Search Results

Predicting clinically relevant patient-reported symptom improvement after carpal tunnel release: A machine learning approach. Hoogendam, L., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Carpal tunnel release - Prognostic model This is a machine learning study aiming to develop and validate a prediction model to determine who would report a clinical relevant improvement at six months post carpal tunnel release. A total of 2,119 participants were included in the study. Participants defined as responders to surgery were those who reported a reduction of 0.8 points out of 5 (20% improvement) on the Boston Carpal Tunnel Questionnaire (BCTQ) at six months post carpal tunnel release. Variables utilised as predictors included the baseline BCTQ score, hand function (VAS), treatment expectations, and depression. The results showed that the prediction model, which is available as a free online tool , had a moderate ability to discriminate who would benefit from carpal tunnel release at six months. This model performed equally well when it was validated on another group of patients (n = 397) whose data was not utilised to develop the model. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, this online tool may help predict whether surgery for carpal tunnel syndrome is likely to improve our clients' symptoms at six months. Currently, conservative interventions for carpal tunnel syndrome, which appear to be backed by evidence, include cortisone injections , and/or a combination of education, exercise, and night splinting . If you would like to know who is more likely to respond to a cortisone injection for carpal tunnel syndrome read this synopsis . Alternatively, you can have a look at the whole CTS database . URL : https://doi.org/10.1227/neu.0000000000001749 Abstract BACKGROUND: Symptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering a carpal tunnel release (CTR). OBJECTIVE: To predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR. METHODS: We split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire-symptom severity scale were classified as "improved." Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397). RESULTS: A gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81. CONCLUSION: We developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

