Effects of Occupational Therapy Intervention on Motor Function,Muscle Strength,and Pain in Adults With Hand Injuries: A Systematic Review With Meta-Analysis

Abstract

Importance:

Hand injuries impair motor function, strength, and daily activity participation. Occupational therapy is widely used, but its effectiveness requires systematic evaluation.

Objective:

To evaluate and synthesize the scientific evidence on the effectiveness of occupational therapy interventions in improving motor function, muscle strength, and pain among adults with hand injuries.

Data Sources:

Seven electronic databases (PubMed/MEDLINE, EBSCOhost, CINAHL Complete, Cochrane, ProQuest, Scopus, and Web of Science) were searched through May 2025. Additional sources included reference lists of relevant articles. The review was registered in PROSPERO (CRD420251043818).

Study Selection and Data Collection:

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Included studies involved occupational therapy interventions targeting motor function, muscle strength, and pain management in hand injury rehabilitation. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine scale, Cochrane Risk of Bias 2, and Grading of Recommendations, Assessment, Development, and Evaluation pro tools.

Findings:

Of 2,235 records, 8 studies met inclusion criteria. The meta-analysis demonstrated significant improvements after occupational therapy interventions. Motor function showed a large and significant effect (Hedges’ g = 1.53, 95% CI [0.58, 2.49], p = .002), muscle strength improved with a significant effect (Hedges’ g = 0.40, 95% CI [0.08, 0.71], p = .01), and pain decreased with a large and significant effect (Hedges’ g = 1.51, 95% CI [0.81, 2.20], p < .001) among adults with hand injuries.

Conclusions and Relevance:

Occupational therapy improves motor function, muscle strength, and pain in individuals with hand injuries, underscoring its key role in functional recovery and rehabilitation.

Plain-Language Summary

Hand injuries are common and can limit a person’s ability to eat, dress, or work independently. This study reviewed evidence from high-quality clinical trials to assess how occupational therapy supports recovery after such injuries. The results showed that occupational therapy improves hand movement, strength, and pain management, leading to better performance in daily activities. The interventions were safe, well accepted, and contributed to greater independence and quality of life. These findings support occupational therapy as an essential part of rehabilitation for hand injuries.

The authors reviewed evidence from high-quality clinical trials to assess how occupational therapy supports recovery after a hand injury.

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References

* Abolfazli

Lajevardi

Mirzaei

Abdorazaghi

H. A.

Azad

, & Taghizadeh

(2019). The effect of early intervention of mirror visual feedback on pain, disability, and motor function following hand reconstructive surgery: A randomized clinical trial. Clinical Rehabilitation, 33, 494–503. https://doi.org/10.1177/0269215518811907

American Occupational Therapy Association. (2021). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410030. https://doi.org/10.5014/ajot.2021.75S3004

Amini

(2011). Occupational therapy interventions for work-related injuries and conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 65, 29–36. https://doi.org/10.5014/ajot.2011.09186

Cantero-Téllez

Pérez-Cruzado

Villafañe

J. H.

García-Orza

Naughton

, & Valdes

(2022). The effect of proprioception training on pain intensity in thumb basal joint osteoarthritis: A randomized controlled trial. International Journal of Environmental Research and Public Health, 19, 3592. https://doi.org/10.3390/ijerph19063592

Case-Smith

(2003). Outcomes in hand rehabilitation using occupational therapy services. American Journal of Occupational Therapy, 57, 499–506. https://doi.org/10.5014/ajot.57.5.499

* Che Daud

A. Z.

Yau

M. K.

Barnett

, & Judd

(2016). Occupation-based intervention in hand injury rehabilitation: Experiences of occupational therapists in Malaysia. Scandinavian Journal of Occupational Therapy, 23, 57–66. https://doi.org/10.3109/11038128.2015.1062047

Chen

Qian

Sun

Liu

Sun

Liu

, … Fan

(2022). Effectiveness of therapeutic ultrasound for the treatment of carpal tunnel syndrome (the USTINCTS trial): Study protocol for a three-arm, prospective, multicentre, randomised controlled trial. BMJ Open, 12, e057541. https://doi.org/10.1136/bmjopen-2021-057541

Cochrane Methods. (2020). RoB 2: A revised Cochrane risk-of-bias tool for randomized trials . https://methods.cochrane.org/bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials

Cochrane Methods. (2023). GRADEpro GDT . https://methods.cochrane.org/gradeing/gradepro-gdt

10.

