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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

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

The impact of social deprivation and hand therapy attendance on range of motion after flexor tendon repair. Stonner, M. M., Keane, G., Berlet, L., Goldfarb, C. A. and Pet, M. A. (2022) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Flexor tendon repair - Effect of social deprivation This is a retrospective study assessing the effect of social deprivation in recovery following flexor tendon repairs zone I-III. A total of 109 participants with flexor tendon repair took part in the study. The outcome of interest was Strickland’s percentage of finger range of movement. Social deprivation was determined by participants' addresses. Social deprivation is calculated based on several factors (e.g. income, education - see figure below). Most participants presented with a zone II repair followed by zone I and III. The results showed that greater social deprivation was associated with worse range of movement recovery whilst controlling for other factors including the number of hand therapy sessions attended, age, and flexor tendon zone. To give some context, the least socially deprived group recovered 10% more range of movement compared to the most socially deprived group. Figure from The English Index of Multiple Deprivation (IMD) 2015 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 socially deprived clients are likely to get worse outcomes following a flexor tendon repair zone I-III . Encouraging our clients to attend our hand therapy sessions and explaining the potential benefits of doing so may be useful. Providing a maximum of two exercises may get our clients to buy into our recovery plan. URL : https://doi.org/10.1016/j.jhsa.2022.03.018 Abstract Purpose: To examine the influence of social deprivation and hand therapy attendance on active range of motion (AROM) outcomes following flexor tendon repair. Methods: We performed a retrospective analysis of patients who underwent primary zone I–III flexor tendon repair between November 2016 and November 2020. Area deprivation index (ADI) was used to quantify social deprivation. Medical record review determined each patient’s demographic characteristics, injury details, total hand therapy visits, and final AROM outcome. Active range of motion was converted to Strickland’s percentage for analysis. Spearman correlation and simple and multivariable linear regression models were used to assess relationships between explanatory variables and outcomes. Results: There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was associated with significantly decreased Strickland’s percentage. In the multivariable model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations with Strickland’s percentage. Conclusions: Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after flexor tendon repair. Social deprivation is likely to contribute to poor outcomes both by its association with decreased therapy attendance and by other potential pathways that make it difficult for deprived patients to achieve good surgical 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

A matched comparison of postoperative complications between smokers and nonsmokers following open reduction internal fixation of distal radius fractures. Galivanche, A. R., et al. (2021). Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Prognostic Topic : Distal radius fracture – Smoking and prognosis This is a retrospective study assessing the effect of smoking on post-surgical complications in participants undergoing open reduction and internal fixation (ORIF) for distal radius fracture. A total of 16,158 participants were included in the study. Of these, 3,062 (19%) were smokers. Participants' average age ranged from 50 to 58. Complications were measured 30 days after surgery and included infections, re-operation, readmission, cardiovascular events, and mortality. The statistical analyses took into account demographic and comorbidity information to reduce the contribution of confounding factors to the overall results. The results showed that although mortality was not different between smokers and non-smokers, all the other complications were more likely in smokers. In particular, the prevalence of any adverse event was 4% in smokers and 3% in non-smokers. Clinical Take Home Message : Based on what we know today, smoking not only increases the risk of post-surgical infections but also increases the chance of other complications (e.g. re-operation) following distal radius fracture. Hand therapist may therefore ask their clients about their smoking status and whether they are interested in quitting. If they are, a previous synopsis provides information on evidence-based advice to help clients quit smoking . URL : http://www.sciencedirect.com/science/article/pii/S0363502320305712 Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Purpose: The purpose of the present study was to identify differences in 30-day adverse events, reoperations, readmissions, and mortality for smokers and nonsmokers who undergo operative treatment for a distal radius fracture. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients who had operatively treated distal radius fractures between 2005 and 2017. Patient characteristics and surgical variables were assessed. Thirty-day outcome data were collected on serious (SAEs) and minor adverse events (MAEs), as well as on infection, return to the operating room, readmission, and mortality. Multivariable logistic analyses with and without propensity-score matching was used to compare outcome measures between the smoker and the nonsmoker cohorts. Results: In total, 16,158 cases were identified, of whom 3,062 were smokers. After 1:1 propensity-score matching, the smoking and nonsmoking cohorts had similar demographic characteristics. Based on the multivariable propensity-matched logistic regression, cases in the smoking group had a significantly higher rate of any adverse event (AAE) (odds ratio [OR], 1.75; 95% confidence interval [95% CI], 1.28–2.38), serious adverse event (SAE) (OR, 1.75; 95% CI, 1.22–2.50), and minor adverse event (MAE) (OR, 1.84; 95% CI, 1.04–3.23). Smokers also had higher rates of infection (OR, 1.73; 95% CI, 1.26–2.39), reoperation (OR, 2.07; 95% CI, 1.13–3.78), and readmission (OR, 1.83; 95% CI, 1.20–2.79). There was no difference in 30-day mortality rate. Conclusions: Smokers who undergo open reduction internal fixation of distal radius fractures had an increased risk of 30-day perioperative adverse events, even with matching and controlling for demographic characteristics and comorbidity status. This information can be used for patient counseling and may be helpful for treatment/management planning.

