Research Updates

The ASHT Research Division offers research updates to increase awareness of emerging research in the field of hand therapy. Each month, the Research Division releases a brief summary of an original published research paper selected by members of the Research Division.

2020 Research Updates

 

September Research Update

Occupational Neuroplasticity in the Human Brain: A Critical Review and Meta-Analysis of Neuroimaging Studies
Summary provided by Cindy C. Ivy, M.ED, OTD, CHT

Hand therapists rely on the concept of neuroplasticity when rehabilitating upper extremity injuries that have affected mapping in the primary motor and sensory cortices, and other areas of the brain. While the brain continues to reorganize and change throughout life, the concept of neuroplasticity refers to the brain’s adaptation to external and internal factors with changes of structure and function. This meta-analysis introduces the concept of “occupational neuroplasticity.” The authors review studies of the neuroimaging of athletes, taxi drivers, musicians, dancers, simultaneous interpreters, acupuncturists, seafarers, mathematicians, pilots and creative writers to explore neuroplastic changes in the brain that may be driven by these professions. The review excluded studies that did not compare experts with novices, did not report on brain activation as a result or contained fewer than three stereotactic coordinates in imaging.

The results show clusters of changes in the brain when comparing experts to novices. While studying of occupations implies more than repetitive training (i.e. numerous considerations such as environmental, social, genetic, etc.), there are implications for therapists when choosing interventions for generating neuroplasticity. This study enriches our knowledge on neuroplasticity and presents new questions. It remains unclear whether neuroplasticity is principally determined by nature or nurture or both; however, the study of groups (occupational groups in this case) over time adds to the body of knowledge and brings insight and context to the use of purposeful, meaningful and repetitive activities in the hand therapist’s intervention strategies.

Wu H, Yan H, Yang Y, Xu M, Shi Y, Zeng W, Li J, Zhang J, Chang C and Wang N (2020) Occupational Neuroplasticity in the Human Brain: A Critical Review and Meta-Analysis of Neuroimaging Studies. Front. Hum. Neurosci. 14:215.

Journal SourceFrontiers in Human Neuroscience

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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.


August Research Update

Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents.
Summary provided by Jenny Dorich, MBA, OTR/L, CHT

This retrospective study evaluated the outcomes of children under 19 years old who underwent surgery for triangular fibrocartilage complex (TFCC) tears. The results of 153 wrists in a 149 patients who had TFCC injury confirmed through arthroscopy were included. All patients had a history of persistent ulnar-sided wrist pain and/or functional limitations after six months of conservative treatment. Treatment prior to surgical intervention included wrist orthoses, activity modification, anti-inflammatory medication, corticosteroid injections and psychical therapy. Fifty-six percent of the patient population had a history of traumatic injury.

The specific surgical procedure used to address the TFCC pathology was dependent upon the classification of the TFCC pathology. Following surgery, patients were immobilized in a long arm cast for four weeks and a short arm cast for an additional two weeks. Six weeks after surgery, therapy was initiated, and intervention included range of motion, scar management, isometric and then isotonic strengthening and proprioceptive retraining.

Outcome measures included the Modified Mayo Wrist Score (MMWS) and the PROMIS Upper Extremity Short Form. Pain at rest and with activity was rated as at rest and during activity as no pain, mild pain, moderate or severe pain. At final clinical follow up (median 15.4 months), patients had significant improvement in pain, DRUJ stability and MMWS scores. MMWS scores at final follow up were distributed as 65 (61%) excellent, 21(20%) good scores, 12 (11%) fair scores and six (6%) poor scores. PROMIS scores were available on at subset of patients (n= 57). The median t-score was 57 (IRQ 45-57). By a median of 4.1 months (IRQ) following surgery, all patients returned to functional/athletic at the following levels full (83%), restricted (7%) or low-demand (9%). Twenty-nine (19%) of the wrists underwent a secondary surgery due to persistent pain.

This study provides contributes to the limited evidence available on the management and treatment outcomes of children with TFCC pathology.

Wu, M., Miller, P. E., Waters, P. M. & Bae, D. (2020). Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents. The Journal of Hand Surgery, 45(5), 449 – e1

Journal SourceThe Journal of Hand Surgery

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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.


