Search Results

Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions: A scoping review and mapping exercise. Chester, R., et al. (2023) Level of Evidence : 3a Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Exercise completion - Useful strategies This is a scoping review that aims to identify behaviour change techniques (BCTs) utilised to improve home exercise adherence for people with musculoskeletal conditions. The study found that a range of BCTs such as goal setting, self-monitoring, feedback, and social support were useful in helping patients complete their exercises. In the picture below, the authors highlighted steps that can be taken to help somebody with knee osteoarthritis improve the exercise completion rate. Similar steps can be taken to help patients with hand and upper limb conditions complete their exercise programmes. 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, self-efficacy, social support and task appreciation are the most important determinants of home exercise adherence and self-management in musculoskeletal conditions. This study is a nice addition to previous research showing that a maximum of 2-3 exercises boost treatment compliance in patients . URL : https://doi.org/10.1016/j.msksp.2023.102776 Abstract Background: Many patients with musculoskeletal problems do not adhere to home exercises or self-management advice provided by physiotherapists. This is due to numerus factors, many of which can be targeted by Behaviour Change Techniques. Objectives 1) Undertake a scoping review to identify the modifiable determinants (barriers and facilitators) of home exercise adherence and self-management for the physiotherapy management of people with musculoskeletal problems and map them to the Theoretical Domains Framework and Behaviour Change Techniques. 2) For determinants with supporting evidence from ≥2 studies, provide examples of Behaviour Change Techniques for clinical practice. Design: This review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Method: Four electronic databases were searched from inception to December 2022. Two independent reviewers carried out manuscript selection, data extraction, quality assessment, and mapping, the latter using the Theory and Techniques Tool. Results: Thirteen modifiable determinants were identified in 28 studies. The most frequently identified were self-efficacy, social support, and task appreciation. Determinants were mapped to 7 of 14 Theoretical Domains Framework categories, which in turn mapped onto 42 of 93 Behaviour Change Techniques, the most common being problem solving and instruction on how to perform behaviour. Conclusions: By identifying determinants to home exercise adherence and self-management and mapping these to Behaviour Change Techniques, this review has improved understanding of their selection, targeting, and potential application to musculoskeletal physiotherapy practice. This provides support for physiotherapists targeting the determinants of importance for the patient in front of them. 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

Misdiagnosis in Amyotrophic Lateral Sclerosis. Thomson, C. G., Hutchinson, P. R. and Stern, P. J. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic Topic : Amyotrophic Lateral Sclerosis - Diagnosis This is an expert opinion on how to avoid missing Amyotrophic Lateral Sclerosis (ALS) in patients presenting with symptoms mimicking an entrapment neuropathy. Thus, the authors indicate how symptoms of ALS can mimic those of compressive neuropathies, such as carpal or cubital tunnel syndromes. Clinicians should maintain a heightened awareness of ALS and consider red flag symptoms such as the absence of sensory symptoms, profound weakness and atrophy in multiple body regions, progressively global symptoms over time, presence of fasciculations/twitching and bulbar symptoms when assessing their patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical take home message : Based on what we know today, we should be aware of the signs and symptoms of ALS, as it can easily be misdiagnosed as compression neuropathy. If any of the red flags listed above are present, and we are unable to reproduce symptoms with common orthopaedic tests, we should consider other differential diagnoses and possibly refer the patient to a specialist. Have a look at other interesting cases of uncommon entrapment neuropathies of the musculocutaneous , median and ulnar nerve s . URL : https://doi.org/10.1016/j.jhsa.2023.03.023 Abstract The symptoms of amyotrophic lateral sclerosis (ALS) can mimic those of compressive neuropathies, such as carpal and cubital tunnel syndromes, especially early in a patient?s clinical course. We surveyed members of the American Society for Surgery of the Hand and found that 11% of active and retired members have performed nerve decompression surgeries on patients later diagnosed with ALS. Hand surgeons are commonly the first providers to evaluate patients with undiagnosed ALS. As such, it is important to be aware of the history, signs, and symptoms of ALS to provide an accurate diagnosis and prevent unnecessary morbidities, such as nerve decompression surgery, which invariably results in poor outcomes. The major ?red flag? symptoms warranting further work-up include weakness without sensory symptoms, profound weakness and atrophy in multiple nerve distributions, progressively bilateral and global symptoms, presence of bulbar symptoms (such as tongue fasciculations and speech/swallowing difficulties), and, if surgery is performed, failure to improve. If any of these red flags are present, we recommend neurodiagnostic testing and prompt referral to a neurologist for further work-up and 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

