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International Journal of Dental Hygiene Aug 2023The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals. (Review)
Review
OBJECTIVE
The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals.
METHODS
Three databases were utilized from September 2019 to November 2021 in addition to hand-searching specific journals and reference lists. Research articles that examined pinch force generation in dental professionals during scaling with manual instruments only were included. Bias was assessed in the individual articles.
RESULTS
Six research articles were included with sample populations that varied from 12 to 24 participants. Four articles evaluated instrument designs in relation to pinch force generation during scaling by dental professionals. Two articles evaluated the clinicians' experience levels and the impact on pinch force generation. Results of three articles revealed instruments with large diameters and low weights produced the least amount of pinch force (p < 0.05). Additionally, two articles found instruments with a round, tapered shape produced less pinch force and instrument handles made of silicone produced higher pinch strength post-scaling (p < 0.05). One study indicated instrument designs associated with modified scaling techniques may reduce thumb and index finger pinch force (p < 0.05).
CONCLUSION
The findings from this review indicate weak evidence for instrument choices to reduce pinch force during scaling. Dental professionals should consider lightweight and large diameter instruments for manual scaling. Clinicians may also want to consider round, tapered handles and instrument designs with modified scaling techniques. This systematic review further identified the need for clinical research studies with rigorous research designs that examine the ergonomic impacts of instrument designs.
Topics: Humans; Research Design; Dental Scaling; Hand; Ergonomics; Dentists
PubMed: 36524311
DOI: 10.1111/idh.12649 -
Hand Therapy Dec 2023Upper extremity injuries are common, and often treated by occupational therapists. The need to evaluate the effectiveness of occupational therapy interventions to guide... (Review)
Review
Effectiveness of occupational therapy-led computer-aided interventions on function among adults with conditions of the hand, wrist, and forearm: A systematic literature review and meta-analysis.
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, I = 0%) and pinch strength (Fixed Effects Model, SMD -0.12, 95% CI 1.25; -1.50, I = 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.
PubMed: 38031572
DOI: 10.1177/17589983231209678 -
Hand (New York, N.Y.) Oct 2023Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The...
Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The primary purpose of this systematic review was to compare the subjective improvement in patient-reported outcomes in regard to disability for patients undergoing LRTI and SBS for trapeziometacarpal osteoarthritis. A secondary purpose was to compare the subjective improvement, objective outcome scores, and complication rates following both procedures. We performed a systematic review using PubMed, Scopus, and Embase to compare the clinical outcomes of LRTI and SBS. Inclusion criteria were level I-IV evidence articles reporting postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH scores. Study methodological quality, risk of bias, and recommendation strength were assessed. This systematic review included 31 studies for final analysis with 1289 thumbs undergoing LRTI (25 studies) and 113 thumbs undergoing SBS (6 studies). Both procedures demonstrated similar improvement in DASH and/or QuickDASH scores, while key pinch and grip strength inconsistently improved following both procedures. Complication rate was similar between the 2 procedures; LRTI 12% and SBS 13%. Although both LRTI and SBS seem to provide improved short-term patient-reported functional improvement and objective strength, there was significant heterogeneity within the included studies, and those studies discussing SBS were of lower quality evidence than those of LRTI. Thus, to truly delineate whether a difference exists between these 2 techniques for the treatment of first carpometacarpal joint arthritis, larger prospectively designed studies of high-quality evidence are necessary.
Topics: Humans; Osteoarthritis; Plastic Surgery Procedures; Tendons; Ligaments; Sutures
PubMed: 35272518
DOI: 10.1177/15589447211043217 -
JPRAS Open Mar 2024In thumb carpometacarpal (CMC) instability, laxity of the ligaments surrounding the joint leads to pain and weakness in grip and pinch strength, which predisposes the... (Review)
Review
In thumb carpometacarpal (CMC) instability, laxity of the ligaments surrounding the joint leads to pain and weakness in grip and pinch strength, which predisposes the patient to developing CMC joint arthritis. Recent advancements in joint anatomy and kinematics have led to the development of various surgical reconstructive procedures. This systematic review outlines the available ligament reconstruction techniques and their efficacy in treating nontraumatic and nonarthritic CMC instability. Additionally, we aimed to provide evidence which specific ligament reconstruction technique demonstrates the best results. Four databases (Embase, MEDLINE, Web of Science, and Cochrane Central) were searched for studies that reported on surgical techniques and their clinical outcomes in patients with nontraumatic and nonarthritic CMC instability. Twelve studies were analyzed for qualitative review, including nine different surgical ligament reconstruction techniques involving two hundred and thirty thumbs. All but one of the reported techniques improved postoperative pain scores and showed substantial improvement in pinch and grip strength. Complication rates varied between 0% and 25%. The included studies showed that ligament reconstruction effectively alleviated the patients' complaints regarding pain and instability, resulting in overall high patient satisfaction. Nevertheless, drawing definitive conclusions regarding the superiority of any ligament reconstruction technique remains challenging owing to the limited availability of homogeneous data in the current literature.