July Research Update

A Comprehensive Rehabilitation Program for Treating Lateral Elbow Tendinopathy
Summary provided by Erika Lewis, PT, EdD, MS, CHT

This article discusses the importance of strengthening the scapular muscles in patients with lateral elbow tendinopathy and presents a comprehensive clinical program to treat lateral elbow tendinopathy. Research has shown that patients with lateral elbow tendinopathy have scapular weakness thus increasing the demand on the distal portion of the extremity. There is little published literature on specific rehabilitation guidelines addressing both the scapular muscle weakness and the elbow and wrist issues related to this diagnosis. This very specific program developed by experienced clinicians offers a menu of exercise options, grouped by rehabilitation phases, that addresses both areas of weakness and provides a progression along the rehab continuum. The clinical program includes recommendations on all aspects of treatment such as cryotherapy, soft tissue mobilization and joint mobilization. This clinical commentary is helpful for offering guidance in treating your patients with lateral elbow tendinopathy. A randomized controlled trial is being conducted on this clinical protocol so stay tuned.

Day, JM, Lucado, AM, Uhl, TL. A Comprehensive Rehabilitation Program for Treating Lateral Elbow Tendinopathy. IJSPT. Vol. 14:5. October 2019. pp. 818-834

Journal Source: IJSPT

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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.


June Research Update

Utility of the iPhone 4 Gyroscope Application in the Measurement of Wrist Motion
Summary provided by Katherine Loomis, MA, OTR/L, CHT

This cross-sectional study evaluates the accuracy and ease of use of the iPhone gyroscope application compared to goniometer measurement to assess wrist range of motion. Measurements were taken of 306 adult wrists without pathology present using both techniques for wrist flexion, extension, radial deviation and ulnar deviation. The measurements were then compared and analyzed. To obtain the gyroscope measurement, the phone was placed against the dorsal hand. The study found that wrist motion measured similarly with both the iPhone gyroscope and goniometer techniques, with the only statistically significant difference being an average of 1 degree of wrist flexion; however, the authors experienced some technical difficulties when using the gyroscope application, such as its inability to detect the position of the forearm relative to the hand, and needing to subtract the initial angle from the measured angle. The authors conclude that these difficulties present a barrier for patient use of the application for self-assessment. The authors recommend additional features that could increase the application’s ease of use, such as a reset button for starting position or a strap to secure the phone to the dorsal hand. Further research is recommended to refine the use of the application in a rehabilitation setting.

Nuphar Lendner, Erik Wells, Idit Lavi, Yan Yan Kwok, Pak-Cheong Ho, Ronit Wollstein. Utility of the iPhone 4 Gyroscope Application in the Measurement of Wrist Motion. HAND 2019 14(3): 352-356

Journal Source: HAND

Access the Journal Abstract 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

Early Versus Late Motion Following Volar Plating of Distal Radius Fractures
Summary provided by Nancy Naughton, OTD, OTR/L, CHT

Following a distal radius fracture, does early motion have better outcomes than late motion?

A prospective clinical trial randomly assigned 33 patients following a distal radius fracture with volar plate fixation to either an early motion or late motion group.

The early motion group began by 14 days post-surgery and included both active and passive ROM. The late motion group received the same treatment but began at five weeks post-surgery. Outcomes of interest included motion, strength, DASH and the PRWE. All outcomes were assessed through one year. The early motion group had improved outcomes up to the six-week interval. There were no differences between groups for long term outcomes.

The late motion group had two complications: one patient developed CRPS and the other developed adhesive capsulitis. This led the authors to question if delayed motion may lead to potential complications not found with patients receiving early motion.

David G. Dennison, Charlene L. Blanchard, Bassem Elhassan, Steven L. Moran, Alexander Y. Shin. Early Versus Late Motion Following Volar Plating of Distal Radius Fractures. Hand (N Y). 2020 Jan;15(1):125-130. Epub 2018 Jul 15.

Journal Source: HAND

Access the Journal Abstract 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.


