The evidence on ways to improve patient's adherence in hand therapy

A description of the barriers, facilitators, and experiences of hand therapists in providing remote (tele) rehabilitation: An interpretive description approach

BACKGROUND

Telerehabilitation is increasingly being used to meet the rehabilitation needs of situations where face-to-face therapy is not possible. Nevertheless, reports on barriers and facilitators of implementing this method from the perspective of therapists still need to be made available.

PURPOSE

To investigate the experiences of hand therapists when implementing telerehabilitation, examining the difficulties, barriers, and facilitators encountered during its implementation.

STUDY DESIGN

Qualitative study.

METHODS

This study used a purposive sampling method to recruit therapists with varying experiences in telerehabilitation and conducted semi-structured interviews. Data collection and analysis continued iteratively until thematic saturation was achieved. A total of 14 therapists were interviewed via Zoom. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The process of interpretive description guided interviews and analysis of the interviews to identify key barriers and facilitators in providing telerehabilitation.

RESULTS/DISCUSSION

Six main themes and 10 corresponding sub-themes were constructed concerning facilitators and barriers to telerehabilitation: factors related to the patient, therapy, therapists, injury, technology, and policy. Therapists implemented different coping strategies in their interventions and measurements to facilitate treatment. However, some interventions, such as orthotic fabrication, could not be done online. Educating therapists, providing a standard method, and integrating with in-person rehabilitation can overcome the barriers to telerehabilitation in hand therapy.

CONCLUSIONS

Technology was the main facilitator and, on the other hand, a barrier to providing online hand therapy interventions. Therapists generally reported high satisfaction and usability of this method. Despite all barriers, telerehabilitation can be implemented as a part of hand therapy interventions alongside face-to-face therapy as a hybrid method. The barriers and facilitators experienced and raised by therapists can be added to what is already known regarding telerehabilitation in hand therapy. They might be applied to guide therapeutic procedures and upcoming studies.

The role of therapist-patient relationships in facilitating engagement and adherence in upper extremity rehabilitation

BACKGROUND

Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.

OBJECTIVE

To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.

METHODS

Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.

RESULTS

SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.

CONCLUSION

In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study

INTRODUCTION

Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem.

PURPOSE OF THE STUDY

This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Two hundred twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 h a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence.

RESULTS

One hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01].

CONCLUSIONS

Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence.

An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial

BACKGROUND

Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated.

OBJECTIVE

This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands.

METHODS

A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups.

RESULTS

In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F_1.62,85.67=9.163; P<.001; η²=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05).

CONCLUSIONS

Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-020-04713-4.

Use of mobile applications in hand therapy

INTRODUCTION

Mobile devices can be incorporated into therapy as an engaging alternative to traditional therapy options. The use of mobile devices and smartphone applications can enhance the quality of care provided by health care professionals.

PURPOSE

To find mobile apps that can be incorporated into hand therapy practice.

METHODS

Hand therapy evaluation, interventions, proprioception, laterality, and home exercise program applications can be incorporated into practice. Patient education can also be provided via the use of mobile applications.

CONCLUSION

Smartphone applications can be a valuable intervention and impact performance in individuals with impaired hand function. Smartphone applications offer a client-centered, and potentially motivating, activity option that can be utilized to aid the hand therapist.

The effects of an 8-week knitting program on osteoarthritis symptoms in elderly women: A pilot randomized controlled trial

BACKGROUND

Exercise therapy is effective in reducing symptoms and disability associated with hand osteoarthritis (HOA) but often has low adherence. An intervention consisting in a meaningful occupation, such as knitting, may improve adherence to treatment. This pilot randomized controlled trial (RCT) studied the adherence and clinical effectiveness of a knitting program in older females suffering from HOA to evaluate the acceptability of this intervention and assess the feasibility of a larger-scale RCT.

METHODS

Single-blind, two-arm pilot RCT with a parallel group design with 37 participants (18 control, 19 intervention). Control participants were given an educational pamphlet and assigned to a waiting list. The knitting program (8-week duration) had two components: bi-weekly 20-min group knitting sessions and daily 20-min home knitting session on the 5 remaining weekdays. Measures included knitting adherence (implementation outcomes) as well as stiffness, pain, functional status, hand physical activity level, patient's global impression of change, health-related quality of life, self-efficacy, and grip strength (clinical outcomes measured throughout the 8-week program and 4 weeks after the intervention).

RESULTS

Our protocol is feasible and the intervention was acceptable and enjoyable for participants, who showed high adherence. No difference was observed between the two groups for any of the clinical outcome measures (all p > .05).

