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Exercise training and bone mineral density in postmenopausal women: An updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Mohebbi, R., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Bone health – Exercise The systematic review and meta-analysis assessed the effects of exercise on bone mineral density (BMD) in postmenopausal women. The study included controlled exercise trials of at least six months. The review analyzed BMD changes at the lumbar spine (Lx), femoral neck, and total hip from 80 studies for a total of 5,581 participants. Results indicated that exercise positively impacted BMD, with small to moderate effect sizes. No significant differences were found in the type of exercise, menopausal status, or exercise supervision. 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, exercise has a positive impact on Bone Mineral Density (BMD) in postmenopausal women, regardless of bone status (osteopenia/osteoporosis vs. normal), menopausal stage (early vs. late postmenopausal), or the level of supervision (supervised vs. non-supervised). This is supported by previous evidence suggesting that exercise has a positive effect on bone remodelling in older adults . Keep in mind that you can screen for osteopenia/osteoporosis by looking at hand x-rays and that all patients presenting with a low energy trauma leading to distal radius fracture should undergo bone mass density assessment . URL : https://doi.org/10.1007/s00198-023-06682-1 Abstract The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16–0.42), 0.27 (95% CI: 0.16–0.39), and 0.41 (95% CI: 0.30–0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I2 = 20%, TH BMD) to substantial (I2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur. 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

Impact of lifestyle and clinical factors on the prognosis of tennis elbow. Zhang, C., Jia, Z., Li, J., Wang, X. and Yang, S. (2024) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Lateral epicondylalgia – NSAIDs and CSI This prospective case-control study attempted to identify prognostic factors for recovery from common extensor origin tendinopathy. The study included 265, of which 53 underwent surgery and 212 did not. The results showed that smoking, alcohol consumption, and frequent physical exercise increased the risk of surgery. In particular, heavy drinkers had a 3.74-fold higher risk, while smokers had a 4.2-fold higher risk of needing surgery. In terms of conservative treatment, the combination of oral NSAIDs and local corticosteroid injections significantly reduce the need for surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, risk factors for surgical intervention for tennis elbow include smoking and high levels of alcohol consumption as well as frequent physical exercise. Protective factors included the combination of oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections. This last finding is in contrast with previous research , and it may be best to discuss with patients the lack of certainty regarding the benefits/side effects of CSI for lateral epicondylalgia. It may be valuble to remind patients that cortisone injections appear to have a similar effect to a saline injection when combined with exercise . URL : https://doi.org/10.1038/s41598-024-53669-x Abstract Tennis elbow (lateral epicondylitis) typically responds well to conservative treatment, and few patients require surgical intervention. This study aimed to investigate the influence of lifestyle and clinical factors on the prognosis of tennis elbow. This prospective, multicenter, nested case–control study included patients diagnosed with lateral epicondylitis after excluding other conditions. Patients who required surgery because of inadequate improvement after 6 months of conservative treatment were defined as the case group; the remaining patients constituted the control group. Propensity score matching was performed to eliminate baseline differences. Univariate and multivariate analyses were performed using logistic regression. This study included 265 patients (53 in the case group, 212 in the control group). Multivariate analysis revealed that smoking, alcohol consumption, and frequent physical exercise were independent risk factors for surgical intervention, whereas combined treatment with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections was a protective factor against surgery. Subgroup analysis showed that heavy drinkers had a 3.74-fold higher risk of requiring surgical treatment within 1 year than occasional drinkers. Smoking and alcohol consumption were associated with non-operative treatment failure in patients with lateral epicondylitis. Combining oral NSAIDs and corticosteroid injections is a favorable conservative treatment option. 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

