebo effect, which can make the pain worse. URL: https://doi.org/10.1016/j.jseint.2021.11.010 Abstract Background: There is an ongoing controversy regarding the nonoperative treatment of lateral epicondylitis. Given that the evidence surrounding the use of various treatment options for lateral epicondylitis has expanded, an overall assessment of nonoperative treatment options is required. The purpose of this systematic review and meta-analysis was to compare physiotherapy (strengthening), corticosteroids (CSIs), platelet-rich plasma (PRP), and autologous blood (AB) with no active treatment or placebo control in patients with lateral epicondylitis. Methods: MEDLINE, Embase, and Cochrane were searched through till March 8, 2021. Additional studies were identified from reviews. All English-language randomized trials comparing nonoperative treatment of patients >18 years of age with lateral epicondylitis were included. Results: A total of 5 randomized studies compared physiotherapy (strengthening) with no active treatment. There were no significant differences in pain (mean difference: −0.07, 95% confidence interval [CI]: −0.56 to 0.41) or function (standardized mean difference [SMD]: −0.08, 95% CI: −0.46 to 0.30). Seven studies compared CSI with a control. The control group had statistically superior pain (mean difference: 0.70, 95% CI: 0.22 to 1.18) and functional scores (SMD: −0.35, 95% CI: −0.54 to −0.16). Two studies compared PRP with controls, and no differences were found in pain (SD: −0.15, 95% CI: −1.89 to 1.35) or function (SMD: 0.14, 95% CI: −0.45 to 0.73). Three studies compared AB with controls, and no differences were observed in pain (0.49, 95% CI: −2.35 to 3.33) or function (−0.07, 95% CI: −0.64 to 0.50). Discussion: The available evidence does not support the use of nonoperative treatment options including physiotherapy (strengthening), CSI, PRP, or AB in the treatment of lateral epicondylitis. 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

The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. De Nys, L., et al. (2022) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Therapeutic Topic: Physical activity - Effect on sleep This is a systematic review and meta-analysis assessing the effect of physical activity on cortisol (stress) and sleep quality. Ten randomised controlled trials were included for a total of 756 participants. All the studies were included in the meta-analysis and they were assessed through the Risk of Bias criteria recommended by the Cochrane Review Group. The overall strength of evidence was assessed through the GRADE approach ("low", "very low", "moderate", "high"), which has also been suggested by the Cochrane group for systematic reviews. Most of the studies assessed the effect of aerobic or mind and body exercise (e.g. yoga) on cortisol (stress indicator) or the Pittsburgh Sleep Questionnaire (score 0 to 21). The results showed that moderate quality evidence supports the use of physical activity to reduce stress. Low-quality evidence also showed a significant effect of physical activity on sleep, although this result is unlikely to be clinically relevant as the difference between groups was not even close to what has been suggested the minimum threshold of 5.5 points. 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, physical activity may reduce stress but is unlikely to improve sleep to a clinically relevant level. Advising our clients to engage in regular physical activity may therefore be useful as stress appears to be a risk factor for the development of persistent pain, especially in young people. Considering, that regular physical activity also reduces low-grade inflammation, it is worth encouraging our clients to exercise. To improve sleep quality, reading a book just before sleeping may be more effective than taking part in physical activity. Open Access URL: https://doi.org/10.1016/j.psyneuen.2022.105843 Abstract BACKGROUND: Managing stress and having good quality sleep are inter-related factors that are essential for health, and both factors seem to be affected by physical activity. Although there is an established bidirectional relationship between stress and sleep, remarkably few studies have been designed to examine the effects of physical activity on cortisol, a key biomarker for stress, and sleep. Research is particularly scarce in older people despite both sleep and cortisol changing with age. This systematic literature review addresses this gap. METHODS: A systematic review was conducted following the PRISMA guidelines. Original, peer-reviewed records of intervention studies such as randomized controlled trials (RCTs) and non-RCTs with relevant control groups were eligible for inclusion. The Participant, Intervention, Comparison, Outcome (PICO) characteristics were (1) adults or older adults (2) physical activity programmes of any duration, (3) controls receiving no intervention or controls included in a different programme, (4) cortisol measurement, and subjective or objective measures of sleep. RESULTS: Ten original studies with low-to-moderate risk of bias were included. Findings from this review indicated with moderate- and low-certainty evidence, respectively, that physical activity was an effective strategy for lowering cortisol levels (SMD [95% CI] = -0.37 [-0.52, -0.21] p < .001) and improving sleep quality (SMD [95% CI] = -0.30 [-0.56, -0.04], p = .02). Caution is needed to generalize these findings to the general population, as included trials were predominantly participants with breast cancer, included few males and no older adults. CONCLUSION: Cortisol regulation and sleep quality are intertwined, and physical activity programmes could improve both in several ways. Further, physical activity may benefit adults with long term conditions or current poor (mental) health states the most, although more research is needed to support this claim fully. Few intervention studies have examined the inter-relationship between cortisol and sleep outcomes in males or older adults, indicating fruitful enquiry for future research. 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

