Search Results

The influence of kinesiophobia on perceived disability in patients with an upper-extremity injury: A critically appraised topic. Bartlett, O. and J. L. Farnsworth (2021) Level of Evidence : 2a Follow recommendation : 👍 👍 👍 Type of study : Symptoms prevalence study Topic : Psychology in upper limb conditions - Kinesiophobia and disability This was a systematic review of studies assessing the association between kinesiophobia and self-perceived disability in participants with an upper limb injury. Three studies in total were included, two of which were cross-sectional studies and one a prospective study. A total of 1,140 general population participants (no athletes) were included across all studies. Kinesiophobia was assessed through the Tampa Scale for Kinesiophobias (TKS) and upper limb disability was assessed through the Disability of the Arm, Shoulder and Hand (DASH) or the Shoulder Pain and Disability Index (SPADI). The results showed that kinesiophobia was a significant predictor of upper limb disability. 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, fear of movement contributes to disability in upper limb injuries in the general population. It may be useful to keep this in mind when treating our clients and immobilise a joint/limb only if required. Following tissue healing, reassuring patients that pain is probably associated with tissue sensitivity rather than actual tissue damage may be a useful approach to reduce pain and self-reported disability. Open Access URL : https://doi.org/10.1123/jsr.2020-0179 Abstract Clinical Scenario: Kinesiophobia is a common psychological phenomenon that occurs following injury involving fear of movement. These psychological factors contribute to the variability among patients' perceived disability scores following injury. In addition, the psychophysiological, behavioral, and cognitive factors of kinesiophobia have been shown to be predictive of a patient's self-reported disability and pain. Previous kinesiophobia research has mostly focused on lower-extremity injuries. There are fewer studies that investigate upper-extremity injuries despite the influence that upper-extremity injuries can have on an individual's activities of daily living and, therefore, disability scores. The lack of research calls for a critical evaluation and appraisal of available evidence regarding kinesiophobia and its contribution to perceived disability for the upper-extremity. Focused Clinical Question: How does kinesiophobia in patients with upper-extremity injuries influence perceptions of disability and quality of life measurements? Summary of Key Findings: Two cross-sectional studies and one cohort study were included. The first study found a positive relationship between kinesiophobia and a high degree of perceived disability. Another study found that kinesiophobia and catastrophic thinking scores were the most important predictors of perceived upper-extremity disability. The third study found that kinesiophobia contributes to self-reported disability in the shoulder. Clinical Bottom Line: There is moderate evidence that supports the relationship between kinesiophobia and perceived disability, and the relationship between elevated perceptions of disability and increased kinesiophobia scores in patients with an upper-extremity injury. Clinicians should evaluate and monitor kinesiophobia in patients following injury, a condition that can enhance perceptions of disability. An elevated perception of disability can create a cycle of fear that leads to hypervigilance and fear-avoidance behavior. Strength of Recommendation: Consistent findings from reviewed studies suggest there is grade B evidence to support that kinesiophobia is related to an increased perceived disability following upper-extremity injuries. 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 efficacy of graded motor imagery in post-traumatic stiffness of elbow: A randomized controlled trial. Birinci, T., E. K. Mutlu and S. Altun (2022) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Post-fracture elbow rehab - graded motor imagery This is a randomised single-blind controlled trial assessing the effectiveness of Graded Motor Imagery (GMI) and traditional rehabilitation in participants following surgical treatment of an elbow fracture. Participants (N = 50) were included if they were between 20 and 55, if they were 4 to 8 weeks postoperatively, and if they had elbow stiffness. Participants were excluded if they had an infection, heterotopic ossification, malunion, or nerve lesions. The effectiveness of each intervention was assessed through the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, elbow range of movement, and several other outcomes, which were not included in this synopsis. The outcomes were measured at baseline and after 6 weeks of treatment. All participants attended two sessions with a physiotherapist each week for 6 weeks. Treatment allocation was randomised. The assessor was blinded to treatment allocation. Participants were provided with either GMI (n = 25) or traditional rehabilitation (n = 25). Participants in the GMI completled left/right-hand discrimination during the first stage. This was followed by explicit motor imagery in which participants had to look at a hand/shoulder picture and imagine moving their upper limb. The last phase of the GMI involved mirror therapy. The traditional rehabilitation group included a gradual range of movement, stretching, and strengthening program. The results showed that both groups improved to a clinically relevant level at 6 weeks. Function improved to a larger extent in the GMI compared to the traditional rehabilitation group (10 points out of 100 between-group difference), although it is uncertain whether this difference was clinically relevant. Similarly, range of movement was slightly larger for the GMI group, but it is unclear whether this would be clinically relevant. 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, traditional rehabilitation or graded motor imagery appear to equally improve function and range of movement in people treated surgically for an elbow fracture. These findings are similar to previous research showing similar effectiveness of GMI and standard rehabilitation following a distal radius fracture . Graded motor imagery may be particularly appropriate in the initial stages of the rehabilitation when immobilisation is required and pain may limit clients' willingness to perform exercises. URL : https://doi.org/10.1016/j.jse.2022.05.031 Abstract Background: Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion. However, no results have been reported for motor-cognitive intervention programs in post-traumatic elbow stiffness management. The objective was to investigate the efficacy of Graded Motor Imagery (GMI) in post-traumatic elbow stiffness. Methods: Fifty patients with post-traumatic elbow stiffness (18 female; mean age, 41.9±10.9 years) were divided into two groups. The GMI group (n=25) received a program consisting of left/right discrimination, motor imagery, and mirror therapy (twice a week for six weeks); the structured exercise (SE) group (n=25) received a program consisting of the range of motion, stretching, and strengthening exercises (twice a week for six weeks). Both groups received a 6-week home exercise program. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH). The secondary outcomes were the active range of motion (AROM), Visual Analogue Scale (VAS), Tampa Scale for Kinesiophobia (TSK), muscle strength of elbow flexors and extensors, grip strength, left/right discrimination, and Global Rating of Change. Patients were assessed at baseline, at the end of treatment (12 sessions), and a 6-week follow-up. Results: The results indicated that both GMl and SE interventions significantly improved outcomes (p<0.05). After a 6-week intervention, the DASH score was significantly improved with a medium effect size in the GMI group compared to the SE group and improvement continued at the 6-week follow-up (F1,45=3.10, p=0.01). The results with a medium to large effect size were also significant for elbow flexion AROM (p=0.02), elbow extension AROM (p=0.03), VAS-activity (p=0.001), TSK (p=0.01), muscle strength of elbow flexors and elbow extensors (p=0.03) in favor of GMI group. Conclusion: The GMI is an effective motor-cognitive intervention program that might be applied to the rehabilitation of post-traumatic elbow stiffness to improve function, elbow AROM, pain, fear of movement-related pain, and muscle strength. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Determining the level of cervical radiculopathy: Agreement between visual inspection of pain drawings and magnetic resonance imaging. Barbero, M., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Symptoms prevalence study Topic : Cervical radiculopathy – Dermatomal patterns This is a retrospective study assessing whether clinicians were able to determine the level of cervical radiculopathy given pain drawings. A total of 98 participants with single-level cervical radiculopathy were recruited. Participants were included if they presented with persistent pain for at least two months, were between 18 and 70, and showed evidence of radiculopathy on MRI. Potential participants were excluded if they had any fractures, previous surgery to the cervical spine, and multilevel cervical radiculopathy. Two musculoskeletal physiotherapists and spine surgeons with a minimum of 17 and 22 years of experience respectively, determined the level of radiculopathy based on the pain drawings. The results showed that both the physiotherapists and surgeons presented a low level of agreement with the MRI findings regarding the level of cervical radiculopathy (see table below for further details). 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, even experienced clinicians are unable to identify correctly the level of cervical radiculopathy based on pain distribution. This is not surprising as pain/numbness of single-level radiculopathies does not always follow the dermatomal distribution . It is possible that the combination of subjective and objective assessment, including cervical myotomes , will help clinicians determine the radiculopathy level. If you would like to read more about cervical radiculopathies, look at the whole database . URL : https://doi.org/10.1111/papr.13147 Abstract Background and Aims: Pain drawings are commonly used in the clinical assessment of people with cervical radiculopathy. This study aimed to assess: 1) the agreement of clinical interpretation of pain drawings and MRI findings in identifying the affected level of cervical radiculopathy 2) the agreement of these predictions based on the pain drawing among four clinicians from two different professions (i.e. physiotherapy and surgery) 3) the topographical pain distribution of people presenting with cervical radiculopathy (C4 to C7). Methods: Ninety-eight pain drawings were obtained from a baseline assessment of participants in a randomised clinical trial, in which single-level cervical radiculopathy was determined using MRI. Four experienced clinicians independently rated each pain drawing, attributing the pain distribution to a single nerve root (C4-C7). A post-hoc analysis was performed to assess agreement. Outcome measures: Percentage agreement and kappa values were used to assess the level of agreement. Topographic pain frequency maps were created for each cervical radiculopathy level as determined by MRI. Results: The radiculopathy level determined from the pain drawings showed poor overall agreement with MRI (mean=35.7%, K=-0.007-0.139). The inter-clinician agreement ranged from fair to moderate (K=0.212-0.446). Topographic frequency maps revealed that pain distributions were widespread and overlapped markedly between patients presenting with different levels cervical radiculopathy. Conclusion: This study revealed a lack of agreement between the segmental level affected determined from the patient's pain drawing and the affected level as identified on MRI. The large overlap of pain and non-dermatomal distribution of pain reported by patients likely contributed to this result. 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

Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. Schmitt, J. S. and R. P. Di Fabio (2004) Level of Evidence : 1b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Diagnostic Topic : Minimal clinically important difference - DASH This was a prospective study assessing the minimally clinically important difference in the Disability of the Arm, Shoulder, and Hand questionnaire in people undergoing hand therapy. By minimal clinically important difference, we refer to the smallest change in a measure (e.g. DASH) which can be considered as a real improvement in the clinical presentation of our clients. In this study, the anchor-based method calculated the minimal clinical important difference by determining the score of those participants who report benefiting from the intervention/treatment. In this paper, a total of 155 participants with shoulder, elbow, wrist, and hand problems were included. These participants underwent three months of hand therapy regime, after which their DASH score was recorded. The results showed that, for those patients with elbow, wrist, and hand conditions, the minimal clinically important difference was 17 points out of 100. 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 minimal clinically important difference for the DASH is 17 points out of 100. This is similar to the minimal clinically important difference for the QuickDASH, which was 18 out of 100 points . This means that if one of our clients scored 50/100 on the QuickDASH at the first assessment and 33/100 on discharge, we would have achieved a clinically meaningful improvement. Considering that both the QuickDASH and DASH present the same minimal clinically important difference, we can confidently choose the QuickDASH, which takes less time to complete. URL : https://doi.org/10.1016/j.jclinepi.2004.02.007 Abstract Objective: This study contrasted the use of responsiveness indices at the group level vs. individual patient level. Study Design and Setting: We followed a cohort of 211 patients (50% male; mean age 47.5 years; SD 14) with musculoskeletal upper extremity problems for a total of 3 months. Outcome measures: included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Shoulder Pain and Disability Index (SPADI), Patient-Rated Wrist Evaluation (PRWE), and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12). We calculated confidence intervals on various group-level responsiveness statistics based on effect size and correlation with global change. The proportion of patients exceeding the minimum detectable change (or reliable change proportion) and minimum important difference (MID proportion) were included as indices applicable to the individual patient. Results: For the DASH, effect size ranged from 1.06 to 1.67 for various patient subgroups, and the reliable change and MID proportions indicated that 50%–70% of individuals exhibited change based on individual change scores. Only the SRM and reliable change proportion indicated differences among the outcome measures used in this study. Conclusion: The reliable change and MID proportions have an intuitive interpretation and facilitate quantitative responsiveness comparisons among outcome measures based on individual patient criteria. 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

Does reading a book in bed make a difference to sleep in comparison to not reading a book in bed? The People’s Trial—an online, pragmatic, randomised trial. Finucane, E., et al. (2021) Level of Evidence : 1b- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Reading in bed - Sleep quality This is randomised pragmatical trial assessing whether sleeping before bed improves sleep within one week in healthy participants. A total of 774 participants took part in the study. Participants were randomised to either read a book for 15-30 minutes prior to sleeping or the control group, who did not read a book. Both groups could use devices such as phone/tablet prior to sleeping if they liked. Sleep quality was assessed at baseline and after one week through the single item sleep quality scale. The results showed that sleep improve by 8% to 22% in the reading group compared to the control. In a small portion of the reading (10%) and control group (16%), sleep worsened after one week. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, reading in bed at night for 15-30 minutes improves sleep quality. This may be useful advice for our clients as it appears that worse sleep increases the risk of them developing persistent pain . Considering that this is a simple, low-cost option to improve sleep, it may be worth trialling. Open Access URL : https://doi.org/10.1186/s13063-021-05831-3 Abstract Background: The best way of comparing healthcare treatments is through a randomised trial. In a randomised trial, we compare something (a treatment or intervention) to something else, often another treatment. Who gets what is decided at random, meaning everyone has an equal chance of getting any of the treatments. This means any differences found can be put down to the treatment received rather than other things, such as where people live, or health conditions they might have. The People’s Trial aimed to help the public better understand randomised trials by inviting them to design and carry out a trial. The question chosen by the public for The People’s Trial was: ‘Does reading a book in bed make a difference to sleep, in comparison to not reading a book in bed?’ This paper describes that trial, called ‘The Reading Trial’. Methods: The Reading Trial was an online, randomised trial. Members of the public were invited to take part through social media campaigns. People were asked to either read a book in bed before going to sleep (intervention group) or not read a book in bed before going to sleep (control group). We asked everyone to do this for 7 days, after which they measured their sleep quality. Results: During December 2019, a total of 991 people took part in The Reading Trial, half (496 (50%)) in the intervention group and half (495 (50%)) in the control group. Not everyone finished the trial: 127 (25.6%) people in the intervention group and 90 (18.18%) people in the control group. Of those providing data, 156/369 (42%) people in the intervention group felt their sleep improved, compared to 112/405 (28%) of those in the control group, a difference of 14%. When we consider how certain we are of this finding, we estimate that, in The Reading Trial, sleep improved for between 8 and 22% more people in the intervention group compared to the control group. Conclusions: Reading a book in bed before going to sleep improved sleep quality, compared to not reading a book in bed. 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

Hand laterality recognition in distal radius and/or ulna fracture. Geete, D. B., P. U. Mehta, N. Dewan and A. A. Mehta (2022) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Aetiologic Topic : Motor imagery - Immobilisation This is a case-control study assessing differences in motor imagery following immobilisation in people who had a distal radius/ulna fracture. A total of 60 participants were included in the study. Of these, 30 had undergone 4-6 weeks of wrist immobilisation and 30 were age-matched controls. Motor imagery was assessed through a hand left-right discrimination task (reaction time and response accuracy). The results showed that participants who had undergone immobilisation were significantly slower (0.4 seconds slower) and less accurate (20% less accurate) in discriminating between left-right hands during the motor imagery task. It is unknown whether these impairments resolved with rehabilitation as there wasn't a longer-term follow-up. 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, clients who undergo a period of immobilisation, are likely to present with impairments in hand motor imagery. This is similar to what happens with persistent pain (e.g. Hand OA) and may be due to limb disuse. We should probably aim at keeping immobilisation to a minimum as we know that early mobilisation, if possible, not only improves function but also the psychological well-being of our clients . URL : https://doi.org/10.1016/j.jht.2022.01.003 Abstract Introduction: Hand laterality, an important ability to determine the orientation of a limb is common to get affected after short term immobilization. Distal radius and/or ulna fracture is a commonly encountered fracture resulting from upper-limb trauma. Conservative treatment using closed reduction and plaster cast application to immobilize the joint remains choice of treatment over surgery in the treatment of these fractures. There is a paucity of literature reporting impairment in hand laterality after long term immobilization as commonly performed in patients with distal radius and/or ulna fractures. Understanding effect of immobilization on hand laterality in distal-end radius/ulna fractures warranted present investigation. Purpose: To evaluate hand laterality based on the accuracy and response time for hand determination after plaster cast removal in distal radius and/or ulna fracture. Study design Prospective cross-sectional study. Methodology: Subjects (n = 60, age range = 40-59 years, females (n) = 28 and males (n) = 32) were shown 24 real-hand images with various degrees of angular rotation and instructed to identify the hand as left and/or right. Accuracy (% correctly identified) and Response time (milliseconds to identify left or right hand in the image) of motor imagery during hand laterality task were recorded. Pain intensity before and after the hand laterality task were noted using Visual Analogue Scale. Repeated measures of ANOVA and t-tests were used to analyze the accuracy and response times among two groups. Results: The experimental group showed significantly (P < .05) lower accuracy and longer response time as compared to the control group. No significant difference in the accuracy and response time were noted in the immobilization of the dominant and the non-dominant hand within the experimental group (P > .05). Also, there was no change in pain pre- to post-hand laterality task. Conclusion: Findings of this study could aid in enhancing the understanding of post-immobilization effect on hand laterality and open new arenas for assessment and rehabilitation of distal-end radius and/or ulna fractures where immobilization is the principal 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

Home exercise program compliance of service members in the deployed environment: An observational cohort study. Eckard, T., J. Lopez, A. Kaus and J. Aden (2015) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 Type of study : Therapeutic Topic : Exercise compliance - Less is more This is a prospective observational study assessing the association between the number of exercises prescribed and compliance with treatment. United States soldiers were recruited (N = 155) to participate in the study if they presented with a musculoskeletal condition. Compliance was assessed through the Henry-Eckert Performance Assessment Tool . Other demographic variables and pain intensity scores were recorded. The results showed that participants who were given 2 or fewer exercises had higher compliance compared to those participants who were given 3 or more. In particular, participants who were given 2 or fewer exercises had 40% more compliance compared to those that were given 4 or more exercises (see figure). 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, prescribing 2 or fewer exercises is advisable to boost treatment compliance. Three exercises are acceptable, however, when 4 or more exercises are provided, the likelihood of clients completing them is reduced by a large extent. This information does not only apply to soldiers but also to older people. Thus, a study in 1998 has shown similar findings in a population of adults over 65 years old . Open access URL : https://doi.org/10.7205/milmed-d-14-00306 Abstract BACKGROUND Home exercise programs (HEP) are an integral part of any physical therapy treatment plan, but are especially important in theater. The primary aim of this study was to determine if the number of exercises prescribed in a HEP was associated with compliance rate of Service Members (SM) in theater with a secondary aim of determining variables associated with compliance and noncompliance. MATERIALS/METHODS Subjects were 155 deployed SM undergoing physical therapy in Iraq and Afghanistan. Clinical evaluation and prescription of a HEP were performed. Pathologic, demographic, and treatment data were obtained. Subjects returned to the clinic 1 week later to demonstrate their HEP. Subjects' performance of each prescribed exercise was rated on a 12-point scale to quantify compliance. RESULTS 2 variables were found to be significantly associated with rate of compliance. These were the number of exercises prescribed (p = 0.02) and if a subject left the base at least once per week (p = 0.01). CONCLUSIONS SM prescribed 4 or more exercises had a lower rate of compliance than those prescribed 2 or fewer. SM who left the base at least once per week also had a lower rate of compliance. 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

Attempting to separate placebo effects from exercise in chronic pain: A systematic review and meta-analysis. Miller, C. T., et al. (2022) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic : Persistent pain - exercise This is a systematic review on the effect of exercise on pain in people with persistent pain. Of note, studies included both fibromyalgia and persistent pain due to OA, lower back pain, and patellofemoral pain. This is important as fibromyalgia may present with different pain mechanicsms compared to other conditions. A total of 4 randomised placebo controlled studies were included. Different types of exercise were implemented and they included aerobic, motor control, and resistance training. Placebo interventions included sham electrotherapeutic interventions (e.g. inactive TENS). The intervention duration ranged from 4 to 8 weeks. Pain intensity was assessed through the visual analogue or numerical rating scale (0-10). 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 very low-quality evidence showing no difference between exercise and placebo interventions (e.g. inactive TENS). I calculated for you the absolute difference between the exercise group and the placebo group. This equated to 1 point out of 10 in favour of the exercise group compared to placebo, which would not be defined as clinically relevant (To calculate it yourself, do the following: Standardise mean differece x the smallest SD; 0.94 x 0.91 = 0.86 points out of 10). 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, aerobic/resistance/motor control training exercise are as effective as non-exercise placebos for people with persistent pain. The improvement in pain intensity, beyond placebo, appears to be modest and clinically irrelevant (1 pint out of 10). This is consistent with previous research . Overall, we still may want to advice our clients to take part in general exercise as this has been shown to positively modulate pain mechanisms (e.g. aerobic exercise), improve tissue recovery (if we are still suspecting tissue damage), reduce our clients' risk of developing depression , or reduce their depression symptoms if they already have the condition . URL : https://doi.org/10.1007/s40279-021-01526-6 Abstract Background: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Design: Systematic review with meta-analysis. Data Sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Eligibility Criteria: Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). Results: We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [− 0.17, 2.06], P = 0.098, I2 = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P < 0.001, I2 = 92.43%, studies: n = 42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P < 0.001, I2 = 76.52%, studies: n = 33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I2 = 90.02%, studies: n = 79). Conclusions: There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria. 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

Carpometacarpal and metacarpophalangeal joint collapse is associated with increased pain but not functional impairment in persons with thumb carpometacarpal osteoarthritis. Duong, V., et al. (2021) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs) Type of study : Symptoms prevalence Topic : Thumb osteoarthritis mcpj hyperextension - Symptoms This is a retrospective analysis of a previously published randomised controlled trial . The aim of the study was to determine whether mcpj hyperextension during pinching was associated with greater pain intensity and worse function in people with thumb OA. Mcpj hyperextension during tip-to-tip pinching was determined by observation. Pain intensity was assessed through visual analogue scale (0 to 100) at baseline, not during pinching. Function was assessed through the functional index of hand OA (FIHOA). The results showed participants presenting with mcpj hyperextension during tip-to-tip pinch presented with greater levels of pain but not worse function. Unfortunately, it is not possible to comment on whether the difference in pain between the two groups was clinically relevant as pain was classified as moderate and high. 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, mcpj hyperextension during tip to tip pinch may be associated with overall greater pain at the base of the thumb in people with OA . At the moment is not possible to determine whether these differences are clinically relevant and whether presenting with this pinch strategy predicts future onset of thumb OA. In addition, it is not known whether modifying this pinching strategy will lead to improvements in pain intensity. What we know is that people with greater levels of 1st cmcj dorsal positioning may be less likely to respond to conservative treatment . URL : https://doi.org/10.1016/j.jht.2020.07.003 Abstract Introduction: Due to the complex shape of the carpometacarpal (CMC) joint, a fixed joint collapse deformity of the thumb CMC (CMC1) and metacarpophalangeal (MCP1) joint can present in advanced stages of CMC1 osteoarthritis (OA), resulting in adduction of the first metacarpal (MC1) and hyperextension of the MCP1. Purpose of the Study: To determine whether joint collapse deformity is associated with worse pain and/or functional impairment. Study Design Cross-sectional. Methods: This study used the baseline data from 140 patients enrolled in a longitudinal study of treatment for CMC1 OA. (efficacy of combined conservative therapies on clinical outcomes in patients with CMC1 OA). Joint collapse was determined at baseline using a pinch gauge. Pain was assessed on a visual analog scale (0-100) and function was assessed using the Functional Index for Hand Osteoarthritis questionnaire (0-30). Pain and function and the presence of joint collapse were entered in a univariate logistic regression. The final adjusted model for pain and joint collapse included age and sex. The final adjusted model for function and joint collapse included Kellgren Lawrence grade and grip strength. Results: About 20% of participants demonstrated joint collapse on the tip-pinch test. The presence of joint collapse was associated with increased pain in the unadjusted [P = .047, OR = 2.45, 95% CI (1.01, 5.910)] and adjusted model [P = .049, OR = 2.45, 95% CI (1.00, 5.98)]. Conclusion: CMC1 patients with joint collapse reported increased pain compared with those without joint collapse. Future studies should determine the relationship between thumb hypermobility and joint collapse and how to manage these conditions effectively. 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