Diagnosis, prevention and treatment of common shoulder injuries in sport: Grading the evidence - A statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Liaghat, B., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Preventative, Therapeutic Topic : Shoulder injury - Prevention This statement paper provided a comprehensive review on prevention strategies and treatment of common shoulder injuries in sports. The authors found that injury prevention programs, including The Oslo Sports Trauma Research Center Shoulder Injury Prevention Programme and FIFA11+ , showed moderate to large effects. Treatment involving rehabilitation programs with various exercises reduced pain and disability. The quality of evidence often ranged from very low to moderate, indicating that further high-quality research is needed to refine clinical recommendations. 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, implementing preventative programs like the Oslo Sports Trauma Research Center and FIFA11+ shoulder exercises (see links in text above) can significantly reduce the risk of shoulder injuries. These programs have demonstrated moderate to large effect sizes. In terms of treatment, active rehabilitation incorporating stretching, and strengthening exercises provide pain relief and improve disability. If you are interested in risk factors for upper limb injury in baseball, have a look at this synopsis . URL : https://doi.org/10.1136/bjsports-2022-105674 Abstract This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C-40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for clinical practice. 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

Effectiveness of proprioceptive neuromuscular facilitation therapy and strength training among post-menopausal women with thumb carpometacarpal osteoarthritis. A randomized trial. Campos-Villegas, C., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Resistance training This randomised controlled study explored the effectiveness of strength training combined with proprioceptive neuromuscular facilitation (PNF) vs strength training alone in managing thumb cmcj osteoarthritis in post-menopausal women. A total of 42 participants were included in this study and they were randomised into two groups: one receiving strength training alone (n=21) and the other receiving strength training plus PNF (n=21). Participants attended sessions three times a week for four weeks. The findings revealed that both groups showed significant improvements in disability. However, the strength training plus PNF group presented with greater improvements in pain, range of movement, and strength. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a strength training regimen plus or minus proprioceptive neuromuscular facilitation leads to positive improvements in disability, pain, and strength in people with symptomatic thumb cmcj. There is a growing body of evidence suggesting that resistance training is beneficial for symptomatic hand osteoarthritis and in contrast to what we used to think in the past, splinting for thumb OA does not appear to be necessary but it could be utilised in a multimodal approach . URL : https://doi.org/10.1016/j.jht.2022.07.005 Abstract Background: Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life. Purpose: Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength. Study Design: Superiority randomized clinical trial. Methods 42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks). Results: Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P <.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P <.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P <.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P = .003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P = .024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P = .003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P = .049; d = 0.62). These improvements were maintained at follow-up. Conclusions: The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength. 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

