Hand Therapy

Neurogenic Thoracic Outlet Syndrome (NTOS) is a complex condition that can be encountered in musculoskeletal and hand therapy services. Rehabilitation is recognised as the primary treatment for NTOS however, detail on rehabilitation components are poorly described. This scoping review aimed to identify and describe the physical assessment and rehabilitation components alongside clinical reasoning strategies that may aid therapists in the conservative management of adults with NTOS.

Four databases (MEDLINE, EMBASE, CINAHL and Cochrane) were searched, utilising the PRISMA-ScR guidelines. The Template for Intervention Description and Replication (TIDieR) checklist was used to organise data regarding rehabilitation interventions for NTOS.

Twenty-Nine out of 1381 studies identified, met the eligibility criteria. NTOS Provocation tests (16/18 89%) were the most frequently described assessment components, followed by palpation of pertinent structures (11/18 61%) and assessment of posture (10/18 56%). ‘Decompressing the thoracic outlet’ was the main aim encountered for rehabilitation programmes. Exercise (17/19 90%) was the most frequent rehabilitation intervention identified, with stretching (n = 15), strengthening (n = 14) and neural mobility (n = 7) exercises being most prevalent. The Scalenes and Pectoralis muscles (n = 10) were the main targets for stretching whilst the Scapula (n = 9), Trapezius and Serratus Anterior muscles (n = 5) were the main targets for strengthening exercises. Other interventions identified included, posture improvement (n = 13), manual therapy (n = 10), adjuncts (n = 8) and activity modification (n = 7).

The reporting of rehabilitation techniques for NTOS is generally poor, particularly regarding treatment intensity. There is an essential need for a standardised and reproducible rehabilitation intervention for NTOS to be developed.

Patients with Severe Recessive Dystrophic Epidermolysis Bullosa (RDEB-S) develop hand contractures that progress over time and impact function and quality of life. The role of the Occupational Therapist includes hand assessment and interventions to help maintain function. We developed the Assessment of Hand Contractures in Epidermolysis Bullosa (ACE-EB) to facilitate sensitive and detailed assessment. The purpose of this article is to describe its development and use.

We undertook a literature search of existing hand assessments and evaluated their use for children with RDEB-S. Most measure contracture recurrence post-operatively and none was sensitive enough to capture emerging contractures seen in children. We developed the ACE-EB by adapting the most relevant existing assessments, to include specific component contracture measurements, a Hand Deformity Grade and a hand surgery Patient Reported Outcome Measure. We explored the validity by surveying clinicians in the field of Epidermolysis Bullosa and we tested the inter-rater reliability.

We describe the development of the ACE-EB. The results of the validity survey showed most respondents agreed that the ACE-EB had sufficiently sensitive grading scales, included relevant aspects of hand assessment and was a useful clinical or research tool. Inter-rater reliability tests showed good strength of agreement.

The ACE-EB is a novel clinical tool designed for use with children with RDEB-S. It can be used to monitor changes, track natural history of hand contractures, guide practice and serve as a post-operative outcome measure in children and adults. Further testing of its validity and reliability is required.

Hand injuries are treated by specialized hand surgeons and certified hand therapists (CHTs) for optimal care. Hand surgeons refer upper extremity patients to CHTs and work closely together. Hand surgeons and CHTs must collaborate effectively to optimize best practice and functional outcomes.

To assess the perceived quality of collaboration between CHTs and orthopedic hand surgeons. In addition, to identify common characteristics within the working relationship that support an effective collaboration to facilitate optimal patient care.

This study utilized a constructivist-interpretive approach through purposive sampling of 10 practicing CHTs with frequent communication with hand surgeons. A 30-min, virtual, semistructured interview identified current CHT perceptions regarding hand surgeon collaboration. Interviews were transcribed via Zoom and confirmed via member checking. Initial codebook was developed with subsequent collaborative thematic analysis. Results: Themes emerged related to common reasons therapists reach out to hand surgeon, common obstacles faced when communicating, and elements of an ideal hand surgeon collaboration. Themes included: let’s chat, what it’s not, and help me help you! The participants defined an ideal hand surgeon collaboration as mutually respectful, interactive and face-to-face, frequent, and ongoing with opportunities for clinical advancement and collaboration to promote optimal patient outcomes.

By intentionally facilitating effective working relationships with hand surgeons, CHTs can promote the practice of occupational therapy, further define the role of CHTs in the healthcare realm and make lasting functional improvements for hand and upper extremity patients receiving skilled occupational therapy services.

