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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

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.

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

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