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

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

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

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

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

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

Association of burden and prevalence of arthritis with disparities in social risk factors, findings from 17 us states. Rethorn, Z. D., et al. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Symptoms prevalence Topic : Social risk factors - Arthritis burden This is a retrospective study assessing the effect of cumulative social risk factors and arthritis burden. A total of 136,432 participants presenting with arthritis (i.e. osteoarthritis, rheumatoid arthritis, lupus, gout, or fibromyalgia) were included in the study. The social risk factors assessed were health care access hardship, unsafe neighbourhoods, and insecurity related to housing, financial status, and food. Arthritis burden was assessed based on joint pain, and activity/work limitations. The results showed that the odds of presenting with greater arthritis burden increased with the number of social risk factors. In other words, greater social insecurity was associated with greater pain. To give some clinical context, severe joint pain was present in more than 30% of people with 4 social risk factors compared to less than 20% in people with only one social risk factor (see figure below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, social risk factors are associated with the arthritis burden. More specifically, the greater the number of social risk factors (e.g. financial insecurity), the greater the odds of having severe joint pain or disability. This is consistent with previous research showing that social deprivation has negative effects on the recovery of people with flexor tendon repair . In addition to social deprivation, we know that psychological factors (e.g. kinesiophobia) are associated with upper limb disability . This is why a biopsychosocial approach is useful in the treatment of our clients. Open Access URL : http://dx.doi.org/10.5888/pcd19.210277 Abstract INTRODUCTION: Social risks previously have been associated with arthritis prevalence and costs. Although social risks often cluster among individuals, no studies have examined associations between multiple social risks within the same individual. Our objective was to determine the association between individual and multiple social risks and the prevalence and burden of arthritis by using a representative sample of adults in 17 US states. METHODS: Data are from the 2017 Behavioral Risk Factor Surveillance System. Respondents were 136,432 adults. Social risk factors were food insecurity, housing insecurity, financial insecurity, unsafe neighborhoods, and health care access hardship. Weighted χ(2) and logistic regression analyses, controlling for demographic characteristics, measures of socioeconomic position, and other health conditions examined differences in arthritis prevalence and burden by social risk factor and by a social risk index created by summing the social risk factors. RESULTS: We observed a gradient in the prevalence and burden of arthritis. Compared with those reporting 0 social risk factors, respondents reporting 4 or more social risk factors were more likely to have arthritis (adjusted odds ratio [AOR], 1.92; 95% CI, 1.57-2.36) and report limited usual activities (AOR, 2.97; 95% CI, 2.20-4.02), limited work (AOR, 2.72; 95% CI, 2.06-3.60), limited social activities (AOR, 3.10; 95% CI, 2.26-4.26), and severe joint pain (AOR, 1.86; 95% CI, 1.44-2.41). CONCLUSION: Incremental increases in the number of social risk factors were independently associated with higher odds of arthritis and its burden. Intervention efforts should address the social context of US adults to improve health outcomes. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The impact of social deprivation and hand therapy attendance on range of motion after flexor tendon repair. Stonner, M. M., Keane, G., Berlet, L., Goldfarb, C. A. and Pet, M. A. (2022) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Flexor tendon repair - Effect of social deprivation This is a retrospective study assessing the effect of social deprivation in recovery following flexor tendon repairs zone I-III. A total of 109 participants with flexor tendon repair took part in the study. The outcome of interest was Strickland’s percentage of finger range of movement. Social deprivation was determined by participants' addresses. Social deprivation is calculated based on several factors (e.g. income, education - see figure below). Most participants presented with a zone II repair followed by zone I and III. The results showed that greater social deprivation was associated with worse range of movement recovery whilst controlling for other factors including the number of hand therapy sessions attended, age, and flexor tendon zone. To give some context, the least socially deprived group recovered 10% more range of movement compared to the most socially deprived group. Figure from The English Index of Multiple Deprivation (IMD) 2015 Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, our socially deprived clients are likely to get worse outcomes following a flexor tendon repair zone I-III . Encouraging our clients to attend our hand therapy sessions and explaining the potential benefits of doing so may be useful. Providing a maximum of two exercises may get our clients to buy into our recovery plan. URL : https://doi.org/10.1016/j.jhsa.2022.03.018 Abstract Purpose: To examine the influence of social deprivation and hand therapy attendance on active range of motion (AROM) outcomes following flexor tendon repair. Methods: We performed a retrospective analysis of patients who underwent primary zone I–III flexor tendon repair between November 2016 and November 2020. Area deprivation index (ADI) was used to quantify social deprivation. Medical record review determined each patient’s demographic characteristics, injury details, total hand therapy visits, and final AROM outcome. Active range of motion was converted to Strickland’s percentage for analysis. Spearman correlation and simple and multivariable linear regression models were used to assess relationships between explanatory variables and outcomes. Results: There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was associated with significantly decreased Strickland’s percentage. In the multivariable model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations with Strickland’s percentage. Conclusions: Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after flexor tendon repair. Social deprivation is likely to contribute to poor outcomes both by its association with decreased therapy attendance and by other potential pathways that make it difficult for deprived patients to achieve good surgical outcomes. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

