Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention

Nursing care after hand replantation based on Roy's adaptation model: A case report

BACKGROUND

Hand injuries are very complex and worrying in terms of hindering activities of daily living, functionality and self-care skills. Hand injuries are caused by traumatic events, resulting in a partial or complete loss. The focus of acute treatment is surgical replantation.

AIM

In this study, nursing care and nursing experiences of a patient who was replanted as a result of hand trauma were discussed in the light of the Roy Adaptation Model.

CASE

The male patient admitted to the emergency room due to traumatic amputation was a 49-year-old farmer. He lost his hand to an agricultural tool while working the land and was taken to the hospital within 4 h. He was taken up for emergency surgery for replantation. He has a history of diabetes mellitus. Nursing follow-up and interventions were applied by evaluating the data according to four adaptation modes (physiological needs, self-concept, role function and interdependence) within the scope of the Roy Adaptation Model.

CONCLUSION

and Suggestions: Patients experience difficulties (loss of function, financial problems, loss of role, psychological traumas) due to disability after injury. Therefore, nurses should know the underlying physiological risks, complications, and interventions to recognize and respond to situations that cause the loss of the reattached limb. Nursing models can identify patients' needs and problems, prevent complications, provide quality care, and manage the process. This study discussed the postoperative nursing care of a patient based on Roy's Adaptation Model.

"Surthriving" Hand Rehabilitation: Proposing Interventions to Support Novice Occupational Therapists Working in Underserved Contexts

Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries.

How international are the editorial boards in the field of hand research? A cross-sectional study of leading subspecialty hand journals

BACKGROUND

Although low- and middle-income countries (LMIC) have great disease burden, but the lack of studies from LMIC have been shown in several fields. Multiple researchers from LMIC perceive editorial bias against their studies. Editorial board members (EBMs) from LMIC are under-represented across many medical journals. It is still unclear whether this phenomenon exists in the field of hand research. The purpose of this study was to investigate the composition of EBMs in leading subspecialty hand journals, and to reveal the international representation of EBMs in the field of hand research.

METHODS

This cross-sectional study included seven leading subspecialty hand journals. The EBMs were obtained from the journals' websites. The country affiliations of EBMs were categorized based on their locations and economy status. The composition of EBMs was investigated.

RESULTS

There were 211 EBMs in the seven journals. A total of 185 EBMs (87.7%) were affiliated with high-income countries (HIC), 18 (8.5%) with upper middle-income countries, and 8 (3.8%) with lower middle-income countries. None EBMs were affiliated with low income countries. The EBMs were affiliated with 30 countries. The biggest number of EBMs were affiliated with the USA 74 (35.07%), followed by the United Kingdom (45, 21.33%), and France (13, 6.16%). Most of EBMs were based in Europe and Central Asia (86, 40.8%) and North America (81, 38.4%).

CONCLUSIONS

The EBMs of leading subspecialty hand journals are dominated by HIC with a very low representation of LMIC. There is a need to make the editorial boards more international in the field of hand research.

Cast selection and non-union rates for acute scaphoid fractures treated conservatively: a systematic review and meta-analysis

Cast selection for conservatively treated acute scaphoid fractures remains controversial. Cast options include short arm versus long arm, and those that include the thumb or leave it free. We sought to investigate the role of how cast choice affects nonunion rates after conservative management of scaphoid fractures. We searched PubMed, Embase, and Google Scholar from inception through July 14, 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including cast type, and non-union rates at the end of the treatment period. We then performed a meta-analysis using the random-effects model. We identified seven relevant studies. Non-union was observed in 15 out of 156 (9.6%) with short-arm cast and 13 out of the 124 (10.5%) with long-arm cast (OR = 0.79, 95% CI [0.19, 3.26], p = 0.74). Non-union was observed in 18 out of 174 (10.3%) with thumb immobilization cast and 18 out of the 179 (10.1%) without thumb immobilization (OR = 0.97, 95% CI [0.49, 1.94], p = 0.69). In our study, short arm casting was proven non-inferior to long arm casting. Similarly, casts without thumb immobilization were equally as effective as casts with thumb immobilization in terms of non-union rates for acute scaphoid fractures treated non-operatively.