A comparison of acute versus chronic thumb ulnar collateral ligament surgery using primary suture anchor repair and local soft tissue advancement. Delma, S., Ozdag, Y., Baylor, J. L., Grandizio, L. C. and Klena, J. C. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Thumb UCL mcpj - Delayed vs prompt surgery This is a retrospective study comparing outcomes of prompt vs delayed repair of ulnar collateral (UCL) ligament of the thumb mcpj at medium to long term follow-up (1-7 years). A total of 36 participants who had undergone UCL repair within 8 weeks of injury (n = 19) or who had surgery more than 8 weeks from injury (n =17) were included. Outcome measures included function (QuickDASH) and pain (visual analogue scale -VAS). The results showed that there was no difference in function or pain after surgery between the two groups. Unfortunately, the sample size of this study is small and baseline data for the outcome measures were not provided. 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, thumb mcpj UCL repair in the acute or late stage provides similar results (1-7 years). Therefore, an 8 weeks trial of conservative treatment appears reasonable. Imaging (e.g. US, MRI) may be useful in identifying a Stener lesion, however, its accuracy has been questioned . On another note, the results of this study are similar to previous evidence assessing the effect of early vs delayed scapholunate repair . Open Access URL : https://doi.org/10.1016/j.jhsg.2022.02.008 Abstract Purpose: To assess patient satisfaction and functional outcomes of primary suture anchor repair with local soft tissue advancement for both acute and chronic thumb ulnar collateral ligament (UCL) injuries. Methods: We retrospectively reviewed patient charts who had undergone operative UCL repair between 2006 and 2013. Patients who had more than 8 weeks between the time of injury and surgery were classified as having chronic injuries. In both acute and chronic cases, a primary suture anchor repair of the ligament was performed with local soft tissue advancement. For each patient, baseline demographics, operative complications, and associated injuries were recorded along with visual analog scale pain scores; Quick Disabilities of the Arm, Shoulder, and Hand scores; and their return to work or sport status. Comparisons of outcomes and complications were made between the groups (acute vs chronic injuries). Results: Among the 36 patients who met our inclusion criteria, both the acute (n = 19) and chronic (n = 17) groups were similar with regards to major or minor comorbidities, visual analog scale scores; Quick Disabilities of the Arm, Shoulder, and Hand scores; return to work or sport status; or patient satisfaction. Conclusions: Patients with both acute and chronic thumb UCL injuries have similarly acceptable functional outcomes, postoperative pain, and satisfaction. Primary suture anchor repair without ligament reconstruction appears to be a safe and effective treatment option for patients’ thumb UCL injuries, even in the chronic setting. 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 randomized controlled trial of topical cannabidiol for the treatment of thumb basal joint arthritis. Heineman, J. T., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Cannabidiol vs placebo This is a cross-over randomised double-blind, placebo controlled trial assessing the effectiveness of topical cannabidiol (cream) on pain and function in participants with thumb osteoarthritis (OA). Participants (N = 18) were included if they presented with clinical and radiological signs of 1st cmcj OA. Participants were excluded if they presented with other conditions including pulmonary, cardiac, or kidney disease. Pain was assessed through the VAS and function through the QuickDASH at baseline and after 2 weeks of cream use. Participants and treatment providers were blinded to treatment allocation. The placebo or experimental cream looked, smelled, and presented with the same consistency. The cream was applied twice daily. The results showed that participants in the experimental group improved to a statistical and clinically relevant level in pain (3/10 points difference between groups) but not to a clinically relevant level in the QuickDASH (see this synopsis for the clinically relevant threshold ). There were no side effects reported. 