Non-or minimally displaced distal radial fractures in adult patients: three weeks versus five weeks of cast immobilization: A randomized controlled trial. Bentohami, A., et al. (2019). Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Distal radius fracture – Conservative management This randomised controlled study compared the effects of 3 vs 5 weeks of cast immobilisation in people with non- or minimally displaced distal radial fractures. A total of 72 patients were included in the study, with 7 lost to follow-up at one year. Only patients with unilateral stable and minimally displaced fractures were included in the study. QuickDASH was measured at follow-up only. Several patients did not complete this outcome at 12 months, which reduces the strength of the study. Results showed 3 weeks of cast immobilisation led to similar outcomes in function and complications compared to 5 weeks of immobilisation. 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, immobilising adults with a non- or minimally displaced distal radial fractures for 3 weeks appears to be safe. From a functional point of view, it provides similar benefits to a 5 weeks immobilisation. Shortening the immobilisation duration may be particularly appropriate in those patients that are at greater risk of developing CRPS . If you are interested in CRPS or distal radius fracture , have a look at the relative databases. URL : https://doi.org/10.1055/s-0038-1668155 Abstract Background: Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome. Purpose: We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks. Materials and Methods: The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement. Results: Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p  = 0.045) and QuickDASH scores (0.0 vs. 12.5, p  = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups ( p  = 0.46). Conclusion: Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning. 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

Exploring the role of artificial intelligence chatbot on the management of scaphoid fractures. Seth, I., Lim, B., Xie, Y., Hunter-Smith, D. J. and Rozen, W. M. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Therapeutic Topic : ChatGPT scaphoid management – Information for patients This study investigated the potential of ChatGPT in assisting in the management of scaphoid fractures. A series of prompts such as "In 300 words, what is the most appropriate treatment for scaphoid fracture management?" were provided to ChatGPT and a series of hand surgeons and specialist assessed the quality of the response. The specialists also assessed adherence to guidelines, complexity of language, management for different patient populations, consistency of recommendations and quality of evidence. The results showed that ChatGPT provided a basic correct management description. 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, artificial intelligence (e.g. ChatGPT) has the potential to provide useful information to patients who have been diagnosed with a scaphoid fracture. For the most part, ChatGPT appears to provide responses which adhere to guidelines and use appropriate language complexity. Despite these positive findings it is important to remember that it is still early days and responses can be inaccurate in some instances. Another important thing to be aware of is that ChatGPT hallucinates when you ask them for scientific reference. In other words, it makes up references that have never been published. If you want to read more about how AI is affecting the field of hand therapy, read this synopsis . URL : https://doi.org/10.1177/17531934231169858 Abstract not available 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 pain in the uninjured arm associated with unhelpful thoughts and distress regarding symptoms during recovery from upper-extremity injury? Romere, C., et al. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Uninjured hand - Increased use and pain This is a cross-sectional study assessing the association between unhelpful thinking and pain intensity in the uninjured arm in people who have had an isolated unilateral upper-extremity injury. A total of 141 adult participants were included in the present study. The results showed that greater pain intensity in both the uninjured and injured arms was independently associated with greater unhelpful thinking regarding symptoms. Additionally, greater self-efficacy was independently associated with better pain-coping mechanisms. 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, pain intensity in the uninjured arm during recovery from upper-extremity injury is associated with unhelpful thinking regarding symptoms. If patients complain of contralateral pain, we should not only assess the uninjured limb but also consider whether they present with unhelpful thinking regarding their symptoms. Additionally, interventions such as mindfulness meditation , cognitive behavioural therapy, physical activity , and relaxation strategies can be effective in improving pain and coping in patients with musculoskeletal injuries. URL : https://doi.org/10.1016/j.jhsa.2023.03.019 Abstract Purpose: During recovery from upper-extremity injury, patients sometimes express concerns regarding pain associated with increased use of the uninjured limb. Concerns about discomfort associated with increased use may represent a manifestation of unhelpful thoughts such as catastrophic thinking or kinesiophobia. We asked the following questions: (1) Among people recovering from an isolated unilateral upper-extremity injury, is pain intensity