背景:虽然关于非手术拇指腕掌骨性关节炎(OA)的手疗法评估和治疗的文献很多,清晰度和均匀性微薄,使其成为建立专家共识的理想诊断。
目的:本研究旨在确定在手疗法临床环境中评估和治疗拇指CMCOA的非手术治疗是否存在共识。
方法:这是一篇通过改进的德尔菲法的共识论文。
方法:使用改进的德尔菲方法来确定专家小组之间的共识,包括手部治疗师和手部外科医生,通过两个在线调查。一个共识文件指导委员会(来自美国手治疗师协会的研究部门)设计了调查并分析了答案。专家小组之间达成了75%的共识。从专家小组收集了人口统计信息。
结果:专家小组包括34位手部治疗师和7位手部外科医生。第一次调查的调查响应率为93.6%,第二次调查为90.2%。共识建议按照世界卫生组织的分类进行分类。这些包括评估身体结构的临床体征/临床测试和身体功能的疼痛,手掌外展的活动范围,径向外展,反对派,拇指掌指骨屈伸,和抓地力和三脚架捏强度。进一步的共识建议是使用特定区域的功能评估,上肢患者报告的结果测量(活动和参与),环境因素,结果期望,以及患者独特的环境和社会背景下的疾病感知。治疗建议包括在疼痛活动期间使用矫形器,动态稳定程序(稳定的C姿态,释放紧密的内收工具,和加强稳定剂),患者教育,联合保护技术,自适应设备,和基于功能的干预。
结论:这些发现描述了一组专家的共识,并为非手术拇指CMC关节OA的手部治疗评估和治疗提供了临床参考工具。
BACKGROUND: While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus.
OBJECTIVE: This study aimed to ascertain if
consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting.
METHODS: This was a
consensus paper via the modified Delphi approach.
METHODS: A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A
consensus paper steering committee (from the American Society of Hand Therapist\'s research division) designed the surveys and analyzed responses.
Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel.
RESULTS: The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey.
Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient\'s unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention.
CONCLUSIONS: The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.