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, topical cannabidiol (6.2 mg/ml) appears to be useful in reducing pain in clients with symptomatic thumb OA. Considering that other interventions such as splinting do not appear to be more effective than placebo , this therapeutic approach may provide useful in the future. URL : https://doi.org/10.1016/j.jhsa.2022.03.002 Abstract Purpose: Since the passage of the Agricultural Improvement Act of 2018, hand surgeons have increasingly encountered patients seeking counseling on over-the-counter, topical cannabidiol (CBD) for the treatment of pain. To this end, we designed a human clinical trial to investigate the therapeutic potential of CBD for the treatment of pain associated with thumb basal joint arthritis. Methods: Following Food and Drug Administration and institutional approval, a phase 1 skin test was completed with 10 healthy participants monitored for 1 week after twice-daily application of 1 mL of topical CBD (6.2 mg/mL) with shea butter. After no adverse events were identified, we proceeded with a phase 2, double-blinded, randomized controlled trial. Eighteen participants with symptomatic thumb basal joint arthritis were randomized to 2 weeks of twice-daily treatment with CBD (6.2 mg/mL CBD with shea butter) or shea butter alone, followed by a 1-week washout period and then crossover for 2 weeks with the other treatment. Safety data and physical examination measurements were obtained at baseline and after completion of each treatment arm. Results: Cannabidiol treatment resulted in improvements from baseline among patient-reported outcome measures, including Visual Analog Scale pain; Disabilities of the Arm, Shoulder, and Hand; and Single Assessment Numeric Evaluation scores, compared to the control arm during the study period. There were similar physical parameters identified with range of motion, grip, and pinch strength. Conclusions: In this single-center, randomized controlled trial, topical CBD treatment demonstrated significant improvements in thumb basal joint arthritis-related pain and disability without adverse events. 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

Differences between men and women in percentage of body weight supported during push-up exercise. Mier, C. M., Amasay, T., Capehart, S. and Garner, H. (2014) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Push-up - Resistance This is a cross-sectional study assessing the percentage of body weight lifted during push-up exercises. A total of 37 healthy participants (males = 19, females = 18) were included in the present study. The regular push-up and modified push-up (knee push-up) were assessed during dynamic and static (elbows straight vs elbow flexed) exercises. The results showed that during a dynamic push-up, 80-100% of body weight was lifted. When performing knee push-ups, body weight resistance is reduced to 70-80%. During a static push-up (elbow extension and flexion), resistance equates to 50-75% of body weight. There were differences between males and females during dynamic push-up exercises (see table), however, they were likely due to disparities in push-up speed. 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, during regular push-up exercises, we lift between 80% to 100% of our body weight. When performing knee push-up the resistance reduces to 70-80% of body weight. Static push-up holds (elbow extension/flexion) further reduce resistance to 50-75% of body weight. This information is useful when people want to return to the gym to do bench press exercises. We will be able to estimate their ability to lift weights by asking them to perform a few push-ups and knowing their body weight. Push-ups can also be utilised as a prognostic factor for future health . If you are interested in other ways of assessing upper limb strength and the ability of the upper limb to withstand load, have a look at the push off test . URL : https://digitalcommons.wku.edu/ijes/vol7/iss2/7/ Abstract The purpose of this study was to investigate the effects of push-up method (standard vs modified) and gender on percentage of body weight supported. Thirty seven men and women completed five push-ups in the standard (SPU) and modified (MPU) positions, and 5-sec hold (static) in the up (elbow extension) and down (elbow flexion) positions. Vertical ground reaction forces (expressed as load relative to body weight) were measured using force platforms. From a video-captured image, a computer software distance tool measured vertical range of motion (ROM) achieved in the down position expressed as a percentage of full vertical ROM. Maximal relative load was greater in men than women (SPU: 97.7 ± 8.1% vs 80.0 ± 3.9%; MPU: 79.7 ± 7.4% vs 68.2 ± 3.0%, p < .0001) with a greater effect during SPU (p < .0001). In the static up position, relative load did not differ between men and women (SPU: 67.0 ± 3.8% vs 65.1 ± 3.1%; MPU: 52.5 ± 3.7% vs 51.5 ± 3.1%); however, relative load was greater in men during the static down position (SPU: 74.6 ± 3.6 vs 70.3 ± 3.1%; MPU: 60.1 ± 4.5 vs 56.6 ± 2.7%, p < .0001). Percentage of full vertical ROM was greater in men than women (SPU: 67.7 ± 6.1% vs 50.1 ± 11.4%; MPU: 66.6 ± 6.9% vs 60.1 ± 8.9%, p = .001). These data indicate that women perform the push-up with less relative load and ROM, likely due to gender differences in movement patterns which can be altered by fatigue.