CONCLUSION

Knitting is a safe and accessible activity for older women with HOA. However, our 8-week knitting program did not result in improvements in any of our outcome measures. Knitting for a longer period and/or with higher frequency may yield better outcomes.

Effects of client-centered multimodal treatment on impairment, function, and satisfaction of people with thumb carpometacarpal osteoarthritis

STUDY DESIGN

Prepost design.

INTRODUCTION

Previous research regarding the non-surgical treatment of thumb carpometacarpal joint osteoarthritis has been based on protocol driven research designs that primarily examined impairment level changes. Exploration is therefore needed to determine the benefits of individually prescribed orthoses, joint protection and assistive device education programs that are based on the activities the person needs to regularly perform.

PURPOSE OF THE STUDY

The primary objective of this study was to examine the effect of client-centered multimodal treatment on activity, participation, impairment, and satisfaction of people with thumb carpometacarpal joint osteoarthritis.

METHODS

A total of 60 participants completed the study that used a prepost design. The Canadian Occupational Performance Measure (COPM) was used to identify the participants' performance and satisfaction concerning their self-identified occupational performance issues. Additional outcome measures that were used included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, total active range of motion (TAROM), lateral pinch strength, and the visual analog scale for pain. All participants completed a client-centered 6-week program that consisted of the use of an orthosis, joint protection, and assistive device education as well as exercises.

RESULTS

At 6 weeks after initiation of treatment, pain, pinch strength, TAROM, the DASH questionnaire and the performance and satisfaction scales of the COPM had significantly improved. The changes in pain, TAROM, and the performance and satisfaction scales of the COPM were all greater than the minimal clinically important difference. The changes in pain and lateral pinch strength were significantly associated with changes in activity and participation.

DISCUSSION

This study demonstrated that a multimodal, client-centered treatment approach resulted in statistically and clinically significant improvement in pain, TAROM and performance and satisfaction as measured by the COPM. The improvement in pain was associated with the participants' improved ability to engage in activities assessed by the DASH.

CONCLUSIONS

Our results support the use of client-centered treatment strategies that are targeted to control pain during meaningful activity when working with patients with thumb carpometacarpal joint osteoarthritis therapists.

LEVEL OF EVIDENCE

4.

Adherence behavior in an acute pediatric hand trauma population: A pilot study of parental report of adherence levels and influencing factors

INTRODUCTION

Descriptive and cross-sectional study.

PURPOSE OF THE STUDY

The hand is a common site of injury in children; however, little is known regarding adherence to hand trauma management in this population.

PURPOSE

This pilot study aimed to describe adherence to plaster slab immobilization, advice regarding return to sport, appointment attendance, and the factors influencing nonadherence.

METHOD

Forty-seven parents of children with hand trauma completed an online questionnaire reporting their child's adherence to the initial medical management.

RESULTS

Parents reported that 34% (16 of 47) of children were adherent to all aspects of management. Nonadherence with plaster slab immobilization was reported by 38% (18 of 47), and 45% (21 of 47) reported nonadherence with advice regarding return to sport. Hygiene, discomfort, and restriction were the most common reasons for plaster removal. Belief that sport would not cause harm and social factors influenced return to sport against medical advice.

CONCLUSION

Nonadherence behavior is commonly reported in children with acute hand trauma.

LEVEL OF EVIDENCE

4.

Utilizing everyday items in play to facilitate hand therapy for pediatric patients

This article describes how hand therapy for pediatric patients can be enhanced through the use of play with everyday items. Playful activities integrate purposeful hand skills of pinch, grasp and manipulation, while encouraging the child to fully participate in therapy and home programs. By referring to Takata's developmental hierarchy of play, therapists can design the sessions to include novel, fun and age appropriate activities. The author offers eight sample activities for specific therapy goals utilizing inexpensive, everyday items.

Custom-Made Finger Orthoses Have Fewer Skin Complications Than Prefabricated Finger Orthoses in the Management of Mallet Injury: A Systematic Review and Meta-Analysis

OBJECTIVE

To investigate which orthosis results in (1) fewer complications; (2) the least extensor lag; and (3) the highest rates of treatment success according to the Abouna and Brown criteria for soft tissue mallet injury in adults.

DATA SOURCES

Electronic databases AMED, CINAHL, Embase, MEDLINE, PubMed, OTseeker, and PEDro were searched from the earliest available date until September 16, 2014.

STUDY SELECTION

Controlled trials evaluating orthosis type in the conservative management of mallet injury were included. Database searching yielded 1024 potential studies, of which 7 met inclusion criteria with a total of 491 participants.

