UNASSIGNED: A variety of techniques for measuring finger range of motion (ROM) are available for hand therapist use, however, there is no clear description of which finger ROM methods are preferred in practice. This study explored the preferred measurement techniques, the factors influencing clinical decision-making, and the clinical reasoning processes employed when faced with practice-based measurement scenarios.
UNASSIGNED: This was a cross-sectional online survey study of hand therapists and American or Canadian Society of Hand Therapists members. Quantitative methods were employed for participant demographics and categorical clinical questions about practice patterns. Qualitative descriptive questions and vignettes were analysed using inductive and deductive content analysis, respectively.
UNASSIGNED: Four hundred and eighty-one responses were included, representing hand therapists with a median age of 51 years and median experience of 19 years. Participants preferred measuring individual joints with a goniometer (N = 210, 44%) for perceived utility in informing treatment decisions, reliability, and confidence in measurement skills. Participants also preferred active functional ROM (N = 117, 24%) for being quick, easy, and useful in informing treatment decisions. Participants reported using different methods with time constraints in a busy clinic, taking precautions with pins/wounds, bulky dressings/casts, pain tolerance levels of patients, or with specific pathologies. Participants\' responses to the multi-stage vignette identified distinct patterns of clinical reasoning approaches within individual vignettes.
UNASSIGNED: Hand therapists use multiple methods to measure finger ROM while preferring to use goniometers to measure individual finger joints. They engage procedural and pragmatic reasoning modified by contextual factors when measuring finger ROM.

UNASSIGNED: Hand injuries affect occupational engagement and participation, yet anecdotal evidence reports a focus on body structures and functions within hand therapy. Failing to address occupational challenges may result in sub-optimal patient outcomes. In line with the growing body of evidence of positive outcomes relating to occupation-based practice (OBP), this article aimed to describe the knowledge, attitudes and practices towards OBP of occupational therapists treating hand-related conditions in South Africa.
UNASSIGNED: In this quantitative, cross-sectional study, South African occupational therapists treating hand conditions were recruited. Data were collected via an emailed survey developed for the study. Data were analysed descriptively.
UNASSIGNED: Sixty-seven responses met the inclusion criteria, a response rate of 62%. Most respondents worked in the private sector (73%) with many holding postgraduate qualifications (54%). Lack of access to evidence and a preference for biomedical literature impacted on acquiring knowledge on OBP. Attitudes towards OBP were mostly positive. Barriers were contextual, patient-related and therapist-related. Practice focussed predominantly on performance components and aimed to reduce impairment rather than promoting occupational engagement.
UNASSIGNED: Current hand therapy services in South Africa reflect a biomechanically-focused practice that is mis-aligned with occupational therapy philosophy. In line with existing research, OBP should be adopted more routinely in hand therapy in South Africa.

This paper explores transformative strategies in hand therapy aimed at improving the patient experience - a critical factor linked to improved clinical outcomes and increased satisfaction for patients and therapists. The focus is on three key areas: personalized interactions, empathic communication, and sensory engagement. Personalized interactions ensure therapy is uniquely tailored to each patient\'s needs, fostering a sense of individual attention and care. Empathic communication involves understanding and responding effectively to patients\' verbal and nonverbal cues, creating a supportive environment where patients feel genuinely heard. Sensory engagement utilizes the therapeutic environment\'s visual, olfactory, and auditory elements to create a calming, welcoming space conducive to healing and relaxation. Integrating these strategies aims to increase treatment effectiveness and improve therapist well-being by promoting a fulfilling and less stressful work environment. Through a comprehensive review of existing evidence, current practices and innovative approaches, this paper advocates for a holistic, patient-centered model of hand therapy that significantly improves treatment outcomes and enhances the overall therapeutic experience, ensuring it is both practical and compassionate.

BACKGROUND: Various virtual goniometers have been used for photographic measurements. However, there is no single method that is both reliable and valid for measuring the forearm, wrist, and finger joints.
OBJECTIVE: This study aimed to investigate the criterion validity and intra- and inter-rater reliability of a virtual goniometer for assessing forearm, wrist, and finger joints using screenshots from video recordings and to calculate the standard error of measurement (SEM) and minimum detectable change (MDC).
METHODS: This is a clinical measurement study.
METHODS: Goniometric measurements were performed independently by two observers in 26 healthy participants (49 hands) using a virtual goniometer. Criterion validity was assessed by examining the agreement between virtual and manual goniometer measurements. Reliability was calculated using the intraclass correlation coefficient (ICC) to assess agreement between virtual and manual goniometers and interobserver agreement for virtual measurements. The difference between measurements was analyzed using the Student test and Bland-Altman plots. SEM and MDC were both used to determine the error associated with the measurements.
RESULTS: Strong agreement between measurements (ICC = 0.69-0.98) and positive moderate to high correlation (r = 0.52-0.96; p < 0.001) were observed. Bland-Altman plots showed the agreement between the two measurement methods. Intra-rater (ICC = 0.80-0.99) and inter-rater reliability (ICC = 0.76-0.99) were high. SEM was low (2°-4°) and MDC ranged from 4°-12°.
CONCLUSIONS: The virtual goniometer proved to be a valid and reliable method for measuring joint angles from screenshots. The inter-rater and intra-rater reliability of the virtual goniometer was high. The average bias between the virtual and manual goniometer was small. Measurement errors were low for forearm, wrist, and hand movements, with the largest measurement errors observed for the second and third fingers.