A machine learning algorithm to estimate the probability of a true scaphoid fracture after wrist trauma. Bulstra, A. E. J., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Diagnostic Topic : Scaphoid fractures - Physical tests This is a retrospective study developing a clinical rule to determine who would benefit from advanced imaging (MRI, CT) in clients with radial wrist pain following a fall or injury. A total of 422 participants were included in the study. All participants were included if they were assessed within 72 hrs of a wrist injury. A machine learning model for the detection of scaphoid fractures was developed. The results showed that age, sex, mechanism of injury, and pain at the anatomical snuff box with ulnar deviation were important factors when making a decision for further imaging. The findings also showed that if the risk of having a scaphoid fracture was equal or greater than 10% ( use this tool to calculate it) , patients would have benefitted from undergoing MRI or CT scan. As for previous research on scaphoid fractures, this study has a flaw. When all the physical tests were negative and follow-up x-rays at two weeks were negative, a scaphoid fracture was excluded, which leaves the possibility of occult fractures being undiagnosed. 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 clinical reasoning may be aided by this online tool to decide whether additional imaging (e.g. MRI, CT) to exclude a scaphoid fracture is advisable in clients who had a wrist injury with a negative x-ray. Considering that advanced imaging is not always available to us, we may decide instead to keep a closer eye on our clients who present a probability of having a scaphoid fracture equal or higher than 10%. Since this tool appears useful for screening purposes (excluding a fracture), the presence of higher probabilities should not necessarily raise red flags. If you are interested in additional information on diagnostic tests for scaphoid fractures, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2022.02.023 Abstract Purpose: To identify predictors of a true scaphoid fracture among patients with radial wrist pain following acute trauma, train 5 machine learning (ML) algorithms in predicting scaphoid fracture probability, and design a decision rule to initiate advanced imaging in high-risk patients. Methods: Two prospective cohorts including 422 patients with radial wrist pain following wrist trauma were combined. There were 117 scaphoid fractures (28%) confirmed on computed tomography, magnetic resonance imaging, or radiographs. Eighteen fractures (15%) were occult. Predictors of a scaphoid fracture were identified among demographics, mechanism of injury and examination maneuvers. Five ML-algorithms were trained in calculating scaphoid fracture probability. ML-algorithms were assessed on ability to discriminate between patients with and without a fracture (area under the receiver operating characteristic curve), agreement between observed and predicted probabilities (calibration), and overall performance (Brier score). The best performing ML-algorithm was incorporated into a probability calculator. A decision rule was proposed to initiate advanced imaging among patients with negative radiographs. Results: Pain over the scaphoid on ulnar deviation, sex, age, and mechanism of injury were most strongly associated with a true scaphoid fracture. The best performing ML-algorithm yielded an area under the receiver operating characteristic curve, calibration slope, intercept, and Brier score of 0.77, 0.84, −0.01 and 0.159, respectively. The ML-derived decision rule proposes to initiate advanced imaging in patients with radial-sided wrist pain, negative radiographs, and a fracture probability of ≥10%. When applied to our cohort, this would yield 100% sensitivity, 38% specificity, and would have reduced the number of patients undergoing advanced imaging by 36% without missing a fracture. Conclusions: The ML-algorithm accurately calculated scaphoid fracture probability based on scaphoid pain on ulnar deviation, sex, age, and mechanism of injury. The ML-decision rule may reduce the number of patients undergoing advanced imaging by a third with a small risk of missing a fracture. External validation is required before implementation. 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

Using the Tampa Scale for Kinesiophobia short form in patients with upper extremity specific limitations. Kortlever, J. T., et al. (2021) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Diagnostic Topic : Kinesiophobia - Short form This was a prospective study assessing the validity and reliability of the Tampa Scale for Kinesiophobia short form (four questions) to assess fear of movement in people with upper limb conditions. A total of 143 participants were included and they presented with traumatic and non-traumatic conditions of the hand, wrist, elbow, or shoulder. These participants completed several questionnaires including the Tampa Scale for Kinesiophobia short and long form. In the short form (see table below) there are four questions compared to 17 in the full form. The results showed that the Tampa Scale for Kinesiophobia short form was valid when compared to the full-length questionnaire and was also reliable. 