April Research Update

The optimal position for arthrodesis of the proximal interphalangeal joints of the border digits
Summary provided by Lori Algar, OTD, OTR/L, CHT

Is there an optimal position for arthodesis of the PIP joints of the border digits in regards to functional performance?

This study simulated arthrodesis of the PIP joint of the index and small fingers via custom orthoses in healthy individuals. The pseudo fused positions were at 25 degrees, 40 degrees and 55 degrees of flexion for the index digit and at 30 degrees, 55 degrees and 40 degrees of flexion for the small digit. Twenty-three participants performed grip and pinch (key, tripod and pulp) strength testing with and without digit fusions as noted above and 25 participants performed the Jebsen Hand Function Test (JHFT) with and without simulated arthrodesis also as noted above in order to assist with gathering information on preferred positioning for border digit arthrodesis. The authors conclude that no border digit PIP joint fusion position was superior related to grip and pinch strength; however, index digit PIP joint fusion at 40 degrees and small digit PIP joint fusion at 55 degrees might be preferred based on performance on the JHFT.

Fram, BR, Seigerman DA, Cross DE, et al. The optimal position for arthrodesis of the proximal interphalangeal joints of the border digits. J Hand Surg. In press

Journal Source: Journal of Hand Surgery

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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.


March Research Update

Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept
Summary provided by Nancy Naughton, OTD, OTR/L, CHT

A cadaveric study examined the viability of relative motion orthoses following a flexor tendon repair. The researchers examined four fresh frozen cadavers. A tenotomy was made in the FDP tendon of the middle fingers (zone III) and immediately repaired. The researchers measured elongation with and without the relative motion splint as well as accessing gapping of the tendon. The results revealed elongation was restricted to less than 1.3mm in repaired tendons in the relative motion flexion orthosis compared to elongation >2mm in the fingers without an orthosis. Visual inspection revealed no tendon gapping with the relative motion orthosis on. The researchers conclude that relative motion orthosis decreases elongation and eliminates tendon gapping in cadaver models. Therefore, the authors suggest that a relative motion orthosis may be a viable protective option for flexor tendon repairs. This consideration will allow for further research examining early tendon motion and less restricted hand function during the post-operative and rehabilitation phase.

Bryan Chung, David T. W. Chiu, Vishal Thanik. Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept. HAND 2019 14(2):193-196

Journal Source: HAND

Access the Journal Abstract 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.


February Research Update

Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial
Summary provided by Cindy Ivy, OTD, CHT, M.Ed

This prospective RCT of 39 subjects compares pain scores between two groups of patients who underwent volar locked plating for distal radius fractures. One group received a post-operative splint to use for two weeks, whereas the other group had a post-operative bandage. The purpose of the study was to not only compare pain scores, but also compare the use of opioid use in the two groups. The use of Tramadol was tracked while in the hospital through the records and at home through a form that the patient filled out. The Disabilities of the Arm Shoulder and Hand score was assessed at six, 12 and 24 weeks and wrist flexion/extension and forearm rotation were assessed at two, six, 12 and 24 weeks by evaluators who were blinded to the treatment group. In addition, a pain scale, edema, a patient satisfaction scale and radiographs were obtained at set intervals. Although there was not a significant difference in pain scores or in Tramadol use, there was a trend toward higher Tramadol use in the no splint group. The authors determined this to be clinically relevant due to the possible harm from opioid use. They also had one subject in the no splint group who lost the fracture reduction; however, this low number is not significant and does not imply causation. The researchers’ data showed no difference in functional outcomes, edema or patient satisfaction between the two groups. The study shows a trend of increased opioid use in the no splint group/early wrist mobilization group with no difference in pain, satisfaction or functional outcomes between the two groups. The fact that the no splint group was using more Tramadol may influence the comparison of pain scores. The authors point out that reasons for immediate immobilization include osteosynthesis protection and controlling pain caused by active and involuntary movements during the early postoperative phase of healing.

F.B. Andrade-Silva, et al., Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial, Injury (2018), Volume 50, Issue 2, Pages 386-391. February 2019

Journal Source: Injury

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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.
 