Crowe

C. S.

Massenburg

B. B.

Morrison

S. D.

Chang

Friedrich

J. B.

Abady

G. G.

, … James

S. L.

(2020). Global trends of hand and wrist trauma: A systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study. Injury Prevention, 26(Suppl. 2), i115–i124. https://doi.org/10.1136/injuryprev-2019-043495

11.

Darragh

A. R.

Huddleston

, & King

(2009). Work-related musculoskeletal injuries and disorders among occupational and physical therapists. American Journal of Occupational Therapy, 63, 351–362. https://doi.org/10.5014/ajot.63.3.351

12.

Davey

Turner

R. M.

Clarke

M. J.

, & Higgins

J. P. T.

(2011). Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: A cross-sectional, descriptive analysis. BMC Medical Research Methodology, 11, 160. https://doi.org/10.1186/1471-2288-11-160

13.

de Putter

C. E.

Selles

R. W.

Haagsma

J. A.

Polinder

Panneman

M. J.

Hovius

S. E.

, … van Beeck

E. F.

(2014). Health-related quality of life after upper extremity injuries and predictors for suboptimal outcome. Injury, 45, 1752–1758. https://doi.org/10.1016/j.injury.2014.07.016

14.

de Putter

C. E.

van Beeck

E. F.

Polinder

Panneman

M. J.

Burdorf

Hovius

S. E.

, & Selles

R. W.

(2016). Healthcare costs and productivity costs of hand and wrist injuries by external cause: A population-based study in working-age adults in the period 2008–2012. Injury, 47, 1478–1482. https://doi.org/10.1016/j.injury.2016.04.041

15.

Filipova

Lonzarić

, & Jesenšek Papež

(2015). Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: Randomized controlled trial. Wiener Klinische Wochenschrift, 127(Suppl. 5), S282–S287. https://doi.org/10.1007/s00508-015-0812-9

16.

* Gravås

E. M. H.

Tveter

A. T.

Nossum

Eide

R. E. M.

Klokkeide

Å.

Matre

K. H.

, … Kjeken

(2019). Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis: A cross-sectional study. BMC Musculoskeletal Disorders, 20, 180. https://doi.org/10.1186/s12891-019-2567-3

17.

Guevara-Alvarez

Schmitt

Russell

R. P.

Imhoff

A. B.

, & Buchmann

(2014). Growth factor delivery vehicles for tendon injuries: Mesenchymal stem cells and platelet rich plasma. Muscles, Ligaments and Tendons Journal, 4, 378–385. https://doi.org/10.32098/mltj.03.2014.18

18.

Haddaway

N. R.

Page

M. J.

Pritchard

C. C.

, & McGuinness

L. A.

(2022). PRISMA2020: An R package and shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimized digital transparency and open synthesis. Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230

19.

* Hall

Lee

H. C.

Fitzgerald

Byrne

Barton

, & Lee

A. H.

(2013). Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: A randomized controlled trial. American Journal of Occupational Therapy, 67, 448–459. https://doi.org/10.5014/ajot.2013.006031

20.

Hammond

Young

, & Kidao

(2004). A randomised controlled trial of occupational therapy for people with early rheumatoid arthritis. Annals of the Rheumatic Diseases, 63, 23–30. https://doi.org/10.1136/ard.2002.001511

21.

* Hansen

A. Ø.

Kristensen

H. K.

Cederlund

Møller

, & Tromborg

(2020). An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale: A randomized controlled trial. Journal of Hand Therapy, 33, 455–469. https://doi.org/10.1016/j.jht.2019.12.009

22.

Hennig

Hæhre

Hornburg

V. T.

Mowinckel

Norli

E. S.

, & Kjeken

(2015). Effect of home-based hand exercises in women with hand osteoarthritis: A randomised controlled trial. Annals of the Rheumatic Diseases, 74, 1501–1508. https://doi.org/10.1136/annrheumdis-2013-204808

23.

Higgins

J. P. T.

, & Green

(Eds.). (2008). Cochrane handbook for systematic reviews of interventions (5th ed.). Wiley.

24.

Higgins

J. P. T.

López-López

J. A.

Becker

B. J.

Davies

S. R.

Dawson

Grimshaw

J. M.

, … Caldwell

D. M.

(2019). Synthesizing quantitative evidence in systematic reviews of complex health interventions. BMJ Global Health, 4(Suppl. 1), e000858. https://doi.org/10.1136/bmjgh-2018-000858

25.

Higgins

J. P. T.

Savović

Page

M. J.

Elbers

R. G.

, & Sterne

J. A. C.

(2023). Chapter 8: Assessing risk of bias in a randomized trial. In Higgins

J. P. T.

Thomas

Chandler

Cumpston

, & Page

M. J.

(Eds.), Cochrane handbook for systematic reviews of interventions (Version 6.4). Wiley. https://training.cochrane.org/handbook/current/chapter-08

26.