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

A comparison of acute versus chronic thumb ulnar collateral ligament surgery using primary suture anchor repair and local soft tissue advancement. Delma, S., Ozdag, Y., Baylor, J. L., Grandizio, L. C. and Klena, J. C. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Thumb UCL mcpj - Delayed vs prompt surgery This is a retrospective study comparing outcomes of prompt vs delayed repair of ulnar collateral (UCL) ligament of the thumb mcpj at medium to long term follow-up (1-7 years). A total of 36 participants who had undergone UCL repair within 8 weeks of injury (n = 19) or who had surgery more than 8 weeks from injury (n =17) were included. Outcome measures included function (QuickDASH) and pain (visual analogue scale -VAS). The results showed that there was no difference in function or pain after surgery between the two groups. Unfortunately, the sample size of this study is small and baseline data for the outcome measures were not provided. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, thumb mcpj UCL repair in the acute or late stage provides similar results (1-7 years). Therefore, an 8 weeks trial of conservative treatment appears reasonable. Imaging (e.g. US, MRI) may be useful in identifying a Stener lesion, however, its accuracy has been questioned . On another note, the results of this study are similar to previous evidence assessing the effect of early vs delayed scapholunate repair . Open Access URL : https://doi.org/10.1016/j.jhsg.2022.02.008 Abstract Purpose: To assess patient satisfaction and functional outcomes of primary suture anchor repair with local soft tissue advancement for both acute and chronic thumb ulnar collateral ligament (UCL) injuries. Methods: We retrospectively reviewed patient charts who had undergone operative UCL repair between 2006 and 2013. Patients who had more than 8 weeks between the time of injury and surgery were classified as having chronic injuries. In both acute and chronic cases, a primary suture anchor repair of the ligament was performed with local soft tissue advancement. For each patient, baseline demographics, operative complications, and associated injuries were recorded along with visual analog scale pain scores; Quick Disabilities of the Arm, Shoulder, and Hand scores; and their return to work or sport status. Comparisons of outcomes and complications were made between the groups (acute vs chronic injuries). Results: Among the 36 patients who met our inclusion criteria, both the acute (n = 19) and chronic (n = 17) groups were similar with regards to major or minor comorbidities, visual analog scale scores; Quick Disabilities of the Arm, Shoulder, and Hand scores; return to work or sport status; or patient satisfaction. Conclusions: Patients with both acute and chronic thumb UCL injuries have similarly acceptable functional outcomes, postoperative pain, and satisfaction. Primary suture anchor repair without ligament reconstruction appears to be a safe and effective treatment option for patients’ thumb UCL injuries, even in the chronic setting. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A randomized controlled trial of topical cannabidiol for the treatment of thumb basal joint arthritis. Heineman, J. T., et al. (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Thumb osteoarthritis - Cannabidiol vs placebo This is a cross-over randomised double-blind, placebo controlled trial assessing the effectiveness of topical cannabidiol (cream) on pain and function in participants with thumb osteoarthritis (OA). Participants (N = 18) were included if they presented with clinical and radiological signs of 1st cmcj OA. Participants were excluded if they presented with other conditions including pulmonary, cardiac, or kidney disease. Pain was assessed through the VAS and function through the QuickDASH at baseline and after 2 weeks of cream use. Participants and treatment providers were blinded to treatment allocation. The placebo or experimental cream looked, smelled, and presented with the same consistency. The cream was applied twice daily. The results showed that participants in the experimental group improved to a statistical and clinically relevant level in pain (3/10 points difference between groups) but not to a clinically relevant level in the QuickDASH (see this synopsis for the clinically relevant threshold ). There were no side effects reported. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, topical cannabidiol (6.2 mg/ml) appears to be useful in reducing pain in clients with symptomatic thumb OA. Considering that other interventions such as splinting do not appear to be more effective than placebo , this therapeutic approach may provide useful in the future. URL : https://doi.org/10.1016/j.jhsa.2022.03.002 Abstract Purpose: Since the passage of the Agricultural Improvement Act of 2018, hand surgeons have increasingly encountered patients seeking counseling on over-the-counter, topical cannabidiol (CBD) for the treatment of pain. To this end, we designed a human clinical trial to investigate the therapeutic potential of CBD for the treatment of pain associated with thumb basal joint arthritis. Methods: Following Food and Drug Administration and institutional approval, a phase 1 skin test was completed with 10 healthy participants monitored for 1 week after twice-daily application of 1 mL of topical CBD (6.2 mg/mL) with shea butter. After no adverse events were identified, we proceeded with a phase 2, double-blinded, randomized controlled trial. Eighteen participants with symptomatic thumb basal joint arthritis were randomized to 2 weeks of twice-daily treatment with CBD (6.2 mg/mL CBD with shea butter) or shea butter alone, followed by a 1-week washout period and then crossover for 2 weeks with the other treatment. Safety data and physical examination measurements were obtained at baseline and after completion of each treatment arm. Results: Cannabidiol treatment resulted in improvements from baseline among patient-reported outcome measures, including Visual Analog Scale pain; Disabilities of the Arm, Shoulder, and Hand; and Single Assessment Numeric Evaluation scores, compared to the control arm during the study period. There were similar physical parameters identified with range of motion, grip, and pinch strength. Conclusions: In this single-center, randomized controlled trial, topical CBD treatment demonstrated significant improvements in thumb basal joint arthritis-related pain and disability without adverse events. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings