Kristin Valdes

A systematic review of conservative interventions for osteoarthritis of the hand.

STUDY DESIGN Systematic Review. INTRODUCTION Hand therapy interventions for patients with hand osteoarthritis (OA) can include splinting, joint protection technique instruction, paraffin, exercises, and provision of a home exercise program. PURPOSE Examine the quality of the evidence regarding the hand therapy interventions for hand OA. METHODS Twenty-one studies dated between 1986 and 2009 were included in the systematic review for analysis. RESULTS The current evidence provides varied support for the interventions of orthotics, hand exercises, joint protection techniques, the utilization of adaptive devices, and paraffin. Findings for the use of joint protection techniques are supported for improvements in function and pain reduction. Minimal evidence exists for paraffin used for the treatment of hand OA. CONCLUSIONS The current literature supports the use of orthotics, hand exercises, application of heat, and joint protection education combined with provision of adaptive equipment to improve grip strength and function. LEVEL OF EVIDENCE 2A.

An exercise program for carpometacarpal osteoarthritis based on biomechanical principles

UNLABELLED A review of the literature was performed to design a hand exercise regimen based on biomechanical principles of the carpometacarpal (CMC) joint and the forces that act upon the joint. Sixteen biomechanical studies were included in the review: four studies developed a mathematical model of the thumb and 12 performed cadaveric dissections to study the CMC joint. Clinical application of the biomechanical findings from the studies was synthesized into specific recommendations for a hand exercise program to preserve CMC joint range of motion and increase the strength of the stabilizing muscles of the thumb. The exercise regimen was developed in accordance with recommendations of the American College of Sports Medicine guidelines for the development of individualized exercise prescriptions. LEVEL OF EVIDENCE 4.

Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis

Abstract Purpose: The purpose of this study was to conduct a current review of randomized controlled trials regarding the effect of conservative interventions on pain and function in people with thumb carpometacarpal (CMC) osteoarthritis (OA), perform a meta-analysis of the findings and summarize current knowledge. Method: Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to May 2014. Reference lists of relevant literature reviews were also searched. All published randomized trials without restrictions to time of publication or language were considered for inclusion. Study subjects were symptomatic adults with thumb CMC OA. Two reviewers independently selected studies, conducted quality assessment and extracted results. Data were pooled in a meta-analysis, when possible, using a random-effects model. Quality of the body evidence was assessed using GRADE approach. Results: Sixteen RCTs involving 1145 participants met the inclusion criteria. Twelve were of high quality (PEDro score > 6). We found moderate quality evidence that manual therapy and therapeutic exercise combined with manual therapy improve pain in thumb CMC OA at short- and intermediate-term follow-up, and from low to moderate quality evidences that magneto therapy improves pain and function at short-term follow-up. Orthoses (splints) were found to improve function at long-term follow-up and pinch strength at short-term follow-up. Finally, we found from very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long-term follow-up. Conclusions: Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain. Additional research is required to determine the efficacy of other therapeutic interventions that are performed with patients with thumb CMC OA. Implications for Rehabilitation Manual therapy and exercise are an effective means of improving pain and function at short-term follow-up by patients with thumb CMC OA. Magneto therapy, manual therapy, manual therapy and exercise and Orthoses (splints) were found to have clinically significant results. Very few of the included studies showed a clinically significant effect size in favor of treatment.

The value of provocative tests for the wrist and elbow: A literature review

UNLABELLED To describe and determine the usefulness of provocative tests for the wrist and elbow a literature search was performed. A total of 31 diagnostic studies were identified, assessed, and ranked. The highest ranking tests had a mean positive likelihood ratio of ≥2.0, or a mean negative likelihood ratio of ≤0.5, from more than one study. The highly recommended tests were found to be the Phalens, Tinels test for carpal tunnel and cubital tunnel, and modified compression test, scaphoid shift test, and elbow flexion test. A total of 14 tests met our requirements to be considered a recommended test. A greater number of provocative tests either do not have adequate data to support their usefulness or their clinical utility has not been assessed. This information may assist hand therapists in choosing which provocative tests are considered clinically useful in improving the probability of the presence or absence of pathology in the hand, wrist, and elbow. LEVEL OF EVIDENCE NA.

Conservative treatment of mallet finger: A systematic review

PURPOSE To determine if there is a superior orthosis and wearing regimen for the conservative treatment of mallet finger injuries. The secondary purpose is to examine the current evidence to evaluate if a night orthosis is necessary following the initial immobilization phase. METHODS A comprehensive literature search was conducted using the search terms mallet finger, splint, orthosis, and conservative treatment. RESULTS Four randomized controlled trials (RCTs) were included in the systematic review. In all 4 RCTs mallet fingers were immobilized continuously for 6 weeks in acute injuries and 8 weeks for chronic injuries. CONCLUSIONS Two of the three studies found a large effect size for orthotic intervention ranging from 2.17 to 12.12. Increased edema and age and decreased patient adherence seem to negatively influence DIP extension gains. Recommended immobilization duration is between 6 to 8 weeks and with additional weeks of immobilization in cases of persistent lags. LEVEL OF EVIDENCE 1a.