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 short version of the Tampa Scale for Kinesiophobia (TKS-4) is reliable and valid when compared to the full questionnaire in our clients with upper limb conditions. Considering that kinesiophobia is associated with upper limb function , we may add this outcome to the information we collect from our clients. Other brief and validated forms that we can use to assess pain catastrophising, anxiety, and depression can be found in this synopsis . URL : https://doi.org/10.1177/1558944719898830 Abstract Background: The Tampa Scale for Kinesiophobia (TSK) is used to quantify fear of painful movement. A shorter form with only 4 questions (TSK-4) can be used by physicians to look for fear of movement independent of catastrophic thinking with less responder and survey burden. We assessed the difference explained in amount of variation in the Patient-Reported Outcomes Measurement Information System Physical Function Upper Extremity (PROMIS PF UE) between the TSK and TSK-4. Additionally, we looked for other factors that were associated with the PROMIS PF UE, and we assessed reliability and validity of the TSK and TSK-4 by looking at mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression, and PROMIS Pain Interference (PROMIS PI). Methods: One hundred forty eight new and follow-up patients were seen at 5 orthopedic clinics in a large urban area and given the TSK, PROMIS PF UE, PROMIS Depression, PROMIS PI, and PCS-4 questionnaires. Results: Both long and short measures of greater fear of painful movement were independently associated with less physical function (PROMIS PF UE). The longer version accounted for more of the variation in physical function than the short version (TSK, semipartial R2 = 0.12, adjusted R2 full model 0.25; TSK-4, semipartial R2 = 0.03, adjusted R2 full model = 0.16, respectively). The shorter measure had slight floor and ceiling effects. There was high internal consistency for both the TSK and TSK-4. Conclusions: A short measure of fear of painful movement may be an adequate screen in the care of patients with upper extremity problems. Using this short form can help decrease questionnaire burden while accounting for kinesiophobia along with catastrophic thinking. 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

Changes in body composition and strength after 12 weeks of high-intensity functional training with two different loads in physically active men and women: A randomized controlled study. Kapsis, D. P., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Weight loss - Resistance training This is a randomised controlled trial assessing weight loss with low load and moderate resistance training interventions compared to a control group. A total of 31 healthy and active (recreational physical activity 2-3/week) participants were included. Participants were randomised to low load or moderate load circuit training (see figure below), which they performed 3 times per week for 12 weeks. The control group continued to perform their normal physical activity routines. Bioelectrical impendence was utilised to assess fat mass at baseline, 6 weeks, and 12 weeks. The results showed that both circuit training interventions led to an increase in strength and fat loss to a greater extent compared to the control group. There were no differences in fat loss between the low load and moderate load circuit 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, circuit training for a total of 85 minutes per week appears to be beneficial for weight loss when using either low loads (body weight exercises) or moderate loads. We can reassure our clients who are recovering from a hand or upper limb injury that they will not get out of shape because they are reducing their gym load as long as they increase the number of repetitions. In addition, considering that physical activity reduces the risk of developing depression and depressive symptoms , the likelihood of developing persistent pain and low-grade inflammation (which appears to be a risk factor for persistent pain ) we should encourage it in our clients. Open Access URL : https://doi.org/10.3390/sports10010007 Abstract This study examined the effects of two different resistance loads during high-intensity Functional Training (HIFT) on body composition and maximal strength. Thirty-one healthy young individuals were randomly assigned into three groups: moderate load (ML: 70% 1-RM), low load-(LL: 30% 1-RM), and control (CON). Each experimental group performed HIFT three times per week for 12 weeks with a similar total volume load. Body fat decreased equally in both experimental groups after 6 weeks of training (p < 0.001), but at the end of training it further decreased only in LL compared to ML (-3.19 ± 1.59 vs. -1.64 ± 1.44 kg, p < 0.001), with no change in CON (0.29 ± 1.08 kg, p = 0.998). Lean body mass (LBM) increased after 6 weeks of training (p = 0.019) in ML only, while after 12 weeks a similar increase was observed in LL and ML (1.11 ± 0.65 vs. ML: 1.25 ± 1.59 kg, p = 0.034 and 0.013, respectively), with no change in CON (0.34 ± 0.67 kg, p = 0.991). Maximal strength increased similarly in four out of five exercises for both experimental groups by between 9.5% and 16.9% (p < 0.01) at the end of training, with no change in CON (-0.6 to 4.9%, p > 0.465). In conclusion, twelve weeks of HIFT training with either low or moderate resistance and equal volume load resulted in an equal increase in LBM and maximal strength, but different fat loss. 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