Prevalence and risk factors for postoperative complications following open a1 pulley release for a trigger finger or thumb . Koopman, J. E., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Trigger finger injections - Are they associated with complications This is a retrospective study assessing post-surgical complications in clients who underwent cortisone injections prior to surgery for trigger finger release. A total of 3,428 participants, took part in this study. Of these, 1303 (38%) did not receive a cortisone injection prior to trigger finger release, and 2,125 (62%) received at least one cortisone injection prior to surgery. The outcome assessed was the presence of complications, which ranged from an increase in analgesic/hand therapy treatment to complex regional pain. The analyses controlled for comorbidities (e.g. diabetes) and other confounders. The results showed that the participants who underwent a cortisone injection one month prior to trigger finger release or had more than three injections prior to surgery had two to three times the odds of developing a complication after surgery compared to those who had more time between the injection and surgery or fewer cortisone injections. Despite these results, we need to keep in mind that association is not equivalent to prediction. 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, more than three cortisone injections or a cortisone injection within one month of trigger finger release appear to be associated with a greater probability of post-surgical complications. These findings are consistent with a previous study in trigger finger release and two previous studies showing that both ialuronic acid injections and cortisone injections increase the risks of post-surgical complications in people 1st cmcj OA. It is important to remember that associations are not necessarily predictions. URL : https://doi.org/10.1016/j.jhsa.2022.04.017 Abstract Purpose: Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pulley release. Methods: Patients completed baseline questionnaires, including patient characteristics, clinical characteristics, and the Michigan Hand outcomes Questionnaire. We retrospectively reviewed medical records to identify complications classified using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions tool. Grade 1 complications comprise treatment with additional hand therapy, splinting, or analgesics, grade 2 treatment with antibiotics or steroid injections, grade 3A minor surgical treatment, grade 3B major surgical treatment, and grade 3C complex regional pain syndrome. Logistic regression analyses were performed to examine the contribution of patient characteristics, clinical characteristics, and patient-reported outcome measurement scores to complications. Results: Of the included 3,428 patients, 16% incurred a complication. The majority comprised milder grades 1 (6%) and 2 (7%) complications, followed by more severe grades 3B (2%), 3C (0.1%), and 3A (0.1%) complications. A longer symptom duration (standardized odds ratio [SOR], 1.09), ≥3 preoperative steroid injections (SOR, 3.22), a steroid injection within 3 months before surgery (SOR, 2.02), and treatment of the dominant hand (SOR, 1.34), index finger (SOR, 1.65), and middle finger (SOR, 2.01) were associated with a higher complication rate. Conclusion: This study demonstrates that ≥3 preoperative steroid injections and a steroid injection within 3 months before surgery were the most influential factors contributing to complications. These findings can assist clinicians during patient counseling and may guide preoperative treatment. We recommend that clinicians should consider avoiding steroid injections within 3 months before surgery and to be reluctant to perform >2 steroid injections. 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

Efficacy of waterproof cast protectors and their ability to keep casts dry. Kwan, S., et al. (2022) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Keeping an arm cast dry - Available devices This was an experimental study assessing the water tightness of a plastic bag vs several commercially available cast protectors. A total of 23 participants tested the plastic bag and the different cast protectors by immersing for 30 seconds their covered arm in the water. To assess the effect of motion on water tightness, the same test was repeated with the arm rotating clockwise and counterclockwise for the same amount of time. A piece of paper towel was inserted between the hand and the cast cover to assess the amount of moisture absorbed. The difference in weight of the paper towel between post- and pre-immersion provided a measurement of water tightness. Participants were also asked which device they thought was the most comfortable and reliable. The results showed that the devices labeled as A, B, C, E, and F (see below) were fully waterproof, and most of the participants felt device A as the most comfortable and reliable. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a plastic bag wrapped around an arm cast is insufficient to keep the cast or a wound dry. Commercially available alternatives such as the DryPro cast cover appear to be waterproof and may be offered to our clients, especially during the summer months, to limit the impact of their injury on their social and physical activity routines. URL : https://doi.org/10.1016/j.jhsa.2022.05.006 Abstract Purpose: The purpose of the study was to compare the efficacy of 6 different commercially available waterproof cast protectors in their ability to maintain a dry environment and evaluate whether cast protectors perform better than a plastic bag secured with tape in keeping casts dry. Methods: We enrolled 23 adult participants to test 6 different commercially available cast protectors and a plastic bag. Participants trialed all cast protectors twice, with and without motion, by fully submerging each cast protector in water with a paper towel held between their index and middle fingers. Moisture accumulation within the cast protectors was estimated by the change in weight of paper towel. An analysis of variance test was performed to compare differences between cast protectors in their ability to maintain a dry internal environment. Results: The plastic bag showed an average moisture accumulation of 5.50 g without motion compared with all other cast protectors, which had 0.0 g of moisture accumulation. One cast protector and the plastic bag had an average moisture accumulation of 0.46 g and 4.51 g with motion compared to all other cast protectors. The plastic bag was ranked the worst by 100% of participants. Conclusion: Cast protectors appear to offer superior protection from moisture compared with a plastic bag. 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

Long-term leisure-time physical activity and risk of all-cause and cardiovascular mortality: dose–response associations in a prospective cohort study of 210,327 Taiwanese adults. Martinez-Gomez, D., et al. (2022) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Leisure physical activity - Effect on all-cause and cardiovascular mortality This is a retrospective study assessing the effect of leisure physical activity on all-cause and cardiovascular mortality. A total of 210,327 participants were followed up for 20 years and weekly physical activity was averaged across several time points. The amount of physical activity was compared to World Health Organisation (WHO) guidelines and defines as "none", "insufficient", "recommended", and "additional" through metabolic equivalents (MET). The results showed that "insufficient" or "recommended" levels of physical activity reduce mortality by 20% to 30% respectively compared to people who performed no physical activity (see graph). If you would like to determine whether you or your clients reach the weekly WHO guidelines for physical activity, use to OMNI calculator which is kindly been made available for free (see 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, engaging in physical activity can reduce mortality risk even though we do not reach the recommended WHO guidelines for physical activity . Clearly, if we were to reach the threshold suggested, this would provide additional benefits. We can therefore advise our clients that any exercise is better than no exercise. Physical activity not only reduces the risk of mortality in our clients but also the risk of developing depressive symptoms . If this was not enough, aerobic exercise has also been shown to expedite wound healing , which is something that as hand therapists we see often. URL : http://dx.doi.org/10.1136/bjsports-2021-104961 Abstract Objectives: We aimed to investigate the dose–response associations of long-term leisure-time physical activity (LTPA) obtained from repeated measures with all-cause and cardiovascular disease (CVD) mortality outcomes in Taiwanese adults. Methods: We included 210 327 participants with self-reported LTPA at least in two medical examinations (867 968 data points) for up to 20 years (median, IQR: 4.8 years, 2.3–9.0). Dose–response relationships were modelled with restricted cubic spline functions and Cox regressions HRs (95% CIs) adjusted for main covariates. Results: During up to 23 years of follow-up (3 655 734 person-years), 10 539 participants died, of which 1919 of CVD. We observed an inverse, non-linear dose–response association between long-term LTPA and all-cause and CVD mortality. Compared with the referent (0 metabolic equivalent of task (MET) hours/week), insufficient (0.01–7.49 MET hours/week), recommended (7.50–15.00 MET hours/week) and additional (7.50-15.00 MET hours/week) amounts of LTPA had a lower mortality risk of 0.74 (0.69–0.80), 0.64 (0.60–0.70) and 0.59 (0.54–0.64) for all-cause mortality and 0.68 (0.60–0.84), 0.56 (0.47–0.67) and 0.56 (0.47–0.68) for CVD mortality. When using only baseline measures of LTPA, the corresponding mortality risk was 0.88 (0.84–0.93), 0.83 (0.78–0.88) and 0.78 (0.73–0.83) for all-cause and 0.91 (0.81–1.02), 0.78 (0.68–0.89) and 0.80 (0.70–0.92) for CVD mortality. Conclusion: Long-term LTPA was associated with lower risks of all-cause and CVD mortality. The magnitude of risk reductions was larger when modelling repeated measures of LTPA compared with one measure of LTPA at baseline. Data may be obtained from a third party and are not publicly available. The data of this study can be requested from the MJ Health Research Foundation (http://www.mjhrf.org). 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