Clinical and ultrasonographic effectiveness of two different splints used for the treatment of lateral epicondylitis: A prospective randomized controlled study. Songur, K., Demir, Z. D., Baysan, C. and Dilek, B. (2024) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – Counterforce brace vs wrist splint This randomized controlled study assesses the clinical and ultrasonographic effectiveness of two splints for people with lateral epicondylalgia. In particular, a counterforce brace and a wrist splint were compared. A total of 159 participants diagnosed with unilateral LE were included in the study. Participants were randomised into three groups: counterforce brace, wrist splint, or an education-only group. Participants' tendon thickness was measured at baseline and after six weeks. The results showed that over course of 6 weeks, the counterforce and wrist splint groups exhibited significant improvements in the Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, pain, hand grip strength, and pain sensitivity compared to the education-only group, which only showed minor improvements. Among the two splints, the counterforce brace showed superior benefits on hand grip strength and patient satisfaction. Ultrasonographic parameters, such as maximum tendon thickness did not show significant differences between splint groups and the education-only approach. 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, both a counterforce brace and a wrist splint appear to be an effective treatment options for individuals with lateral epicondylitis (LE) over six weeks. The counterforce brace seemed to perform slightly better than the wrist splint, however, recent evidence suggests that the addition of splinting to a multimodal approach does not provide significant differences . That being said, if you or the patients wanted a splint for LE, a counterforce brace may be more appropriate than a wrist splint . URL : https://doi.org/10.1016/j.apmr.2023.12.010 Abstract Objective: This study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). Design: Randomized controlled single-blind trial. Setting: Outpatient clinic. Participants: 159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). Interventions: One group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. Main Outcome Measures: The primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. Results: Participants’ mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). Conclusion: Using either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial. Tveter, A. T., et al. (2023) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Usual vs multimodal care This multicentre randomised controlled study evaluated the cost-effectiveness of a 3-month multimodal occupational therapy intervention for patients with thumb carpometacarpal osteoarthritis (CMC1 OA) compared to usual care. The study was conducted across three rheumatology departments in Norway. A total of 180 patients were randomly assigned to receive either the multimodal therapy including patient education, hand exercises, assistive devices, and thumb splinting or usual care. Over a 2-year follow-up, patients in the intervention group gained more quality-adjusted life-years and €1151 were saved in direct costs compared to the control group. The graph below provides you a visual representation of the multimodal approach compared to usual care. 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, multimodal interventions, including patient education, hand exercises, assistive devices, and splinting are cost-effective for managing thumb cmcj OA over a 2-year period. This is inline with previous research on combined interventions for thumb OA, even though the effectiveness of interventions like splinting remains debatable . Thus, integrating these conservative therapies into routine care for thumb OA is recommended to enhance patient outcomes within a cost-effective framework. It appears to be important for people with hand OA to do activities with their hands that they find meaningful (e.g. knitting ) as this does not appear to make their symptoms any worse. URL : https://doi.org/10.1136/bmjopen-2022-063103 Abstract Objective: The aim was to evaluate the cost-utility of a 3-month multimodal occupational therapy intervention in addition to usual care in patients with thumb carpometacarpal osteoarthritis (CMC1 OA). Methods: A cost-utility analysis was performed alongside a multicentre randomised controlled trial including three rheumatology departments in Norway. A total of 180 patients referred to surgical consultation due to CMC1 OA were randomised to either multimodal occupational therapy including patient education, hand exercises, assistive devices and orthoses (n=90), or usual care receiving only information on OA (n=90). The outcome measure was quality-adjusted life-years (QALYs) derived from the generic questionnaire EQ-5D-5L over a 2-year period. Resource use and health-related quality of life of the patients were prospectively collected at baseline, 4, 18 and 24 months. Costs were estimated by taking a healthcare and societal perspective. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis with 1000 replications following intention-to-treat principle was done to account for uncertainty in the analysis. Results: During the 2-year follow-up period, patients receiving multimodal occupational therapy gained 0.06 more QALYs than patients receiving usual care. The mean (SD) direct costs were €3227 (3546) in the intervention group and €4378 (5487) in the usual care group, mean difference €−1151 (95% CI −2564, 262). The intervention was the dominant treatment with a probability of 94.5% being cost-effective given the willingness-to-pay threshold of €27 500. Conclusions: The within-trial analysis demonstrated that the multimodal occupational therapy in addition to usual care was cost-effective at 2 years in patients with CMC1 OA.Trial registration number NCT01794754.Data are available upon reasonable request. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Multidisciplinary strategies to treat painful mononeuropathies in the upper extremity: from lab to bedside. Rijsdijk, M., Tuffaha, S. and Coert, J. H. (2024) Level of Evidence : 5 Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic, Therapeutic Topic : Entrapment neuropathies - Assessment and treatment This narrative review discussed the multidisciplinary approach to symptomatic entrapment neuropathies of the upper limb. The authors suggest an accurate diagnosis, which is based on a detailed history, identification of neuropathic pain, clinical signs, and imaging techniques. Moreover, they suggest differentiating amongst different pain types (e.g. nociceptive, nociplastic) to tailor treatment strategies, which would lead to a personalized pain treatment. They also highlight how a multidisciplinary approach is likely to enhance treatment outcomes compared to a single clinician approach. 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, integration of both conservative (medication, neuromodulation) and interventional therapies (nerve blocks, surgical techniques) may be useful for upper limb entrapment neuropathies. Despite the author suggesting that personalised treatment should be provided, there is limited evidence supporting the statement. There is however a fair amount of research suggesting that communication and collaboration across disciplines may help creating a cohesive treatment plan possibly leading to better outcomes. If you want to read more about neuropathic pain, have a look at the entire collection . URL : https://doi.org/10.1177/17531934241240389 Abstract Neuropathic pain in the upper extremity is a serious problem, commonly involving relatively young patients. The pain causes loss of function and productivity, changes a patient’s lifestyle and can progress into a chronic pain syndrome with secondary psychosocial co-morbidities. Treating patients with a painful mononeuropathy remains challenging, with a monodisciplinary approach often having limited treatment efficacy. This narrative review discusses how to deal with this challenge in the treatment of patients with peripheral nerve injury pain, addressing the four important pillars: (1) diagnosing a painful mononeuropathy; (2) clinical pain phenotyping; (3) personalized pain treatment; and (4) using a multidisciplinary team approach. 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

