Margo Sheerin

Purpose: To evaluate the effectiveness of therapy-led conservative management of acute hand injury in adults when compared to medical-led, care as usual. Design: Cluster non-randomised trial. Setting: Four intervention sites and one control site, acute hospitals providing emergency care for hand injuries. Participants: Adults (18 years +) with acute hand injuries, such as hand fracture, mallet, volar plate and central slip injuries. Intervention: The intervention group had access to therapy-led hand therapy management of their hand injury, compared to care as usual. Main measures: Standardised outcome tools measuring function, health-related quality of life, pain, and occupational value and competence were completed at baseline, 8 weeks and 6 months. Results: A total of 133 participants were recruited (intervention, n = 67; control, n = 66). Baseline demographics of participants were similar between groups. There was no statistically significant between-group differences in the primary outcome of QuickDASH function at 8 weeks (mean difference −0.05; 95% CI −6.41 to 6.3; p = 0.99) or 6 months (mean difference −1.74; 95% CI −6.35 to 2.87; p = 0.46), or in the secondary outcomes at each time point. However, the difference in scores across time was statistically significant for the primary outcome ( p < 0.001), and a number of secondary outcomes. The intervention group had a significantly lower number of onward referrals ( p < 0.001) and a reduced number of healthcare contacts. Conclusion: No statistically significant differences were detected between groups on primary or secondary outcomes, suggesting comparable functional recovery between therapy-led and medical-led pathways, while requiring fewer healthcare contacts and onward referrals. Greater utilisation of therapy-led pathways is indicated in the management of hand injury. Registration: ClinicalTrials.gov (NCT06399614).

Hand injuries account for up to one third of acute hospital presentations. Current guidelines and standards of care recommend patients with hand trauma are seen by hand therapists, typically occupational therapists. This study explored the feasibility of implementing an occupational therapy–led hand therapy service for adults presenting acutely with a hand condition, using the RE-AIM framework. Purposeful sampling was used to recruit adult participants ( n = 13). Outcome measures assessing function, health-related quality of life, pain, and occupational value and competence were completed. Focus groups were completed with patients and health care professionals. Data analysis revealed improvements in outcome measures post intervention and at 6-month follow-up. Participants were receptive of therapy-led services, and barriers and facilitators to service integration were identified using the RE-AIM framework. Occupational therapy–led hand therapy clinics show potential in treating people with acute hand conditions at emergency department settings, based on RE-AIM evaluation.

Background Functional hand use post injury is important in enabling a person’s engagement in daily living tasks. Without proper treatment, there may be difficulties in self-care, engaging in job roles, or leisure pursuits. Occupational therapists are key health care practitioners for people with upper limb conditions. This systematic review aims to appraise and summarise current evidence regarding effectiveness of occupational therapy interventions among adults with conditions of the hand, wrist, and forearm. Methods A systematic review of randomised control trials and quasi randomised controlled trials will be completed. MEDLINE OVID, CINAHL, CENTRAL, COCHRANE, PUBMED and EMBASE databases will be systematically searched. Grey literature will be searched for via Google Scholar. Studies will be included if they include provision of occupational therapy to adults with a hand, wrist, or forearm condition when compared to treatment as usual or an alternative treatment option. The primary outcome will be function. Secondary outcomes will include satisfaction with occupational performance, quality of life, pain experience, and participation. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions will be used to categorise outcomes. The Cochrane Risk of Bias 2 (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework will be utilised to assess quality. A pooled meta- analysis will be completed using RevMan, depending on the uniformity and availability of data. Results This review aims to synthesise high quality evidence to identify the effectiveness of occupational therapy interventions with patients with a hand, wrist, or forearm condition, categorising outcomes in relation to the ICF Core Set for Hand Conditions. Conclusions By synthesising the evidence there is potential for improved evidence base for clinicians; improved outcomes for patients; as well as potential economic benefit. This study is registered with PROSPERO: CRD42022337070.