Higgins

J. P. T.

, & Thompson

S. G.

(2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558. https://doi.org/10.1002/sim.1186

27.

Hirth

M. J.

Howell

J. W.

, & O’Brien

(2016). Relative motion orthoses in the management of various hand conditions: A scoping review. Journal of Hand Therapy, 29, 405–432. https://doi.org/10.1016/j.jht.2016.07.001

28.

* Jarvik

J. G.

Comstock

B. A.

Kliot

Turner

J. A.

Chan

Heagerty

P. J.

, … Deyo

R. A.

(2009). Surgery versus non-surgical therapy for carpal tunnel syndrome: A randomised parallel-group trial. Lancet, 374, 1074–1081. https://doi.org/10.1016/S0140-6736(09)61517-8

29.

Jayakumar

Overbeek

C. L.

Lamb

Williams

Funes

C. J.

Gwilym

, … Vranceanu

A.-M.

(2018). What factors are associated with disability after upper extremity injuries? A systematic review. Clinical Orthopaedics and Related Research, 476, 2190–2215. https://doi.org/10.1097/CORR.0000000000000427

30.

Johansen

Strøm

Simic

, & Rike

P. O.

(2020). Effectiveness of training with motion-controlled commercial video games on hand and arm function in young people with cerebral palsy: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 52, jrm00012. https://doi.org/10.2340/16501977-2633

31.

Khan

Amatya

, & Hoffman

(2012). Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. British Journal of Surgery, 99(Suppl. 1), 88–96. https://doi.org/10.1002/bjs.7776

32.

Lanhers

Grolier

Dutheil

Gay

Goldstein

Mourgues

, … Coudeyre

(2024). Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial. Annals of Physical and Rehabilitation Medicine, 67, 101813. https://doi.org/10.1016/j.rehab.2023.101813

33.

Manterola

Zavando

, & Grupo

(2009). How to interpret the “levels of evidence” in different clinical scenarios. Chilean Journal of Surgery, 61, 582–595. https://doi.org/10.4067/S0718-40262009000600017

34.

Marik

T. L.

, & Roll

S. C.

(2017). Effectiveness of occupational therapy interventions for musculoskeletal shoulder conditions: A systematic review. American Journal of Occupational Therapy, 71, 7101180020. https://doi.org/10.5014/ajot.2017.023127

35.

Mathieux

Marotte

Battistini

Sarrazin

Berthier

, & Miossec

(2009). Early occupational therapy programme increases hand grip strength at 3 months: Results from a randomised, blind, controlled study in early rheumatoid arthritis. Annals of the Rheumatic Diseases, 68, 400–403. https://doi.org/10.1136/ard.2008.094532

36.

Minakawa

Miyazaki

Waki

Akimoto

, & Itoh

(2024). Clinical effectiveness of trigger point acupuncture on chronic neck and shoulder pain (katakori) with work productivity loss in office workers: A randomized clinical trial. Journal of Occupational Health, 66, uiad016. https://doi.org/10.1093/joccuh/uiad016

37.

Morris

S. B.

, & DeShon

R. P.

(2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 105–125. https://doi.org/10.1037/1082-989x.7.1.105

38.

* Nadar

M. S.

Alotaibi

, & Manee

(2023). Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of carpal tunnel syndrome: An assessor-blinded randomised controlled trial. BMJ Open, 13, e076961. https://doi.org/10.1136/bmjopen-2023-076961

39.

Nguyen

Fiest

K. M.

McChesney

Kwon

C.-S.

Jette

Frolkis

A. D.

, & Gallagher

(2016). The international incidence of traumatic brain injury: A systematic review and meta-analysis. The Canadian Journal of Neurological Sciences, 43, 774–785. https://doi.org/10.1017/cjn.2016.290

40.

Page

M. J.

McKenzie

J. E.

Bossuyt

P. M.

Boutron

Hoffmann

T. C.

Mulrow

C. D.

, … Moher

(2021). PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Revista Española de Cardiología (English Edition), 74, 790–799. https://doi.org/10.1016/j.rec.2021.07.010

41.

Pereira

M. F.

Prahm

Kolbenschlag

Oliveira

, & Rodrigues

N. F.

(2020). Application of AR and VR in hand rehabilitation: A systematic review. Journal of Biomedical Informatics, 111, 103584. https://doi.org/10.1016/j.jbi.2020.103584

42.