Therapist supervised clinic-based therapy versus instruction in a home program following distal radius fracture: A systematic review

PURPOSE The primary purpose of this systematic review is to determine the effectiveness of a home program or a structured therapy program for patients following distal radius fracture. METHODS A search was performed using terms wrist fracture, supervised therapy, occupational therapy, physical therapy, splint, orthosis, distal radius fracture, exercise, and home program. Studies that met the inclusion criteria were evaluated for research quality using The Structured Effectiveness for Quality Evaluation of Study (SEQES). RESULTS Five of the seven trials found no difference between outcomes for their subjects that had uncomplicated distal radius fractures. The population that has complications following distal radius fractures was not represented in the studies reviewed. CONCLUSION The available evidence from randomized controlled trials is insufficient to support a home program or therapist supervised clinic-based program as a superior method of treatment for adults following a distal radius fracture without complications or the presence of comorbidities.

Attitudes and Opinions of Evidence-based Practice among Hand Therapists: A Survey Study

UNLABELLED The adoption of evidence-based practice (EBP) principles is advocated by many professional organizations. The purpose of this study was to assess the current attitudes and opinions of hand therapists toward EBP. A 35-item electronic survey was sent via e-mail to 2,997 hand therapists and 312 (10.4%) of eligible therapists responded. There was an overall strong endorsement of EBP among most respondents. Nearly all respondents believe that EBP plays a positive role in clinical practice, improves patient outcomes and clinical decision making, and that therapists should be familiar with EBP techniques to critically appraise clinical research studies. Respondents had a positive attitude toward EBP and the main barriers to EBP included: time limitations, limited journal access, and lack of evidence for treating specific diagnoses. Efforts to advance EBP in hand therapy should focus on reducing these barriers. LEVEL OF EVIDENCE 3b.

Reliability of pinch strength testing in elderly subjects with unilateral thumb carpometacarpal osteoarthritis.

[Purpose] The aim of this study was to examine the test-retest reliability of pinch strength testing in elderly subjects with thumb CMC OA. [Subjects and Methods] A total of 27 patients with unilateral right-thumb CMC OA (mean ± SD age: 81.3 ± 4.7 years) were recruited. Each patient performed three pain-free maximal isometric contractions on each hand on two occasions, one week apart. Three different measurements were taken: tip, tripod, and key pinch strength. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) calculations were performed. [Results] Test-retest reliability of measurements of tip, tripod, and key pinch strength was excellent for the affected side (ICC=0.93, 0.96, and 0.99) and the contralateral thumb (ICC=0.91, 0.92, and 0.94). [Conclusions] The present results indicate that maximum pinch strength can be measured reliably using the Pinch Gauge Dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving pinch strength.

Sensorimotor interventions and assessments for the hand and wrist: A scoping review

STUDY DESIGN Scoping review. INTRODUCTION Sensorimotor deficits can impair function and may be present in individuals with common upper extremity conditions. PURPOSE OF THE STUDY To provide clinicians with an understanding of the usefulness of the assessments to evaluate sensorimotor function and the interventions reported in the literature to effect positive change in our patients with sensorimotor deficits affecting the hand and wrist. METHODS A systematic search produced seventeen studies involving sensorimotor retraining and assessment of sensorimotor performance for the upper extremity. RESULTS Sensorimotor interventions and assessments found in the literature vary in regards to their effectiveness in restoring sensorimotor function in subjects with a number of conditions that affect hand and wrist function. CONCLUSIONS There is a potential value of sensorimotor interventions for individuals with specific upper extremity conditions. There is a need for further studies to improve treatment of sensorimotor deficits and understanding of sensorimotor interventions.

Combined Thumb Abduction and Index Finger Extension Strength: A Comparison of Older Adults With and Without Thumb Carpometacarpal Osteoarthritis

OBJECTIVE The objectives of this study were to compare thumb combined abduction/index finger extension (hand opening) strength between subjects with carpometacarpal (CMC) osteoarthritis (OA) and normal controls and to assess the reproducibility of hand opening strength and abduction range of motion (ROM) measurements in patients with thumb CMC OA to establish the cutoff values scores for minimal detectable change. METHODS Seventy-seven subjects, 96% female (age, 77 ± 7 years), participated in the study. The CMC OA group consisted of 39 patients (mean ± SD, 81 ±7) and 38 healthy subjects (mean ± SD, 78 ± 6). Mixed models analysis of variance was conducted to determine the differences between groups. RESULTS The post hoc testing revealed statistically significant differences in pain pressure threshold, opening strength, and ROM measurements within the CMC OA group as compared with the healthy group (all, P < .01) in the dominant right hand. The average measure of CMC OA in the right hand did differ from that of the left hand for opening strength and abduction measurements. No statistical differences were revealed between groups nondominant left (all, P > .05), except in case of opening strength (P < .001). There was also large effect size between the means of the Disabilities of the Arm, Shoulder, and Hand scores between the healthy group and the CMC OA group of 1.17 (confidence interval, 1.19-2.14). CONCLUSION Subjects with CMC OA exhibited decreased combined thumb abduction and index finger extension strength, reduced thumb abduction ROM, and increased pain sensitivity when compared with their healthy counterparts. The minimal detectable change score in this patient population was 0.23 to 0.25 kg/cm(2) for pain pressure threshold, 0.12 to 0.13 lb for opening force, and 1.24° to 1.46° for abduction ROM measurement.