January Research Update

A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient​
Summary provided by Nancy Naughton, OTD, OTR/L, CHT

A prospective randomized controlled trial compared open and endoscopic carpal tunnel release techniques. The goal was to prospectively examine various outcomes, patient satisfaction and complications after both ECTR and OCTR in the opposite hands of the same patient. Thirty subjects with bilateral CTS were included and underwent surgical release with both techniques.

Several outcome measures were utilized and included pain score, two-point discrimination, Semmes-Weinstein monofilament testing, thenar strength testing, grip strength, carpal tunnel syndrome functional status score, carpal tunnel syndrome symptom severity score and overall satisfaction.

The results reflected no significant differences in any measure at any of the postoperative time points.  Although pain scores were not found with a statistically significant difference, 24 of 30 patients subjectively reported a preference for the endoscopic technique, citing pain as the primary reason. The authors concluded no difference in outcomes with either technique and due to the increased cost and equipment associated with ECTR, the usefulness of ECTR is questionable.

Brett M. Michelotti, Kavita T. Vakharia, Diane Romanowsky, Randy M. Hauck. A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient. HAND Nov. 2017

Journal Source: HAND

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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.

 


2019 Research Updates

 

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 Abstract 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.


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 Abstract 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.
 


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.   

Access the Journal Abstract 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 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   

Access the Journal Abstract 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.


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 Abstract 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.


2018 Research Updates

August Research Update

Low-Intensity Pulsed Ultrasound for Nonoperative Treatment of Scaphoid Nonunions: A Meta-Analysis
                    
Scaphoid fractures have high nonunion rates, which can be from 5% to 10% in nondisplaced fractures and up to 45% in displaced fractures. Standard treatment in these cases is surgery. However, not all patients are optimal surgical candidates or amenable to surgical intervention; a comprehensive review of current literature is needed to assess these nonoperative methods of healing. Low-intensity pulsed ultrasound (LIPUS), a noninvasive treatment using a pulsed 30 mW/cm2 ultrasound signal for 20-minute intervals per day over a period of several weeks, has been shown to improve fracture nonunion healing. This study performed a meta-analysis to determine LIPUS success for treatment of scaphoid nonunion. The authors found 166 nonunions across five studies with a combined healing percentage of 78.6% and average time to union of 4.2 months. These high success rates were seen with multiple fracture types, as well as in cases where LIPUS was attempted following different failed treatments. The results are encouraging in which these challenging fractures can heal without further surgical intervention in the majority of patients. 

Journal Source: Hand
Edward W. Seger et al. "Low-Intensity Pulsed Ultrasound for Nonoperative Treatment of Scaphoid Nonunions: A Meta-Analysis. Hand. Volume 13, Issue 3, Pages 275-280. Issued published: May 1, 2018. 

Access the Journal Abstract Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


July Research Update

Impact of Axillary Web Syndrome on Function, Shoulder Motion, Pain and Lynohedema in Post-surgical breast cancer
                    
A longitudinal prospective cohort study followed 36 women using a repeated measures design. Physical therapy treatment was only provided if ordered by the subject’s physician and was not necessarily provided by the authors. Axillary web syndrome (AWS) can develop following breast cancer surgery and may present either as a visible or palpable cord in the axilla. Subjects were divided into two groups based on presence or absence of AWS, regardless of when it occurred. Measures assessed included presence of AWS, DASH, shoulder active and passive range of motion, pain and lymphedema. These measures were recorded at 2, 4, and 12 weeks, and again at 18 months post-surgically. At the 12-week assessment, subjects were provided verbal and written education by a physical therapist in lymphedema precautions, signs and symptoms, and description of lymphedema treatment. This may have resulted in a treatment effect in that 12 women received lymphedema treatment during the 18-month period. Thirty-two subjects completed all assessments (4 were lost to follow up for the 18-month assessment). Physical impairments in one or more areas were noted in 66-97% of subjects at one or more visits. The cumulative prevalence of AWS was 50% and it was found to persist at least as long as 18 months, recur after resolution, and to develop beyond the early post-operative period. The authors found that women with AWS had lower BMI and a greater number of lymph nodes removed. AWS was also found to be associated with reduced shoulder range of motion and long term functional impairment. There was no apparent effect by AWS on pain and lymphedema (possible treatment effect from education). The findings of AWS-related impairments and that only 36% of subjects received rehabilitative treatment at least once indicates a need for increased attention to physical impairments in this population. 