The impact of socioeconomic status on hand injury severity

Socioeconomic status (SES) is an important factor affecting different aspects of human health, including self-care and healthcare service use. The relation between SES and hand injury severity is not well defined; therefore, the present study aimed to investigate the relation between SES and hand injury severity. This cross-sectional descriptive and analytical study included 215 patients with hand injury. Demographic, clinical, and SES-related factors were collected by questionnaire. Injury severity was assessed on Hand Injury Severity Score (HISS). Statistical analysis used the Student t-test, chi-square test and a multinomial regression model to calculate the odds ratio (OR) of each predictive factor. Mean age was 38.02 ± 13.49 years (range, 12-80 years). 73.5% of the participants were men. Patients with low SES were significantly more likely to develop severe hand injury (OR = 5.25 and 9.25 at HISS levels 3 and 4, respectively). In addition, there was a significant association between being born in rural areas and severe (HISS level 3, OR = 2.63) or major (HISS level 4, OR = 2.63) hand injury. Also, major (HISS level 4) hand injuries were significantly more prevalent in patients living in rural areas (OR = 4.23) and those injured in road accidents (OR = 1.98) or practicing sports (OR = 3.51). The study concluded that patients with low SES were 5-10-fold more likely to suffer from severe and major hand injuries, and thus provided valuable information for Iranian policymakers to take preventive measures for hand injuries. It is recommended to improve postoperative care in patients with low SES who underwent hand surgery, take the necessary measures to decrease the incidence of road accident injuries, facilitate early referral of patients with hand injury to trauma centers, and improve postoperative follow-up until full recovery. LEVEL OF EVIDENCE: III.

Conceptualization of an Anthropomorphic Replacement Hand with a Sensory Feedback System

In this paper, a concept for an anthropomorphic replacement hand cast with silicone with an integrated sensory feedback system is presented. In order to construct the personalized replacement hand, a 3D scan of a healthy hand was used to create a 3D-printed mold using computer-aided design (CAD). To allow for movement of the index and middle fingers, a motorized orthosis was used. Information about the applied force for grasping and the degree of flexion of the fingers is registered using two pressure sensors and one bending sensor in each movable finger. To integrate the sensors and additional cavities for increased flexibility, the fingers were cast in three parts, separately from the rest of the hand. A silicone adhesive (Silpuran 4200) was examined to combine the individual parts afterwards. For this, tests with different geometries were carried out. Furthermore, different test series for the secure integration of the sensors were performed, including measurements of the registered information of the sensors. Based on these findings, skin-toned individual fingers and a replacement hand with integrated sensors were created. Using Silpuran 4200, it was possible to integrate the needed cavities and to place the sensors securely into the hand while retaining full flexion using a motorized orthosis. The measurements during different loadings and while grasping various objects proved that it is possible to realize such a sensory feedback system in a replacement hand. As a result, it can be stated that the cost-effective realization of a personalized, anthropomorphic replacement hand with an integrated sensory feedback system is possible using 3D scanning and 3D printing. By integrating smaller sensors, the risk of damaging the sensors through movement could be decreased.

Musculoskeletal Diseases and Disorders in the Upper Limbs and Health Work-Related Quality of Life in Spanish Sign Language Interpreters and Guide-Interpreters

Disorders in the upper limbs are common among sign language interpreters and are related with different risk factors, among which are the difficulties of interpreting work in the educational setting, posture, and emotional together with physical stress. The aim of this study was to inquire about the different musculoskeletal disorders and diseases present in a group of sign language interpreters, and to examine its relationship with the work-related quality of life. A battery of four instruments was administered to 62 sign language interpreters, composed of a sociodemographic data and musculoskeletal disease questionnaire, a health-related quality of life measurement scale (SF-36), a measurement scale of the impact of fatigue (MFIS), and an instrument for assessing hand-function outcomes (MHOQ). All the study participants had presented some kind of musculoskeletal pathology during their work career, such as tendinitis, overuse syndrome, and repetitive strain injury. In addition, many of the participants present difficulties in occupational performance that affect their daily activities. A high percentage, close to 70%, of the interpreters suffer from musculoskeletal disorders, serious enough to modify their activities and affect both the quality of their work as interpreters and their quality of life, with important mediating variables being the number of diseases; physical, cognitive, and social fatigue; and satisfaction with the hand function.