in the uninjured arm associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Is pain intensity in the injured extremity, magnitude of capability, or accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms? Methods: In this cross-sectional study of new or returning patients presenting to a musculoskeletal specialist for care for an upper-extremity injury, the patients completed scales that were used to measure the following: pain intensity in the uninjured arm, pain intensity in the injured arm, upper-extremity–specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis was used to evaluate factors associated with pain intensity in the uninjured arm, pain intensity in the injured arm, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors. Results: Greater pain intensity in both uninjured and injured arms was independently associated with greater unhelpful thinking regarding symptoms. A greater magnitude of capability and pain accommodation were independently associated with less unhelpful thinking regarding symptoms. Conclusions: Given that greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking, clinicians can be attuned to patient concerns about contralateral pain. Clinicians can facilitate recovery from upper-extremity injury by evaluating the uninjured limb as well as identifying and ameliorating unhelpful thinking regarding symptoms. 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

Relative motion orthoses for early active motion after finger extensor and flexor tendon repairs: A systematic review. Shaw, A. V., Verma, Y., Tucker, S., Jain, A. and Furniss, D. (2023) Level of Evidence : 2a Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Relative motion extension/flexion splint - Do we have enough evidence This systematic review assessed the use of relative motion (RM) orthoses for early active motion after finger extensor and flexor tendon repairs. A total of ten studies were included in the review. The modified cochrane risk of bias tool was utilised to assess study quality. The results showed that there were more studies available for the use of RM in extensor compared to flexor tendon repair. The findings support the use of RM splinting for zone V and VI extensor, however, there is still limited evidence for their use in extensor zone IV and VIII as well as flexors zone I and II. 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 relative motion (RM) splint can be used with confidence for zone V and VI extensor tendon repair. However, there is still not enough evidence to support their use for extensor zone IV and VII or flexor tendon repairs. The findings from this review are consistent with what has been previously shown . URL : https://doi.org/10.1016/j.jht.2023.02.011 Abstract BACKGROUND: The relative motion (RM) orthosis was introduced over 40 years ago for extensor tendon rehabilitation and more recently applied to flexor tendon repairs. PURPOSE: We systematically reviewed the evidence for RM orthoses following surgical repair of finger extensor and flexor tendon injuries including indications for use, configuration and schedule of orthosis wear, and clinical outcomes. STUDY DESIGN: Systematic review. METHODS: A PRISMA-compliant systematic review searched eight databases and five trial registries, from database inception to January 7, 2022. The protocol was registered prospectively (CRD42020211579). We identified studies describing patients undergoing rehabilitation using RM orthoses after surgical repair of acute tendon injuries of the finger and hand. RESULTS: For extensor tendon repairs, ten studies, one trial registry and five conference abstracts met inclusion criteria, reporting outcomes of 521 patients with injuries in zones IV-VII. Miller's criteria were predominantly used to report range of motion; with 89.6% and 86.9% reporting good or excellent outcomes for extension lag and flexion deficit, respectively. For flexor tendon repairs, one retrospective case series was included reporting outcomes in eight patients following zones I-II repairs. Mean total active motion was 86%. No tendon ruptures were reported due to the orthosis not protecting the repair for either the RME or RMF approaches. DISCUSSION: Variation was seen in use of RME plus or only, use of night orthoses and orthotic wear schedules, which may be the result of evolution of the RM approach. Since Hirth et al's 2016 scoping review, there are five additional studies, including two RCTs reporting the use of the RM orthosis in extensor tendon rehabilitation. CONCLUSIONS: There is now good evidence that the RM approach is safe in zones V-VI extensor tendon repairs. Limited evidence currently exists for zones IV and VII extensor and for flexor tendon repairs. Further high-quality clinical studies are needed to demonstrate its safety and efficacy. 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