Journal Source: Physical Therapy
Linda A. Koehler, David W. Hunter, Anne H. Blaes, Tufia C. Haddad. "Function, Shoulder Motion, Pain, and Lymphedema in Breast Cancer With and Without Axillary Web Syndrome: An 19-Month Follow-Up. Physical Therapy. Volume 98, Issue 6, 1 June 2018, Pages 518-527. 

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


June Research Update

A prospective randomized study investigated if includion of the thumb MCP joint is necessary in orthoses for individuals with thumb CMC joint osteoarthritis.
                    
Sixty six patients were randomly assigned to equal groups. One group had a custom fabricated orthosis that included the MCP joint while the other group’s orthosis immobilized the CMC joint only.  Both groups received identical wearing schedules and were fabricated from the same thermoplastic material. The main outcome measures were the Quick DASH and the VAS.  Both groups achieved statistically significant differences for pain and function. No significant differences were found by including or not including the MCP joint of the thumb for pain or function. Likewise, an orthosis is found to be an effective sole treatment intervention in the conservative treatment of thumb CMC joint OA.

Journal Source: Hand
Cantero-Téllez R, Valdes K, Schwartz DA, Medina-Porqueres I, Arias JC, Villafañe JH. Necessity of Immobilizing the Metacarpophalangeal Joint in Carpometacarpal Osteoarthritis: Short-Term Effect. Hand.  2017 1-6.

Access the Journal Abstract Here

Note: For non Journal of Hand Therapy articles: If you or your institution cannot access the complete article via the link, please contact Aviva Wolff, ASHT Research Division Director at wolffa@hss.ed


April Research Update

What does the evidence say regrding surgical versus nonsurgical management in the treatment of mallet finger injuries?
                    
This systematic review included forty-four studies examining clinical outcomes of mallet finger management. Twenty-two of the studies evaluated operative treatment, seventeen conservative treatment, and five compared operative versus nonoperative treatment. The included articles studied a variety of surgical techniques and orthotic interventions. Fracture size of >1/3 the joint surface area and subluxation of the distal phalanx were the most frequently described indications for surgery. However, the authors of this study concluded that there is insufficient evidence to determine when surgical intervention is indicated. One conservative management study specifically examined fracture sizes >1/3 of the joint surface area, and achieved an average 9-degree extension lag with thermoplastic orthotic intervention, supporting the use of an orthosis in the management of these cases. Across studies, the average DIP joint extension lag for surgical treatment was 5.7 degrees, with a complication rate of 14.5%. For nonsurgical management, the average DIP extension lag was 7.6 degrees with a complication rate of 12.8%. The study concluded both interventions result in favorable clinical outcomes, and that an individualized treatment approach is appropriate. 

Journal Source: Journal of Hand Surgery
Lin JS, and Samora JB. Surgical and nonsurgical management of mallet finger: A systematic review. Journal of Hand Surgery. February 2018. Volume 43, Issue 2, Pages 146-163.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.ed


March Research Update

Do cadaveric studies demonstrate a dose dependent relationship for loading of the OP and the FDI for thumb CMC joint subluxation?
                    
A recent cadaveric study examined the effect of applying 0%, 25%, 50%, 75% and 100% loads to the first dorsal interosseous (FDI) and opponens pollicis (OP) on subluxation at the thumb CMC joint. Findings suggest that selective activation of the OP alone did reduce subluxation, while activation of the FDI alone did not. Activation of both the OP and FDI improved subluxation to within 10% of pre-subluxed state with 75% or greater load to the FDI and OP. The authors conclude that activation of the FDI and OP reduces subluxation of the thumb CMC joint in a dose-dependent fashion and that the OP is likely the major reducing force and therefore requires emphasis in a hand therapy program for arthritis at the thumb CMC joints. 

Journal Source: Hand
Adams JE, O’Brien V, Magnusson E, Rosenstein B, Nuckley DJ. First dorsal interosseous and opponens pollicis loading upon thumb CMC joint subluxation: a cadaver study. Hand. 2018. 13: 40-44.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


2017 Research Updates

December Research Update

Is the use of a nighttime-only orthosis effective in decreasing symptoms of trigger finger?
                    
