Personality type and patient education in hand therapy

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.

Patients' views on early sensory relearning following nerve repair-a Q-methodology study

STUDY DESIGN

Descriptive study.

INTRODUCTION

Early sensory relearning where the dynamic capacity of the brain is used has been shown to improve sensory outcome after nerve repair. However, no previous studies have examined how patients experience early sensory relearning.

PURPOSE OF THE STUDY

To describe patient's views on early sensory relearning.

METHODS

Statements' scores were analyzed by factor analysis.

RESULTS

Thirty-seven consecutive adult patients with median and/or ulnar nerve repair who completed early sensory relearning were included. Three factors were identified, explaining 45% of the variance: (1) "Believe sensory relearning is meaningful, manage to get an illusion of touch and complete the sensory relearning"; (2) "Do not get an illusion of touch easily and need support in their sensory relearning" (3) "Are not motivated, manage to get an illusion of touch but do not complete sensory relearning".

DISCUSSION

Many patients succeed in implementing their sensory relearning. However, a substantial part of the patient population need more support, have difficulties to create illusion of touch, and lack motivation to complete the sensory relearning. To enhance motivation and meaningfulness by relating the training clearly to everyday occupations and to the patient's life situation is a suggested way to proceed.

CONCLUSION

The three unique factors indicate motivation and sense of meaningfulness as key components which should be taken into consideration in developing programs for person-centered early sensory relearning.

LEVEL OF EVIDENCE

3.

The Role of Hand Therapy in Dupuytren Disease

The role of hand therapy in the treatment of Dupuytren disease varies depending on the patient and the procedure. There is limited evidence for hand therapy as a preventive treatment of Dupuytren disease. Before corrective treatment, the hand therapist can contribute with assessments to promote evaluation of outcome. After corrective treatment, hand therapy is tailored to each patient's needs and consists of orthoses, exercise, edema control, and pain or scar management. Orthoses are usually part of the hand therapy protocol after corrective procedures despite lack of strong supporting evidence and should be provided based on individual patient needs.

Exploring Occupational Therapists' Perceptions of the Usefulness of Musculoskeletal Sonography in Upper-Extremity Rehabilitation

OBJECTIVE

To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.

METHOD

Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.

RESULTS

The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.

CONCLUSION

Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.