Patient-perceived outcomes of recovery after trigger digit release. Blazar, P. E., et al. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Prognostic Topic : Trigger finger surgery - How long does it take to recover? This was a prospective study assessing recovery time for patients recovering from trigger finger release (TFR) surgery. A total of 50 patients were included in the study, with 27 excluded for lack of follow-up. Patients completed a visual analogue scale (VAS) for pain and the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) to assess baseline pain and function respectively before surgery. In addition, patients were asked when they felt they had "fully recovered". The results showed that the mean time to full recovery was 6 months. Both the VAS and QuickDASH improved to a clinically relevant level at 6 weeks and 3 months. Eight per cent of patients did not feel fully recovered one year after the procedure, and these patients had higher preoperative QuickDASH and VAS pain scores. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, patients may take longer to feel fully recovered after trigger finger release (TFR) than expected. We should be aware of the discrepancy between what surgeons suggest and what patients expect during their recovery. On average, it takes 6 months for people to feel fully recovered after TFR. If you are interested in trigger finger pathophysiology, you could read about the adhesions between flexor tendons contributing to this pathology . If you want further information about this pathology, have a look at the full database on trigger finger . URL : https://doi.org/10.1016/j.jhsa.2023.03.016 Abstract Purpose: Trigger finger release (TFR) is one of the most commonly performed hand surgeries; nevertheless, the time until patients subjectively feel recovered has not been well documented. The limited literature on patient perceptions of recovery after any type of surgery has described that patients and surgeons may have differing views on the time until full recovery. Our primary study question was to determine how long it takes for patients to subjectively feel fully recovered after TFR. Methods: In this prospective study, patients who underwent isolated TFR completed questionnaires before surgery and at multiple time points following surgery until they reported full recovery. Patients completed visual analog scale (VAS) pain scores and Quick DASH (Disabilities of the Arm, Shoulder, and Hand) and were asked if they felt fully recovered at 4 weeks, 6 weeks, and 3, 6, 9, and 12 months. Results: The average time to self-reported full recovery was 6.2 months (SD 2.6), and the median time to self-reported full recovery was 6 months (IQR 4 months). At 12 months, four out of 50 patients (8%) did not feel fully recovered. Quick DASH and VAS pain scores improved significantly from preoperative assessment to final follow-up. All patients reported improvement in both VAS pain scores and Quick DASH scores greater than the minimal clinically important difference between 6 weeks and 3 months after surgery. Higher preoperative VAS and Quick DASH scores were associated with failure to fully recover by 12 months after surgery. Conclusions: The length of time after surgery until patients felt fully recovered after isolated TFR is longer than the senior authors’ expectations. This suggests that patients and surgeons may consider distinctly different parameters when discussing recovery. Surgeons should be aware of this discrepancy when discussing recovery after surgery. 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 influencing patient experience after cubital tunnel syndrome surgery. Paramsewaran, P., et al. (2021) Level of Evidence : 4 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Cubital tunnel syndrome - Pre-surgical education This is a qualitative study investigating the experiences of patients undergoing cubital tunnel surgery. A total of 17 participants took part in the study. All of them underwent a semistructured interview to explore their experiences. The results showed that preoperative education and counseling was important to set expectations and providing detailed information about the surgery and recovery process. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials. They also emphasised the importance of surgeon-to-patient education and noted gaps in preoperative education. Overall, the authors suggested that greater emphasis should be placed on preoperative communication to increase patients' satisfaction. 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, communication and expectation management are key components of patient care prior to cubital tunnel surgery. Useful information would include incision size and recovery timeframes. A blend of written materials, videos, online resources, and in-person discussions would ensure that patients have a clear understanding of what to expect from the procedure. Prior to undergoing surgery, a trial of conservative treatment is required as it appears to provide patients with significant symptom relief . URL : https://doi.org/10.1016/j.jhsa.2023.03.012 Abstract Purpose: The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care. Methods: Patients who underwent surgery ( in situ decompression or anterior transposition) for cubital tunnel syndrome within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding “their experiences with ulnar nerve surgery.” An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved. Results: Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials, and setting expectations for symptom resolution. Conclusions: Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery. 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 a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study. Tran, T., Harris, C. and Ciccarelli, M. (2021) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : Lateral epicondylalgia – Personalise work-based advice This randomised controlled study, investigated the effectiveness of a hand therapy program for tennis elbow. A total of 49 participants were randomly allocated to either the intervention or control group. The intervention group received the same program as the control group but also received an additional 30-minute session, within the first 4 weeks, which was a tailored workplace-based educational intervention. Both groups received a hand therapy program consisting of 10 sessions of 1 hour each over 12 weeks. The hand therapy programme included the prescription of orthoses, the application of heat packs, soft tissue massage, static wrist flexion/extension stretches, and an eccentric strengthening exercise program. Outcome measures included pain level, pain-free grip strength, and upper limb function. The results showed that there was no difference between the two groups. 