A sample of 46 individuals with Quinnell grade I or 2 trigger fingers (actively correctable symptoms for less than three months) were issued a custom orthosis for night wear only to be used for six weeks. The orthosis was an MCP block orthosis with the IP joints free for the digits or a hand-based thumb spica including the IP for the thumb. Fifty-three percent of the 34 participants who did follow-up had complete resolution of symptoms, and pain and function according to the Quick DASH improved following the six weeks of orthosis use for these participants. Satisfaction with the treatment was rated as 5.8/10 with greater satisfaction among the participants with resolution of their symptoms. 

Journal Source: Hand
Drijkoningen T, van Berckel M, Becker SJ, Ring DC, Mudgal CS. “Night splinting for idiopathic trigger digits.” Hand. 2017; Aug 1: 1558944717725374.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


November Research Update

New rehab program for wrist instability shows promising outcomes  
                    
Six patients with stage 1 scapho-lunate ligament injury participated in The Birmingham Wrist Instability Programme, a program that targets proprioceptive training for wrist instability over a 16 month period.  Following participation in the program, improvements were reported in this small pilot cohort for grip strength, pain, and self-reported outcomes (DASH & Euro-Qol).  These early findings suggest promising outcomes of this type of intervention for SL injury rehabilitation. 

Journal Source: Hand Therapy
Holmes MK, Taylor S, Miller C, and Brewster MBS. "Early outcomes of The Birmingham Wrist Instability Programme: A pragmatic intervention for stage one scapholunate instability." Hand Therapy. 2017.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


October Research Update

Are there patient and clinical characteristics that predict health status and recovery of hand function after hand burn injury?  
                    
A sample of 41 community dwelling adults (80.5% males) who were between one and two years after admission to a burn clinic for treatment of burns to one or both of their hands were asked to complete the Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ). These questionnaires in addition to their demographic, injury and treatment data were used to identify predictors of outcomes. The researchers found that psychiatric illness and female gender were key predictors of poorer global status on the BSHS-B. In addition, the need for reconstructive surgery and female gender were important predictors of poorer hand function, leading the researchers to conclude that individuals with these characteristics might benefit from intensive rehabilitation support and long-term follow-up. 

Journal Source: Burns
Knight A et al. "Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge." Burns. 2017.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


September Research Update

Does underwater ultrasound affect pain, inflammation, hand function and quality of life in patients with rheumatoid arthritis?   
                    
Previous research results have already confirmed the effects of ultrasound therapy on pain and function in a range of musculoskeletal disorders. In this randomized controlled trial, 25 patients received seven minutes of underwater ultrasound at 0.7W/cm2 for 10 sessions to both hands and wrists. The 23 patients in the control group received sham treatment under the same conditions. The researchers found promising short-term (two-week post-treatment) effects of underwater US therapy on pain, quality of life and joint function in patients with rheumatoid arthritis, but in the long-term (14 weeks post-treatment) ultrasound was not superior to sham treatment.

Journal Source: Brazilian Journal of Physical Therapy
Kiraly M. et al. “Effects of underwater ultrasound therapy on pain, inflammation, hand function and quality of life in patients with rheumatoid arthritis - a randomized controlled trial.” Brazilian Journal of Physical Therapy. 2017.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


August Research Update

What is the optimal method for rehabilitating LCL (lateral collateral ligament) injury of the elbow?                                   
In this study, LCL injury, LCL with common extensor origin injury and an intact elbow was actively and passively tested in seven cadavers in three arm positions (overhead, dependent and varus) and two forearm positions (pronation and supination). The researchers conclude that rehabilitation with the arm overhead is the most stable, and might decrease stiffness and promote ligament healing. If rehabilitation occurs in the dependent position, active pronation is encouraged. Varus arm position was found to be the least stable and is discouraged. .

Journal Source: Journal of Shoulder and Elbow Surgery
Manocha, Ranita HK, et al. "Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study." Journal of Shoulder and Elbow Surgery. 26.4 (2017): 596-603.