Skin involvement is a clinically relevant but insufficiently quantified feature of Dupuytren’s disease (DD). The Cutometer® MPA 580 offers an objective method to assess skin biomechanics, yet its reliability on healthy and DD-affected hands has not been examined using a hand-specific protocol.

In this cross-sectional study, two observers performed Cutometer® measurements on 31 DD-affected and 30 healthy hands using a standardized hand protocol. In DD patients, measurement sites were classified on skin involvement (fused vs non-fused). Reliability was assessed using ICC (2, 1), SEM, reproducibility coefficient (RC), and within-subject coefficient of variation (WSCV). Agreement was evaluated with Bland–Altman analysis. Differences between fused and non-fused sites were analysed for Uf (R0) and Ua/Uf (R2).

Uf (R0) showed good intra-observer reliability on palmar regions in both healthy and DD hands. Reliability decreased on anatomically restricted areas, particularly along the ulnar side of the fourth digit, and inter-observer reliability was consistently lower. Ua/Uf (R2) showed acceptable intra-observer reliability for one observer, while inter-observer agreement remained poor. Absolute errors were smallest on the palm and highest in stiff or curved regions. Fused sites demonstrated lower maximal deformation (Uf) than non-fused skin, although interpretation is limited by the absence of precise anatomical site recording.

Using a hand-specific protocol, the Cutometer® provides reliable within-observer measurements on palmar skin, while digit measurements are less consistent. Differences between fused and non-fused skin support construct validity. Further standardization is recommended to support clinical and longitudinal use in hand evaluation.

The Problematic Experience of Therapy Scale (PETS) identifies barriers to home-based exercise programs but has not been validated in hand therapy populations. This study aimed to translate the extended PETS into Swedish and evaluate its content and construct validity in patients undergoing early sensory relearning following peripheral nerve injury.

The PETS was translated into Swedish (PETS-Swe) following established cross-cultural adaptation guidelines. Fifty-three patients with peripheral nerve injuries completed the PETS-Swe four weeks into a home-based sensory relearning program. Exercise adherence was monitored using a daily exercise diary. Content validity was assessed through expert review (face validity) and patient ratings of item relevance, clarity, and ambiguity. Item-level (I-CVI) and scale-level (SCVI) content validity indices were calculated, alongside modified kappa statistics for interrater agreement. Construct validity was examined using Spearman’s correlation between PETS-Swe scores and reported exercise frequency.

Translation revealed no major discrepancies. Most items demonstrated high content validity (I-CVI and S-CVI >0.8), though lower relevance scores were observed in the technical subscale (I-CVI: 0.65–0.69). Interrater agreement was good to excellent across all items (K >0.74 for items 1–17; K = 0.6–0.74 for items 18–20). Expert reviewers confirmed strong face validity. Moderate negative correlations were found between PETS-Swe scores and exercise adherence (rho = –0.40 to exercise log; –0.57 to diary), supporting construct validity.

The Swedish version of the extended PETS is a valid tool for identifying barriers to home-based sensory relearning in patients with peripheral nerve injuries undergoing hand therapy.

ChatGPT is a popular artificial intelligence (AI) tool used to answer questions on any subject. Given ChatGPT’s popularity, it is prudent to investigate its ability to answer common patient questions in the field of hand therapy to better guide patients as they navigate the resources available to them.

This is a cross-sectional, rater-based comparison study. Four common hand therapy questions were entered into ChatGPT version 3.5. The first five answer tabs that appeared with a Google search for the same four questions were downloaded. Three certified hand therapists blindly graded ChatGPT and Google’s answers using Likert scales to assess for answer accuracy (0-6), comprehensiveness (0-3), and conciseness (0-3).

ChatGPT was significantly more accurate, with an estimated marginal mean (EMM) of 5.75 (95% CI: 4.96, 6.54) compared to Google’s 3.48 (95% CI: 2.86, 4.10) (p < 0.001). ChatGPT was significantly more complete, with an EMM of 2.50 (95% CI: 2.10, 2.90) compared to Google’s 1.48 (95% CI: 1.19, 1.77) (p < 0.001). ChatGPT was significantly more concise, with an EMM of 3.00 (95% CI: 2.66, 3.34) versus 1.60 (95% CI: 1.29, 1.91) for Google (p < 0.001).

ChatGPT is a concise, comprehensive, and accurate alternative to a Google search for people seeking information on hand therapy. The free version of ChatGPT does not update its sourcing past 2019, and the software is known to occasionally present false information. Frequently updated academic websites should therefore remain the primary online medical resource for patients.