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, adding a short and personalised educational session for the patient's workplace does not appear to have a large effect in terms of pain, function, or grip strength in people with lateral epicondylalgia. However, a multimodal approach including the provision of orthoses , stretching , and resistance exercises appears to provide some benefits. In addition to these interventions, mobilisation with movement may allow patients with tennis elbow to exercise with less pain in the initial stages of the presentation. URL : https://doi.org/10.1016/j.jht.2021.09.004 Abstract Background: Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients’ work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. Purposes: First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. Study Design: A randomized controlled trial. Methods: Forty-nine participants were randomized to the control group (n = 25) or intervention group (n = 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, “Working Hands-ED,” delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. Results: There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). Conclusion: The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace. 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

Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture. Kim, J. K., Al-Dhafer, B., Shin, Y. H. and Joo, H. S. (2021) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Symptoms prevalence study Topic : Client's expectations - Distal radius fracture This prospective cohort study assessed the effect of pre-treatment expectations on post-treatment expectation and outcomes in patients with a distal radius fractures. A total of 114 patients were enrolled, 81 of whom underwent surgical treatment and 33 who were managed conservatively. Expectations were measured in all participants prior to the delivery of the intervention. Outcomes measures were re-assessed at 1-year post injury. Results showed that the surgical group had a significantly higher median pre-treatment expectation score than the conservative group. In addition, higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score and better function in the surgical group. There was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment or function in the conservative group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, pre-treatment expectations may have a moderate effect on post-treatment expectation fulfilment and patient-rated outcomes in surgically treated patients with distal radius fractures. These findings are similar to what has been shown in previous evidence for the conservative treatment of hand OA and outcomes of neurodynamic tests . URL : https://doi.org/10.1016/j.jht.2021.04.023 Abstract Background: The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures. Purpose: The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs). Study design: Prospective cohort study Methods: For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire. Results: The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance. Conclusions: In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group. 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 early mobilization after volar locking plate fixation in distal radius fractures really beneficial? A meta-analysis of prospective randomized studies. Lee, J.-K., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Radius fracture ORIF – Early mobilisation This is a meta-analysis comparing clinical outcomes and complications of early and late range of motion exercises distal radius fractures (DRF) ORIF. A total of four randomized prospective studies were included in the analysis, including 127 patients in the early group and 131 patients in the late group. Outcomes included pain, range of movement, grip strength, and Disability of the Arm, Shoulder, and Hand. The results showed that the early mobilisation group had a lower DASH score at 6 weeks as well as 3 months postoperatively. In addition, grip strength and range of movement were greater in the early movement group. The difference between groups was clinically relevant for all these outcomes. Pain was not different between groups at any time point. There were no differences in complication rate between the two groups. 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, early mobilisation after distal radius fracture ORIF is associated with improved function, range of motion, and grip power at 6 weeks, 3 months, and 6 months postoperatively. In addition, early mobilisation is not associated with a greater complication rate. As previous evidence shows, early exercise is safe and does not increase complication rates, and may lead to an earlier return to daily life and work . URL : https://doi.org/10.1016/j.jht.2021.10.003 Abstract Study design: This was a systematic review with a meta-analysis. Introduction Despite rising trends toward surgical treatment of distal radius fractures (DRF) with volar locking plate (VLP) fixation, there is a lack of consensus on when to start vigorous wrist range of motion (ROM) exercises after surgery. Purpose We performed a meta-analysis to compare early and late mobilization after VLP fixation in patients with DRF. Methods: Four prospective randomized controlled trials with a minimum of 6 months