PubMed: 38323100
DOI: 10.1016/j.jpra.2024.01.001 -
Physiotherapy Theory and Practice Oct 2023To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom... (Meta-Analysis)
Meta-Analysis
PURPOSE
To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS).
METHODS
Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach.
RESULTS
Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = -2.36, 95% CI -4.31 to -0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = -1.27 95% CI -1.60 to -0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness.
CONCLUSION
Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.
Topics: Humans; Carpal Tunnel Syndrome; Exercise Therapy; Treatment Outcome; Hand Strength; Pain
PubMed: 35481794
DOI: 10.1080/09593985.2022.2068097 -
Acta Orthopaedica Belgica Sep 2023The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of... (Meta-Analysis)
Meta-Analysis
Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis.
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.
Topics: Humans; Trapezium Bone; Osteoarthritis; Upper Extremity; Thumb; Arthrodesis; Ligaments; Range of Motion, Articular
PubMed: 37935242
DOI: 10.52628/89.3.11618 -
Journal of Hand Therapy : Official... 2023Paraffin bath therapy is noninvasive and is widely used in various hand diseases. Paraffin bath therapy is easy to use, has fewer side effects, and can be applied to...
BACKGROUND
Paraffin bath therapy is noninvasive and is widely used in various hand diseases. Paraffin bath therapy is easy to use, has fewer side effects, and can be applied to various diseases with different etiologies. However, there are few large-scale studies of paraffin bath therapy, and there is insufficient evidence of its efficacy.
PURPOSE
The purpose of the study was to investigate the effectiveness of paraffin bath therapy for pain relief and functional improvement in various hand diseases through a meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis of randomized controlled trials.
METHODS
We searched for studies using PubMed and Embase. Eligible studies were selected based on the following criteria: (1) patients with any diseases of the hand; (2) comparison between paraffin bath therapy and no paraffin bath therapy; and (3) sufficient data on changes in the visual analog scale (VAS) score, grip strength, pulp-to-pulp pinch strength, or Austrian Canadian (AUSCAN) Osteoarthritis Hand index before and after paraffin bath therapy. Forest plots were drawn to visualize the overall effect. Jadad scale score, I statistics, and subgroup analyses were used to assess the risk of bias.
RESULTS
A total of five studies included 153 patients who were treated and 142 who were not treated with paraffin bath therapy. The VAS were measured in all 295 patients included in the study, while the AUSCAN index was measured in the 105 patients with osteoarthritis. Paraffin bath therapy significantly reduced the VAS scores (mean difference [MD], -1.27; 95% confidence interval [CI] -1.93 to -0.60). In osteoarthritis, paraffin bath therapy significantly improved grip and pinch strength (MD -2.53; 95% CI 0.71-4.34; MD 0.77; 95% CI 0.71-0.83) and reduced the VAS and AUSCAN scores (MD -2.61; 95% CI -3.07 to -2.14; MD -5.02; 95% CI -8.95 to -1.09).
DISCUSSION
Paraffin bath therapy significantly reduced the VAS and AUSCAN scores, and improved grip and pinch strength in patients with various hand diseases.
CONCLUSIONS
Paraffin bath therapy is effective for alleviating pain and improving function in hand diseases, thereby improving quality of life. However, owing to the small number of patients included in the study and its heterogeneity, a further large-scale, well-structured study is needed.
PubMed: 36914488
DOI: 10.1016/j.jht.2022.10.005 -
Journal of Plastic, Reconstructive &... Oct 2023Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical...
Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical repair, whereas selected partial tendon injuries may be managed without repair but with splinting and physiotherapy alone. There is limited evidence to support the management of partial lacerations, in particular the decision of whether to repair or not. We aimed to systematically review the literature to determine the optimal management of partial extensor tendon lacerations in the hand and forearm. A protocol for the systematic review was developed prospectively and registered with PROSPERO (CRD42021250431). PubMed, EMBASE, clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1990 to 27/05/2022. 4565 studies were screened, of which 88 underwent full text review. Five studies were included, one randomised control trial and four cohort studies. One study examined outcomes of partial lacerations treated without repair; the other four studies examined outcomes following repair. Pinch and grip strength and time to return to work were similar regardless of management. Adverse outcomes were reported for patients undergoing surgical repair; none were observed in those managed without repair. Meta-analysis was precluded by study heterogeneity and high risk of bias. There is limited evidence to support the management of partial extensor tendon lacerations, with some low-quality evidence that non-operative management of selected partial lacerations is safe. There is a pressing need for pragmatic, multicentre randomised trials to assess the cost-effectiveness of current treatments.
Topics: Humans; Forearm; Hand; Lacerations; Tendon Injuries; Tendons
PubMed: 37454548
DOI: 10.1016/j.bjps.2023.06.004 -
The Medical Journal of Malaysia Mar 2024Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes mellitus (DM) that can significantly result in disability and... (Review)
Review
INTRODUCTION
Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes mellitus (DM) that can significantly result in disability and impaired quality of life. The DPN of the foot has been extensively studied in diabetes care. Nevertheless, the DPN of hand has been the road less taken in research and clinical practice. Thus, a scoping review was conducted to identify all available standardized hand assessments which have been used, developed, or tested in individuals with DM.
MATERIALS AND METHODS
This scoping review was reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were identified through searches of five databases: Cochrane, Scopus, ProQuest, MEDLINE, and Web of Science (WoS).
RESULTS
Of the 294 articles initially identified, 20 studies were included and analysed thematically after removing duplicates. The majority of these assessments measure body function and structure such as grip and pinch strength while the rest are measuring the activity and participation domain. Most of the hand assessments were performancebased measurements. It is suggestible to employ both types of assessments to obtain a comprehensive understanding of hand conditions in individuals with DM. While some validated hand assessments were identified, only the Duruöz Hand Index (DHI) has been validated as a reliable tool specifically for evaluating hand function in individuals with DM.
CONCLUSION
There is a need to evaluate the measurement properties of existing instruments for assessing the hand function in individuals with DM, or to develop hand assessments specifically for the DM population. This scoping review was forging a new path, by discovering diabetes care through the utilisation of hand assessments.
Topics: Humans; Quality of Life; Upper Extremity; Diabetes Mellitus; Lower Extremity
PubMed: 38555903
DOI: No ID Found -
Disability and Rehabilitation Mar 2024This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of... (Review)
Review
PURPOSE
This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of pain, hand function, grip or pinch strength.
METHODS
RCTs that used some type of physiotherapeutic intervention compared to a passive or active control group were included. The quality of the evidence was assessed using the GRADE approach and, for the calculation of the meta-analysis, the standardized difference of means (SMD) was used.
RESULTS
Nineteen studies ( = 1477) were included and eight studies ( = 568) underwent meta-analysis. Orthosis intervention was superior to passive control group for pain improvement (SMD = -1.02, = 0.03, very low evidence), grip strength (SMD = 0.45, = 0.02, very low evidence) and pinch strength (SMD = 1.78, = 0.01, very low evidence), but there was no improvement in hand function ( = 0.54). The use of a neoprene orthosis was similar to the use of a thermoplastic orthosis in improving pain ( = 0.38), hand function ( = 0.50), grip strength ( = 0.42) and pinch strength ( = 0.14). The use of short thermoplastic orthosis was also similar to long thermoplastic orthosis in improving pain ( = 0.88) and hand function ( = 0.58).
CONCLUSION
The use of orthoses is superior to no intervention in all outcomes, exception hand function.IMPLICATIONS FOR REHABILITATIONThe use of orthosis is recommended for the treatment of patients with rhizoarthrosisUse of orthosis is better than no intervention in improving pain, grip and pinch strength.The type of orthosis (neoprene or thermoplastic, short or long thermoplastic) does not affect the clinical improvement of the individual to the outcomes of pain, hand physical function, grip and pinch strength.
PubMed: 38450686
DOI: 10.1080/09638288.2024.2325652