April Research Update
Efficacy of Compression Gloves in the Rehabilitation of Distal Radius Fractures: Randomized Controlled Study
Summary provided by Sarah Doerer, PhD, OTR/L, CHT, CLT
What is the impact on ROM, grip strength, edema, pain and functional outcome of using a made-to-measure compression glove worn 10 hours per day in individuals post distal radius fracture?
This evidence level II study investigated the outcomes of using a made-to-measure compression glove over a period of three to four months post distal radius fracture. In this randomized controlled trial, adults six weeks post distal radius fracture were recruited and divided into a control group (no glove, n=15) and the intervention group (glove, n=17). Both groups received standard rehabilitation twice a week for a half-hour. Outcome measures were assessed at three times: First was 7-10 days after enrollment; second was two weeks later; third was one month later. Results showed that the intervention group was significantly more improved between the first and second assessment periods for edema (measured by tape measure) and ROM (measured by goniometer). Results also showed that the intervention group was significantly more improved between all three assessment periods for pain (measured by PRWE), functioning and participation (PRWE), and dynamic ROM (measured by the HandTutor system).
Journal Source: American Journal of Physical Medicine and Rehabilitation
Miller-Shahabar, I et al. "Efficacy of Compression Gloves in the Rehabilitation of Distal Radius Fractures: Randomized Controlled Study." American Journal of Physical Medicine and Rehabilitation. Volume 97, Issue 12. Pages 904-910. December 2018.
Access the Journal Article Here
Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Cindy Ivy, OTD, CHT, M.Ed, ASHT Research Division Director at Cynthia.Ivy@nau.edu.
May Research Update
Range of Motion Measurements of the Fingers Via Smartphone Photography
Summary provided by Nancy Naughton, OTD, OTR/L, CHT
Fifty consecutive patients with a confirmed diagnosis of Dupuytren contracture were prospectively enrolled in a study to evaluate the reliability of smartphone photography as an alternative to traditional goniometry.
Traditional goniometric measurements were taken of the affected joints (n=123). The same group of subjects then had photographs taken of the affected joints using a smartphone. Two sets of photographs were taken, one by a clinical team member and the other by an individual not associated with the study. A software analysis was performed to compare both sets of the smartphone photographs to the goniometric measures. The mean difference was 3.2° between manual and trained photograph goniometry and 3.0° between manual and untrained photograph goniometry. The authors concluded that smartphone measurements fall within the accepted error of 5°. No statistical significance difference was found between trained and untrained photo set measurements and there was high consistency between separate raters. These findings have relevance from both a clinical and research perspective and may be most noteworthy in the new age of telemedicine.
Journal Source: Hand
John Z. Zhao et al. "Range of Motion Measurements of the Fingers Via Smartphone Photography." Hand. January 28, 2019
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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Cindy Ivy, OTD, CHT, M.Ed, ASHT Research Division Director at Cynthia.Ivy@nau.edu.
October Research Update
Self-reported Home Exercise Adherence: A Validity and Reliability Study Using Concealed Accelerometersy
Summary provided by Erika Lewis, PT, EdD, MS, CHT
Is an exercise diary or self-report scale a valid way to measure exercise adherence?
Fifty-four older adults with chronic knee pain were given a home strengthening program and were followed prospectively for 12 weeks. They were asked to record on a paper exercise diary each time they performed exercise. In addition, participants were seen every two weeks and asked to provide a self-report adherence rating on an 11-point scale without the use of their paper diaries. The exercise program consisted of four common knee strengthening exercises performed at 10 reps, 1-2 sets, five days per week. These data were compared to data collected from a concealed tri-axial accelerometer that was placed in an ankle cuff weight. At the end of the study participants were informed of the accelerometer were given the option to withdraw their data -though no one withdrew. Data showed that exercise adherence was significantly overestimated in the diaries demonstrating questionable validity of the diary. The data also showed that participants over estimated adherence on the self-reported adherence rating scale indicating limited validity of this instrument as well as less than acceptable test-retest reliability. The authors caution the use of exercise diaries and simple self-report scales for assessing exercise adherence.
.Journal Source: Journal of Orthopeadic & Sports Physical Therapy
Nicolson PJA, Hinman RS, Wrigley TV, Stratford PW, Bennell KL. "Self-reported Home Exercise Adherence: A Validity and Reliability Study Using Concealed Accelerometers." Journal of Orthopeadic & Sports Physical Therapy. 2018; 48(12): 943-950.
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Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Cindy Ivy, OTD, CHT, M.Ed, ASHT Research Division Director at Cynthia.Ivy@nau.edu.