Resistance exercise minimal dose strategies for increasing muscle strength in the general population: An overview. Nuzzo, J. L., Pinto, M. D., Kirk, B. J. C. and Nosaka, K. (2024) Level of Evidence : 4 Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Resistance training - Exercise snacking This is a narrative review of strategies to enhance muscle strength in individuals with limited time. The authors suggest that minimalist strategies such as “Weekend Warrior,” single-set resistance, exercise “snacking”, and practicing the strength test are amongst interventions that take the least amount of time. Although these approaches typically fall short of recommended guidelines, they promote muscle strength and sometimes other health benefits. “Weekend Warrior” exercises are performed in a single weekly session, while single-set strategies involve one set of multiple exercises performed multiple times per week. Exercise snacking consists of short bouts of resistance exercise daily, and practicing the strength test involves one maximal repetition set multiple times per week. These methods appear to improve strength, especially the “Weekend Warrior” and single-set strategies, based on current evidence. Below you have a graphical representation of what these approaches may look like during the week. 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, minimal dose resistance exercise strategies have shown to improve muscle strength among individuals who are not currently engaged in any resistance training. Given that perceived lack of time is a major barrier to exercise participation, minimal dose strategies such as the "Weekend Warrior", single-set resistance exercise, and exercise "snacking" provide accessible and feasible options for busy individuals. These approaches, while not meeting standard exercise guidelines , can still yield meaningful health benefits and might serve as a practical starting point for broader engagement in physical fitness. Once again, it appears that most of the exercise benefits can be obtained with 20% effort . If you are struggling to get your patients to adhere to a home exercise program, limit your exercises to 2 or a maximum of three . URL : https://doi.org/10.1007/s40279-024-02009-0 Abstract Many individuals do not participate in resistance exercise, with perceived lack of time being a key barrier. Minimal dose strategies, which generally reduce weekly exercise volumes to less than recommended guidelines, might improve muscle strength with minimal time investment. However, minimal dose strategies and their effects on muscle strength are still unclear. Here our aims are to define and characterize minimal dose resistance exercise strategies and summarize their effects on muscle strength in individuals who are not currently engaged in resistance exercise. The minimal dose strategies overviewed were: “Weekend Warrior,” single-set resistance exercise, resistance exercise “snacking,” practicing the strength test, and eccentric minimal doses. “Weekend Warrior,” which minimizes training frequency, is resistance exercise performed in one weekly session. Single-set resistance exercise, which minimizes set number and session duration, is one set of multiple exercises performed multiple times per week. “Snacks,” which minimize exercise number and session duration, are brief bouts (few minutes) of resistance exercise performed once or more daily. Practicing the strength test, which minimizes repetition number and session duration, is one maximal repetition performed in one or more sets, multiple days per week. Eccentric minimal doses, which eliminate or minimize concentric phase muscle actions, are low weekly volumes of submaximal or maximal eccentric-only repetitions. All approaches increase muscle strength, and some approaches improve other outcomes of health and fitness. “Weekend Warrior” and single-set resistance exercise are the approaches most strongly supported by current research, while snacking and eccentric minimal doses are emerging concepts with promising results. Public health programs can promote small volumes of resistance exercise as being better for muscle strength than no resistance exercise at all. 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

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

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

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

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