DATA EXTRACTION

Data were extracted using an author-designed extraction form by one reviewer, and accuracy was assessed by a second reviewer. The PEDro scale was used to assess methodological quality.

DATA SYNTHESIS

Results were pooled using a random-effects model with inverse variance methods. Dichotomous outcomes are expressed as risk ratios (RRs) and 95% confidence intervals (CIs) and continuous outcomes as standardized mean differences and 95% CIs. There is moderate quality evidence that prefabricated orthoses had 3 times the risk of developing skin complications as compared with all other orthoses (RR, 3.17; 95% CI, 1.19-8.43; I(2)=47%) and nearly 7 times the risk of developing skin complications as compared with custom-made thermoplastic orthoses (RR, 6.72; 95% CI, 1.59-28.46; I(2)=0%). Treatment outcomes were found to be similar for treatment success when prefabricated orthoses were compared with custom-made orthoses (RR, .99; 95% CI, 0.80-1.22; I(2)=39%; very low quality evidence), as well as for extensor lag when custom-made thermoplastic orthoses were compared with other orthoses (standardized mean difference, .03; 95% CI, -.29 to .36; I(2)=0%; moderate quality evidence).

CONCLUSIONS

Prefabricated orthoses were found to increase the risk of developing skin complications as compared with custom-made orthoses, but there were no differences in treatment success, failure, or extensor lag.

Sleight of hand: magic, therapy and motor performance

Finding creative therapeutic activities to help patients regain range of motion and strength in fun ways are keys aspects to many rehabilitation programs. These authors examine the use of magic tricks as a way to enhance a hand therapy program - Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial

BACKGROUND

Hand exercises are recommended for patients with hand osteoarthritis (HOA), though evidence for their effect is conflicting.

OBJECTIVE

To evaluate, in a randomised controlled trial, the effect of HOA information plus home-based hand exercises (exercise group) compared with information only (control group) in women with HOA.

METHODS

Interventions were delivered by two occupational therapists. Exercise group participants received eight follow-up calls over the 3-month study and recorded adherence, pain after exercises and adverse events in a diary. Primary outcome was activity performance measured after 3 months by the Patient-Specific Functional Scale (PSFS), with a range of 0-10. Secondary outcomes were measurements of hand function, disease activity, symptoms and number of responders to treatment according to the OMERACT-OARSI criteria.

RESULTS

Of 80 women randomised (40 : 40) (mean age (SD) 60.8 years (7.0)), follow-up was 89% (n=71). An intention-to-treat analysis was performed. The adjusted mean difference for the exercise versus control group was 1.4 points (95% CI 0.6 to 2.2, effect size 1.0) for the PSFS score. Thirteen patients in the exercise group versus three participants in the control group reached a positive minimal clinical important difference of 2.2 points in the PSFS total score, while none versus two, respectively, had a negative change (p=0.007). For secondary outcomes, significant mean differences were found in grip strength and thumb web space, in fatigue, joint pain and the Functional Index for HOA activity performance scores. Sixteen exercise-group participants fulfilled the OMERACT-OARSI response criteria versus two control-group participants (p<0.001).

CONCLUSIONS

Hand exercises were well tolerated and significantly improved activity performance, grip strength, pain and fatigue in women with HOA.

TRIAL REGISTRATION NUMBER

ISRTCN79019063.

Effect of educational program based on exercise therapy on burned hand function

BACKGROUND

Hands burn was associated with significant functional disorders that severely affected patient's quality of life. The aim of this study was to examine the effect of educational program based on exercise therapy on burned hand function.

METHODS

This experimental research was conducted in a period of ten months in 2010-2011 in Mottahari Hospital in Tehran in Iran. The sample included 60 patients, who were randomly assigned into experimental and control groups, half in intervention and half in control group. Educational program was implemented on experimental group. The data collection tools were two observational checklists about determining of hand function.

RESULTS

Both groups were matched in characteristic of demographic and burn injury. Subjects in experimental group demonstrated significant improvements in range of motion and hand function balance from admission to discharge.

CONCLUSION

In order to reduce the hand functional impairment caused by burns, it is recommended that special attention be paid to patient education about exercise therapy.

Rehabilitative strategies following hand fractures

The importance of rehabilitation in the management of hand fractures cannot be overstated. The breadth of rehabilitative strategies ranges from heat and range-of-motion exercises to more complex splinting and tendon gliding modalities. The goals, however, are clear: control pain; limit soft tissue swelling; provide support for fracture healing; restore motion, strength, and function; and enable the return to work and daily activities.