Introduction: Upper extremity injuries are common, and often treated by occupational therapists. The need to evaluate the effectiveness of occupational therapy interventions to guide practice is pertinent. This systematic review and meta-analysis investigate the effectiveness of occupational therapy-led computer-aided interventions among adults with conditions of the hand, wrist, and forearm. Methods: A systematic literature search of five databases was undertaken for randomized studies examining occupational therapy-led computer-aided interventions for the treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of pain, grip and pinch strength. The quality of the included studies was independently assessed using the Cochrane Risk of Bias V2 tool. Meta-analyses were completed. Results: Three randomized controlled trials were included with 176 participants. One study reported on app use on a tablet and two studies reported on computer gaming. Participants had a variety of hand and wrist diagnoses, treated both conservatively and operatively. There is limited evidence demonstrating that computer-based interventions are as effective as other occupational therapy-led interventions in improving function, pain, grip and pinch strength post-intervention, including small effect size following meta-analysis: grip strength (Fixed Effects Model, SMD 0.13, 95% CI 2.63; –2.36, I² = 0%) and pinch strength (Fixed Effects Model, SMD –0.12, 95% CI 1.25; -1.50, I² = 11%). Conclusions: Limited evidence was found to support the use of computer-aided interventions for adults with a hand, wrist or forearm injury. Further high-quality research is recommended inclusive of a broader range of technologies and a broader range of clinical and patient-reported outcome measures.

Introduction: This systematic review and meta‐analysis examines the effectiveness of occupational therapy interventions for adults with conservatively managed conditions of the hand, wrist, and forearm.Methods: Searches were carried out in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, MEDLINE (OVID), EMBASE, and PubMed. Grey literature was searched for via Google Scholar. A systematic literature search was undertaken for randomised studies that examined occupational therapy interventions for treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of occupational performance, satisfaction with occupational performance, pain, and quality of life. Meta‐analyses were completed, and GRADE was used to determine the certainty of evidence.Results: Twelve studies with 1429 participants were identified. Interventions included combinations of occupation‐based intervention, assistive device provision, education, orthosis provision, and exercise programmes for arthritis, carpal tunnel syndrome, and fracture and tendon injuries of the hand, wrist, and forearm. Occupational therapy resulted in an improvement of function (REM, SMD −0.27, 95% CI −0.00 to −0.53, I² = 69%, low certainty evidence) (p = 0.05), occupational performance (REM, SMD 0.83, 95% CI 1.61–0.06, I² = 91%, low certainty evidence) (p = 0.04), satisfaction with occupational performance (REM, SMD 0.74, 95% CI 1.42–0.05, I² = 89%, low certainty evidence) (p = 0.03), and pain reduction (FEM, MD −1.35, 95% CI −0.84 to −1.86, I² = 0%, moderate certainty evidence) (p < 0.00001).Conclusion: Further high‐quality research is recommended to determine the effects of occupational therapy interventions on specific upper limb conditions, inclusive of a broader range of clinical and patient reported outcome measures.

Background: Functional hand use post injury is important in enabling a person’s engagement in daily living tasks. Without proper treatment, there may be difficulties in self-care, engaging in job roles, or leisure pursuits. Occupational therapists are key health care practitioners for people with upper limb conditions. This systematic review aims to appraise and summarise current evidence regarding effectiveness of occupational therapy interventions among adults with conditions of the hand, wrist, and forearm. Methods: A systematic review of randomised control trials and quasi randomised controlled trials will be completed. MEDLINE OVID, CINAHL, CENTRAL, COCHRANE, PUBMED and EMBASE databases will be systematically searched. Grey literature will be searched for via Google Scholar. Studies will be included if they include provision of occupational therapy to adults with a hand, wrist, or forearm condition when compared to treatment as usual or an alternative treatment option. The primary outcome will be function. Secondary outcomes will include satisfaction with occupational performance, quality of life, pain experience, and participation. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions will be used to categorise outcomes. The Cochrane Risk of Bias 2 (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework will be utilised to assess quality. A pooled meta- analysis will be completed using RevMan, depending on the uniformity and availability of data. Results: This review aims to synthesise high quality evidence to identify the effectiveness of occupational therapy interventions with patients with a hand, wrist, or forearm condition, categorising outcomes in relation to the ICF Core Set for Hand Conditions. Conclusions: By synthesising the evidence there is potential for improved evidence base for clinicians; improved outcomes for patients; as well as potential economic benefit. This study is registered with PROSPERO: CRD42022337070.