Inflammation, physical activity, and chronic disease: An evolutionary perspective. Burini, R. C., Anderson, E., Durstine, J. L. and Carson, J. A. (2020) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Therapeutic Topic : Physical activity - Effect on low-grade inflammation This is a narrative review on the bases of inflammation and the biological repercussions of being inactive/physically activity. The authors suggest that physical inactivity is linked with greater levels of fat accumulation, which contribute to the development of low-grade systemic inflammation. In contrast, the introduction of gradual and regular physical activity reduces systemic inflammation and has the potential to prevent or have an anti-inflammatory effect. 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, regular physical activity has an anti-inflammatory effect. These findings suggest that the addition of physical activity as an intervention may help our clients' hand and upper limb conditions. This may be especially true in those clients who are overweight, inactive and involved in shift work as these factors contribute to low-grade systemic inflammation. If you would like to have a look at what benefits physical activity provides to our clients, have a look at the database . Open Access URL : https://doi.org/10.1016/j.smhs.2020.03.004 Abstract Low-grade inflammation is emerging as a common feature of contemporary metabolic, psychiatric, and neurodegenerative diseases. Both physical inactivity and abdominal adiposity are associated with persistent systemic low-grade inflammation. Thus, the behavioral, biological, and physiological changes that cause a predisposition to obesity and other co-morbidities could have epigenetic underpinnings in addition to various evolutionary scenarios. A key assumption involves the potential for a mismatch between the human genome molded over generations, and the issue of adapting to the modern high calorie diet and common built environments promoting inactivity. This biological mismatch appears to have dire health consequences. Therefore, the goal of this article is to provide a brief overview on the importance of inflammation as part of human survival and how physical activity (PA) and physical inactivity are critical regulators of systemic inflammation. The review will highlight anti-inflammatory effects of PA and exercise training from a metabolic and systemic signaling perspective, which includes skeletal muscle to utilization of fatty acids, TLR4 signaling, and myokine/adipokine effects. The available evidence suggests that PA, regular exercise, and weight loss offer both protection against and treatment for a wide variety of chronic diseases associated with low-grade inflammation through an improved inflammatory profile. 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 biomechanical analysis of the h-taping method used by rock climbers as prophylactic or stabilizing fixation of partial a2 pulley tears. Salas, C., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : A2 pulley injury - H-tape This is a biomechanical study assessing the effect of H-tape (see picture below) on the force required to rupture A2 pulley during crimping (see crimping hold in pciture below). A total of 14 cadavers were assessed during data collection. The force to rupture of A2 pulley was measured in several fingers with and without H-tape. The tests were performed with both intact and partially torn (50%) pulleys. The results showed that there was no difference in the force required to partially/fully rupture the A2 pulley when H-tape or no tape were implemented. Clinical Take Home Message : Based on what we know today, H-tape does not prevent rupture of A2 pulley in climbers using a crimp hold. To avoid ruptures of partially torn A2 pulleys, it may be best to avoid crimping. If you would like to know more about how to treat A2 pulley injuries, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2022.05.002 Abstract Purpose: Rock climbing can lead to upper-extremity injuries, such as A2 pulley ruptures, leading to the bowstringing of the flexor tendons. Climbing finger positions are specific and can put undue stress on the pulley systems. This causes severe hand dysfunction and is a difficult problem to treat, and prevention is important. Using a cadaveric, experimental model, we evaluated the effectiveness of the H-taping method, commonly used by rock climbers, to prevent and treat A2 pulley tears. Methods: Using fourteen matched pairs of fresh-frozen cadaveric hands with forearms, four experiments were conducted with 56 paired comparisons evaluating the failure force, fingertip force, and mode of failure (112 total tests). Comparisons were as follows: index fingers- intact versus 50% distal A2 pulley tears without H-taping (control); ring fingers- intact versus H-taping as a prophylactic for A2 pulley tears; little fingers- 50% distal A2 pulley tears with H-tape versus without tape; and middle fingers- H-taping as a prophylactic versus H-taping as a stabilizing treatment of torn pulleys. Results: The mean index finger failure force was significantly higher in intact vs torn A2 pulleys (control). Failure force for intact H-taped fingers was significantly higher than torn H-taped fingers, but no other finger comparisons for failure force were significant. There were no significant findings in comparison of mean fingertip force values in any of the experiments. Conclusions: We found that H-taping is not effective as prophylaxis against A2 pulley ruptures or as a stabilizing treatment method for partially ruptured pulleys. Clinical relevance: While H-taping has not been recommended as prophylaxis for preventing A2 pulley ruptures, the climbing community has embraced this technique as a preventative measure. The present study provides biomechanical evidence against H-taping for this purpose. Furthermore, it does not appear to aid in increasing fingertip force after injury. 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