Peters

S. E.

Jha

, & Ross

(2021). Rehabilitation following surgery for flexor tendon injuries of the hand. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD012479.pub2

43.

Rayegani

S. M.

Moradi-Joo

Raeissadat

S. A.

Bahrami

M. H.

Seyed-Nezhad

, & Heidari

(2019). Effectiveness of low-level laser therapy compared to ultrasound in patients with carpal tunnel syndrome: A systematic review and meta-analysis. Journal of Lasers in Medical Sciences, 10(Suppl. 1), S82–S89. https://doi.org/10.15171/jlms.2019.S15

44.

Rexe

Lammi

B. M.

, & von Zweck

(2013). Occupational therapy: Cost-effective solutions for changing health system needs. Healthcare Quarterly, 16, 69–75. https://doi.org/10.12927/hcq.2013.23329

45.

Ribak

de Oliveira

E. J. N.

Rosolino

G. P.

Orru

, & Tietzmann

(2018). Epidemiology of traumatic injuries of the upper limbs in a university hospital. Acta Ortopedica Brasileira, 26, 370–373. https://doi.org/10.1590/1413-785220182606180607

46.

Roll

S. C.

, & Hardison

M. E.

(2017). Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 71, 7101180010. https://doi.org/10.5014/ajot.2017.023234

47.

Sahoo

Mohanty

R. K.

Mohapatra

Equebal

, & Das

S. P.

(2023). Efficacy of extension wrist hand orthosis on pain, grip strength, and electromyographic activities in lateral epicondylitis: A randomized single-blind clinical trial. Journal of Hand Therapy, 36, 796–804. https://doi.org/10.1016/j.jht.2023.06.006

48.

Sheerin

O’Riordan

Conneely

Carey

Ryan

Galvin

, & Morrissey

A.-M.

(2024). Effectiveness of occupational therapy interventions on function and occupational performance among adults with conditions of the hand, wrist, and forearm: A systematic review and meta-analysis. Australian Occupational Therapy Journal, 71, 175–189. https://doi.org/10.1111/1440-1630.12905

49.

Shi

Sinden

MacDermid

J. C.

Walton

, & Grewal

(2014). A systematic review of prognostic factors for return to work following work-related traumatic hand injury. Journal of Hand Therapy, 27, 55–62; quiz 62. https://doi.org/10.1016/j.jht.2013.10.001

50.

* Teo

S. H.

D. C. L.

, & Wong

Y. K. Y.

(2019). Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial. Journal of Hand Therapy, 32, 444–451. https://doi.org/10.1016/j.jht.2018.02.007

51.

Tofani

Santecchia

Conte

Berardi

Galeoto

Sogos

, … Castelli

(2022). Effects of mirror neurons-based rehabilitation techniques in hand injuries: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19, 5526. https://doi.org/10.3390/ijerph19095526

52.

Tveter

A. T.

Østerås

Nossum

Eide

R. E. M.

Klokkeide

Å.

Matre

K. H.

, … Kjeken

(2022). Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: Secondary analyses from a randomized controlled trial. Arthritis Care and Research, 74, 955–964. https://doi.org/10.1002/acr.24543

53.

Valdes

Naughton

, & Burke

C. J.

(2015). Therapist-supervised hand therapy versus home therapy with therapist instruction following distal radius fracture. Journal of Hand Surgery, 40, 1110–1116.e1. https://doi.org/10.1016/j.jhsa.2015.01.036

54.

Valenzuela-López

Moreno-Verdú

Cuenca-Zaldívar

J. N.

, & Romero

J. P.

(2024). Effects of hand motor interventions on cognitive outcomes post-stroke: A systematic review and Bayesian network meta-analysis. Archives of Physical Medicine and Rehabilitation, 105, 1770–1783. https://doi.org/10.1016/j.apmr.2023.12.013

55.

Verhagen

A. P.

de Vet

H. C.

de Bie

R. A.

Kessels

A. G.

Boers

Bouter

L. M.

, & Knipschild

P. G.

(1998). The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of Clinical Epidemiology, 51, 1235–1241. https://doi.org/10.1016/s0895-4356(98)00131-0

56.

Williams

Trewartha

Kemp

, & Stokes

(2013). A meta-analysis of injuries in senior men’s professional rugby union. Sports Medicine, 43, 1043–1055. https://doi.org/10.1007/s40279-013-0078-1

57.

Yates

S. E.

Glinsky

J. V.

Hirth

M. J.

, & Fuller

J. T.

(2024). Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis. Journal of Hand Therapy, 37, 495–506. https://doi.org/10.1016/j.jht.2023.12.018