Work transitions after serious hand injury: Current occupational therapy practice in a middle-income country

INTRODUCTION

Work-related transitions following serious hand injury can be complex for people with hand injuries and rehabilitation professionals supporting the return-to-work process. This study explored South African occupational therapy practice related to work transitions after a serious hand injury.

METHODS

In this collective case study, maximum variation sampling was used to select seven occupational therapists involved in facilitating work-related transitions for people with serious hand injuries. Participants selected at least five cases that illustrated the breadth of their practice in terms of work transitions; these cases formed the focus of the semi-structured interviews. Data were analysed using inductive content analysis. Exemplar quotations were extracted to support emergent key themes.

RESULTS

There was one overarching theme-Ongoing appraisal of the fit between function and inherent work demands-which comprised three stages: (1) determining and facilitating readiness to work; (2) managing the risk and trauma of returning to work, and (3) implementing reasonable accommodation. The central theme comprised six strategies that were used to optimise the transition process and achieve the best possible outcome.

CONCLUSION

The study highlighted the importance of work-related transitions that are context-driven, flexible, and involve multiple stakeholders. The occupational therapists demonstrated how they drew on their knowledge of local contexts to solve problems and generate effective individual strategies over the rehabilitation period. The findings may be applicable to other low- or middle-income countries where the return-to-work process may not be as predictable as high-income countries.

Traumatized Hand - Update at the First Visit

The hand is the segment most exposed to trauma, with a large volume of care in urgent and emergency services. Therefore, it is necessary that physicians on duty have the essential knowledge to effectively manage these injuries. In the present article, we will review the main conditions and conduct guidelines.

Acute Ulnar Neurapraxia and Carpal Tunnel Syndrome in the Context of a Distal Radius Fracture

Distal radius fractures, carpal tunnel syndrome, and ulnar nerve compression are common causes of symptoms that result in patients presenting for hand evaluation. This is a unique case of a distal radius fracture leading to both carpal tunnel syndrome and ulnar nerve compression requiring urgent operative management.

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial

QUESTION

In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper?

DESIGN

Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis.

PARTICIPANTS

Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers.

INTERVENTION

Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper.

OUTCOME MEASURES

The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation.

RESULTS

Compared with the control group, the experimental group: returned to work sooner (MD -18 days, 95% CI -33 to -3); required fewer physiotherapy sessions (MD -7.4, 95% CI -13.1 to -1.6), rehabilitation consultations (MD -1.9, 95% CI -3.6 to 0.3) and plastic surgery consultations (MD -3.6, 95% CI -6.3 to -0.9); and had better short-term recovery of functional ability and pinch strength.

CONCLUSION

In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments.

TRIAL REGISTRATION

ACTRN12619000344190.

Postoperative Management of Hand Surgery in the Low- and Middle-Income Countries

The prevention and treatment of hand injuries in low- to middle-income countries needs to be a priority. Surgical outreach trips are a primary avenue for patients to receive interventions. Challenges include language and cultural barriers, poor infrastructure, and limitations in a patient's ability to follow-up. Strategies to maximize patient functional outcomes include cultural competence, patient education resources, overcoming communication barriers, and using task-shifting strategies. Local therapists' knowledge and clinical skills can be enhanced. With improvements in data collection, therapists may contribute to gaining knowledge of outcomes in low- to middle-income countries.

Teaching Hand Surgery in the Developing World: Utilizing Educational Resources in Global Health

The development of surgical capacity in the developing world is essential to address the global burden of surgical disease. Training local surgeons in low-income and middle-income countries is critical in this endeavor. The challenges to teaching hand surgery in the developing world include a shortage of local faculty, absence of a defined curriculum, no competency-based evaluation systems, few subspecialty training opportunities, and lack of financial support. To teach hand surgery in the developing world effectively, the authors suggest principles and components of a global training curriculum.