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


July Research Update

Does wearing a thumb spica or wrist immobilization impact driving performance?                                   
A cohort of 20 healthy subjects completed a cone-marked driving course with four forms of below-elbow immobilization (short-arm cast, wrist orthosis, thumb spica cast and spica orthosis) and without any immobilization. The outcomes measures included pass/fail score from a certified driving instructor, subject-perceived difficulty, number of cones hit and driving time. The researchers found the greatest number of failing scores from a certified driving instructor occurred with use of a right or left thumb spica cast. All forms of immobilization with the exception of the left wrist orthosis increased subject-perceived difficulty compared to the control run, but there was no difference in number of cones hit or driving time in the different situations.

Journal Source: Injury
Jones, E.M., Barrow, A.E., Skordas, N.J., Green, D.P. and Cho, M.S. The effects of below-elbow immobilization on driving performance. Injury. 2017

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


June Research Update

The time has come to update our norms for grip and pinch measures!                                   
A new pilot study found statistically significant differences in hand grips strength in a group of 120 healthy subjects compared to the norms established by Mathiowetz et al over 30 years ago. The new study stratified data by gender, age and handedness and found differences across several groups. Negative differences were more frequent than positive differences, particularly in subjects under the age of 45. These preliminary findings suggest that overall as a population this group has decreased hand grip strength compared to previous populations. The authors conclude that further testing in a larger group is necessary in order to update normative standards to reflect current ability for use in clinical practice.

Journal Source: Computers in Biology and Medicine
Larson, C.C. and Ye, Z. Development of an updated normative data table for hand grip and pinch strength: A Pilot Study. Computers in Biology and Medicine. 2017

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


May Research Update

New study finds that a combination of occupation based intervention and therapeutic exercise produces better recovery than therapeutic exercise alone in hand injured people.                                   
Limited evidence is available to support Occupation Based Intervention (OBI), a therapeutic agent that utilizes occupations (e.g. ADLs, IADLs, work, leisure etc.) and purposeful activity (e.g. writing practice, shoelace tying, shirt buttoning etc.) as a treatment medium. The purpose of this study was to investigate the efficacy of OBI and therapeutic exercise (i.e. assisted AROM/PROM, AROM and strengthening) in comparison to therapeutic exercise alone in hand injury rehabilitation practice. They found that a combination of OBI and therapeutic exercise produced better recovery according to DASH scores, total active motion, neuropathic pain, COPM performance and COPM satisfaction than TE alone in patients with hand injury.

Journal Source: The Journal of Hand Therapy

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April Research Update

Does sensory relearning via the performance of sensory re-education activities improve tactile function for individuals with chronic numbness greater than one year status post carpal tunnel release?    
 A recent prospective, randomized controlled trial out of the UK suggests that a home exercise program of short intensive daily sensory re-education tasks did not significantly impact tactile gnosis (measured via the Shape Identification Test), touch threshold, performance on the locognosia test, and outcome of the Moberg Pick-up Test for individuals with at least minor numbness and difficulty using small objects one year or more after carpal tunnel release. The authors (Jerosch-Herold and colleagues) did find a small change in patient reported function through the Michigan Hand Outcome Questionnaire, but cautioned that this did not meet clinical significance and may have been affected by study drop outs who had low self-reported functional statuses at the start of the study. The study concludes that sensory relearning for chronic sensory and functional deficits after carpal tunnel decompression is not effective.

Journal Source: The Journal of Hand Surgery (European Volume)

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.


March Research Update

Can Goniometric Measurements Be Influenced By Examiner Bias?
A new study from the Physical Therapy Department of Hadassah Medical Center in Jerusalem suggests that information provided to physical therapists prior to wrist range of motion assessment was associated with differential results of objective goniometric measurement of the wrist. Therapists received different information regarding the clinical condition of a healthy woman with no history of wrist injury. Therapists who were told the injury and outcome were more severe consistently measured the wrist motion as more limited, suggesting cognitive bias.

Journal Source: Journal of Orthopaedic and Sports Physical Therapy

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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 Aviva Wolff, ASHT Research Division Director at wolffa@hss.edu.