November Research Update
Intravenous Drug Use-Related Complications of the Hand and Upper Extremity
Summary provided by Gretchen Bachman, OTD, OTR/L, MBA/HCM, CEAS, CHT
Upper extremity infection cases due to elevated intravenous (IV) drug use is rising. Over a 10-year period of time, there has been a 126% increase in IV drug use-related upper extremity infection cases that presented to the emergency department (ED) of Massachusetts General Hospital in Boston, MA. This research article analyzed data over one year, five years apart, for three distinct years: 2005, 2010 and 2015. The purpose of the study was to evaluate the treatment course of intravenous drug use (IVDU) and non-intravenous drug use (non-IVDU) presenting to the ED for upper extremity infections. This was a retrospective case-control design looking at the treatment parameters, demographics and infection specifics between IVUD infections and the non-IVDU infections.
The study found that infections overall in IVDU were related primarily to abscess or cellulitis at the injection site (wrist, elbow, forearm), whereas non-IVDU infection was likely to present for alternative infection diagnosis, primarily of the finger due to a paronychia. It is important to note that in later years after 2005, the IVDU patients were also more likely to be treated for a methicillin-resistant Staphyloccus Aureus infection.
The IVDU group had 33% more hospital admissions and a greater duration of hospital stay. They also had higher ED admissions, more often received IV antibiotics and had higher utilization of diagnostics, such as CT and radiograph. An important implication for hand therapists is that the IVDU group was also discharged more often to a rehabilitation center for continued care due to their upper extremity infection in 2015. It would be interesting to follow up to see if this is a continued upward trend.
This study determined that the number of IVDU-related upper extremity infections presenting to the ED has more than doubled in 10 years and the infection rates rose proportionally. The trend of these infections is increasingly complex in nature with its required interventions, including amputation and flaps. Demographic analysis also found that patients in the IVDU cohort had a higher tendency to be unemployed, were smokers and had a history for hepatitis C and other mental health diagnoses. The study also showed that those patients who identified as male have typically had a higher rate of IVDU; however, the ratio with those who identify as female has narrowed over time.
The study concludes that an effort to curb the opioid crisis is critical in hand surgery, institutions and systems should plan for increased resource allocation as the opioid crisis persists, and additional financial resources may be critical to continue caring for these patients.
Further implications based upon the authors’ conclusions may be:
- Rising costs of healthcare management for this population subset due to increased numbers of individuals seeking care, delaying care, longer hospital stays and more diagnostics being used and more procedures being performed with increasingly complex infections. This can have implications in rising costs to healthcare systems and third-party payers and increased exposure and risk for patients – all of which warrant further investigation.
- Further research may be indicated on the reasons and rationale behind these IVDU infections.
- How can we help to improve medical compliance? What can hand therapists do to promote these efforts?
- Can harm reduction programs, in lieu of abstinence, be implemented to increase access to early care, decreasing the risks that are present with delayed diagnosis, and can education prevent these infections in the first place?
- Why are IVDU presenting later for intervention? Is there an inherent stigma or bias that prevents them from accessing earlier care?
- Are these results generalizable to other regions of the country? Further research would have to be conducted.
Journal Source: Plastic and Reconstructive Surgery
Pong, T. M., Oflazoglu, K., Helliwell, L. A., Chen, N. C., & Eberlin, K. R. (2019). "Intravenous Drug Use-Related Complications of the Hand and Upper Extremity". Plastic and Reconstructive Surgery. Global Open, 7(2), e2116.
Access the Journal Article Here
Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Cindy Ivy, OTD, CHT, M.Ed, ASHT Research Division Director at Cynthia.Ivy@nau.edu.
December Research Update
Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept
Summary provided by Lori Algar, OTD, OTR/L, CHT
Is a relative flexion motion orthosis an option for flexor tendon repair rehabilitation?
This biomechanical study placed a maximum load of 11 newtons to four cadaver’s flexor digitorum profundus and the extensor digitorum communis for 25 cycles (to simulate flexion and extension of the digits) following a repair of the middle digit flexor tendon in zone III. Testing was performed on hands with and without the use of a relative flexion orthosis maintaining the involved digit in 15 to 25 degrees of relative flexion at the MCP joint. The researchers found that there was less elongation and no gapping or ruptures with the use of the orthosis while all tendons ruptured without the use of the relative motion orthosis. The authors suggest the relative flexion orthosis may be a viable option for flexor tendon repair rehabilitation.
Chung B, Chiu D, Thanik V. Relative motion flexion splinting for flexor tendon lacerations: proof of concept. HAND. 2019; 14 (2): 193-196
Journal Source: HAND
Access the Journal Article Here
Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Cindy Ivy, OTD, CHT, M.Ed, ASHT Research Division Director at Cynthia.Ivy@nau.edu.