The impact of previous surgery on scaphoid nonunion reconstruction: A retrospective study of 95 cases. Diehm, Y. F., et al. (2022) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Scaphoid non-union - Success of primary vs secondary reconstruction This is a retrospective study assessing the success rate of primary (one surgery) vs secondary (two surgeries) for scaphoid non-union reconstruction. A total of 95 participants were included. Of these, 64 underwent a secondary whilst 31 a primary reconstruction. No previous surgery was completed in the primary reconstruction group because either the fracture had been missed or the participants had undergone a trial of conservative treatment. The success rate of scaphoid non-union reconstruction was defined by the rate of x-ray union. The results showed that the rate of union was similar in both the primary (89%) and secondary (90%) reconstruction (see table). 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 rate of union following a primary or secondary scaphoid reconstruction is similar. This means that in both cases, 9 out of 10 people have successful surgery for this condition. We can therefore reassure our clients and explain that failure of scaphoid reconstruction surgery does not mean that all hope is lost. In fact, in most cases, it appears that a second surgery is helpful. If you would like to determine whether the next client you assess requires further imaging to exclude a scaphoid fracture, have a look at this synopsis. URL: https://doi.org/10.1177/17531934221108452 Abstract We retrospectively compared 64 scaphoid reconstructions in cases that had not undergone previous surgery with 31 cases in which previous surgery had been performed. The characteristics of the groups were similar except that there were more smokers in the group without previous surgery and a more frequent use of vascularized bone grafts in the group with previous surgery. At final follow-up, 66 and 65 months, respectively, after reconstruction, union incidence was 89% and 90%. In patients with previous surgery, grip strength was higher but not when expressed in percent of the contralateral hand. There were no differences in pinch strength, active wrist motion, functional scores, carpal height or scapholunate angle. We conclude that repeat surgery to the scaphoid did not seem to be a major risk factor for the overall outcomes, keeping in mind that a vascularized bone graft was more frequently used for secondary reconstructions. 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

Association of burden and prevalence of arthritis with disparities in social risk factors, findings from 17 us states. Rethorn, Z. D., et al. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Symptoms prevalence Topic: Social risk factors - Arthritis burden This is a retrospective study assessing the effect of cumulative social risk factors and arthritis burden. A total of 136,432 participants presenting with arthritis (i.e. osteoarthritis, rheumatoid arthritis, lupus, gout, or fibromyalgia) were included in the study. The social risk factors assessed were health care access hardship, unsafe neighbourhoods, and insecurity related to housing, financial status, and food. Arthritis burden was assessed based on joint pain, and activity/work limitations. The results showed that the odds of presenting with greater arthritis burden increased with the number of social risk factors. In other words, greater social insecurity was associated with greater pain. To give some clinical context, severe joint pain was present in more than 30% of people with 4 social risk factors compared to less than 20% in people with only one social risk factor (see figure below). 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, social risk factors are associated with the arthritis burden. More specifically, the greater the number of social risk factors (e.g. financial insecurity), the greater the odds of having severe joint pain or disability. This is consistent with previous research showing that social deprivation has negative effects on the recovery of people with flexor tendon repair. In addition to social deprivation, we know that psychological factors (e.g. kinesiophobia) are associated with upper limb disability. This is why a biopsychosocial approach is useful in the treatment of our clients. Open Access URL: http://dx.doi.org/10.5888/pcd19.210277 Abstract INTRODUCTION: Social risks previously have been associated with arthritis prevalence and costs. Although social risks often cluster among individuals, no studies have examined associations between multiple social risks within the same individual. Our objective was to determine the association between individual and multiple social risks and the prevalence and burden of arthritis by using a representative sample of adults in 17 US states. METHODS: Data are from the 2017 Behavioral Risk Factor Surveillance System. Respondents were 136,432 adults. Social risk factors were food insecurity, housing insecurity, financial insecurity, unsafe neighborhoods, and health care access hardship. Weighted χ(2) and logistic regression analyses, controlling for demographic characteristics, measures of socioeconomic position, and other health conditions examined differences in arthritis prevalence and burden by social risk factor and by a social risk index created by summing the social risk factors. RESULTS: We observed a gradient in the prevalence and burden of arthritis. Compared with those reporting 0 social risk factors, respondents reporting 4 or more social risk factors were more likely to have arthritis (adjusted odds ratio [AOR], 1.92; 95% CI, 1.57-2.36) and report limited usual activities (AOR, 2.97; 95% CI, 2.20-4.02), limited work (AOR, 2.72; 95% CI, 2.06-3.60), limited social activities (AOR, 3.10; 95% CI, 2.26-4.26), and severe joint pain (AOR, 1.86; 95% CI, 1.44-2.41). CONCLUSION: Incremental increases in the number of social risk factors were independently associated with higher odds of arthritis and its burden. Intervention efforts should address the social context of US adults to improve health outcomes. 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