of follow-up were retrieved through MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library, and the KoreaMed databases in March 2021. We divided patients into an early group (patients who started ROM exercises of the wrist within 2 weeks after surgery), and a late group (patients who started ROM exercises 5 or 6 weeks after surgery). The primary outcome was treatment efficacy which was measured through improvement in pain score, function score, ROM, and grip power. The secondary outcome was the incidence of postoperative complications. Results: This meta-analysis included 127 patients in the early group and 131 patients in the late group. The outcomes were compared at 6 weeks, 3 months, and 6 months postoperatively. There was no significant difference in pain score, though the early group had a lower average visual analog scale score. The early group had a lower arm, shoulder, and hand disability score than the late group (95 % CI, -16.25 to -8.35 points; P < .001) at 6 weeks postoperatively, suggesting significantly superior outcomes. A similar trend persisted at 3 (n = 74 in the early group and n = 77 in the late group; 95% CI, -5.45 to -0.30; P = .029) and 6 months (n = 102 in the early group and n = 100 in the late group; 95% CI, -4.81 to 0.21; P = .073), but the differences were smaller. The early group had a higher grip power at all follow-up periods, but the difference was only significant at 6 months postoperatively (n = 88 in the early group and n = 83 in the late group; 95% CI, 0.50 to 6.99; P = 0.024). The early group also had more favorable ROM in all directions at 6 weeks, but only in supination at 6 months. The complication rate was not significantly different between the 2 groups. There were no differences in the rates of secondary operation and reduction loss. Conclusion: Early ROM exercise after VLP in DRF resulted in superior functional scores and grip power until 6 months postoperatively. The dominance of the joint ROM, which was seen at 6 weeks after surgery in the early exercise group, decreased with time and ultimately showed little difference at 6 months. Early exercise is safe and did not increase complication rates. 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 supination/flexion to hyperpronation in the reduction of radial head subluxations. Macias, C. G., Bothner, J. and Wiebe, R. (1998) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Pulled elbow - Treatment This is a randomised controlled study comparing two techniques for reducing radial head subluxations in children. A total of 85 patients were included in the study, with 41 randomly assigned to the hyperpronation technique and 44 to the supination technique. Children presenting with bruising or evidence of fractures on x-ray were excluded from the study. The results showed that the hyperpronation technique (see below) was more successful, with 95% of patients reduced on the first attempt compared to 77% for the supination technique. The hyperpronation technique also required fewer attempts to reduce the subluxations, with 97.5% of patients in the hyperpronation group being reduced successfully compared to 86% in the supination group. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, we should consider using the hyperpronation technique as a primary technique for reducing radial head subluxations in children. This intervention is more successful on the first attempt and requires fewer attempts at reduction compared to the traditional supination technique. This technique should be performed solely if the x-ray is negative for fractures and no other pathologies explain the presentation. URL : https://doi.org/10.1542/peds.102.1.e10 Abstract Objective: To compare supination at the wrist followed by flexion at the elbow (the traditional reduction technique) to hyperpronation at the wrist in the reduction of radial head subluxations (nursemaid's elbow). Materials and Methods: This prospective, randomized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two suburban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation. Patients were randomized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function. The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt. Failure of that technique 30 minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction. The alternate procedure was repeated if baseline functioning did not return 15 minutes after the alternate procedure was attempted. If the patient failed both techniques, radio-graphy of the elbow was performed. Results: A total of 90 patients were enrolled in the study. Five patients were removed from further analysis secondary to a final diagnosis of fracture, 84 were reduced successfully, and 1 failed both techniques. Demographic characteristics of each group were similar. Thirty-nine of 41 patients (95%) randomized to hyper-pronation were reduced successfully on the first attempt versus 34 of 44 patients (77%) randomized to supination. Two patients in the hyperpronation group required two attempts versus 10 patients in the supination group. Hyperpronation was more successful; 40 of 41 patients (97.5%) in the hyperpronation group were reduced successfully versus 38 of 44 patients (86%) in the supination group. Of the 6 patients who crossed over from supination to hyperpronation, 5 were reduced on the first attempt and 1 was reduced on the second attempt. Conclusions: In the reduction of radial head subluxations, the hyperpronation technique required fewer attempts at reduction compared with supination, was successful more often than supination, and was often successful when supination failed. 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