Recently, the wide-awake local anesthesia no tourniquet (WALANT) technique and relative motion extension (RME) splint changed practice in extensor tendon reconstruction and therapy. We wanted to share our approach for zones 5 to 8 extensor tendon management following the up-to-date developments. The impacts of surgery under WALANT and early active motion therapy with RME splinting were explained frankly and shown in several videos throughout the article.

UNASSIGNED: The effect of mental and behavioural disorders (MBD) on the risk of tendon ruptures after flexor tendon repair is not well understood. This study aimed to analyse the association between MBD and tendon rupture after flexor tendon repair in zones I and II.
UNASSIGNED: Data from the Swedish National Registry for Hand Surgery (HAKIR) on patients with a complete flexor tendon repair at our department between 2012 and 2019 were followed for a minimum of 2 years to assess the rate of rupture. Independent variables were collected from HAKIR and clinical records: prevalence MBD based on ICD-10 codes F0-F99, age, sex, injured tendon, number of injured fingers, day to surgery, core suture, digital nerve injury, smoking, injury mechanism, and rehabilitation method. Multiple logistic regression was used to assess the association between variables.
UNASSIGNED: A cohort of 593 patients with 49 ruptures (8.2%) was identified. Potential causes of rupture were non-adherence behaviour in 16 (33%), accidents in seven (14%), infections in six (12%), and no clear cause in 20 (41%) patients. Patients with MBD had an association to rupture (OR 3.6), 17.7% ruptures compared to 7.2% in patients with no diagnosed disorders. Patients >50 years of age had a higher risk compared to patients <25 years (OR 4.3), 15% compared to 3.9%\' respectively. Men had a higher risk compared to women (OR 2.9), 10% compared to 4.3%\' respectively.
UNASSIGNED: We identified an association between the prevalence of mental and behavioural disorders and rupture after flexor tendon repair.

UNASSIGNED: Handgrip strength is crucial for overall health and is often evaluated using hand dynamometers. Two hand dynamometers were used in the study: the Jamar® Hydraulic Hand Dynamometer and Squegg™ Smart Dynamometer and Handgrip Trainer, which is a relatively new, Bluetooth-enabled device to measure handgrip strength. The purpose of the study was to compare Jamar and Squegg to determine concurrent validity and, separately, test-retest reliability of Squegg.
UNASSIGNED: The cross-sectional study measured bimanual handgrip strength using the Jamar and Squegg in two sessions, following standard protocols. Participants were 18+ years old, with no hand disease or dysfunction. Spearman\'s rank correlations were used to evaluate concurrent validity between Jamar and Squegg. Test-retest reliability was evaluated with intraclass correlation coefficient (ICC) estimates and 95% confidence intervals calculated using a mean-rating (k = 2) absolute agreement, 2-way mixed effects model.
UNASSIGNED: Data from 594 participants were used to evaluate concurrent validity. Moderately strong correlations between Jamar and Squegg values for the right hand (RH) (ρ = 0.670; p = .001) and Jamar and Squegg values for the left hand (LH) (ρ = 0.730; p = .001) were found, indicating \'good\' concurrent validity. Test-retest reliability for Squegg ranged from good to excellent (RH, ICC = 0.911, 95% CI (0.895, 0.924), p = .001; LH, ICC = 0.928, 95% CI (0.915, 0.939), p = .001).
UNASSIGNED: The Squegg demonstrated good concurrent validity with Jamar and good-to-excellent test-retest reliability. It can be recommended as an alternative to the Jamar as a handgrip strength measurement tool. Squegg, which uses Bluetooth technology, is a reliable and cost-effective option for consistent handgrip strength testing.

UNASSIGNED: Dupuytren\'s Disease is a fibroproliferative disorder of the hand, with a heterogenous pathogenesis, ranging from early-stage nodule development to late-stage digital contractures. Hand therapy intervention is not routinely provided pre-operatively. The objective of this systematic review was to explore the efficacy of hand therapy interventions provided for pre-operative Dupuytren\'s Disease.
UNASSIGNED: A systematic review was undertaken of the databases CENTRAL, CINAHL, OVID Medline and OVID EMBASE, PubMed, BNI, Web of Science, with grey literature and reference searches conducted from database inception to April 2022, and confirmed in August 2023. Included studies required non-surgical intervention and outcome data on individuals with Dupuytren\'s Disease who have not had surgical intervention. Two reviewers conducted the searches, independently assessed eligibility and completed methodological quality assessments. Data were summarised narratively.
UNASSIGNED: Seventeen studies were selected for final inclusion. Interventions included Extracorporeal Shockwave Therapy (ESWT), Corticosteroid Injection (CSI), Splinting, Massage and Stretching, Ultrasound Therapy (US), Temperature Controlled High Energy Adjustable Laser (THEAL). ESWT positively maintained or improved pain, active range of motion (AROM), Disabilities of the Arm Shoulder, and Hand (DASH) scores, and grip strength. US positively maintained or improved ROM and grip. Splinting positively maintained or improved ROM, CSI positively improved nodule size. Cross Frictional Massage positively impacted AROM and THEAL improved pain and DASH scores.
UNASSIGNED: Outcomes from therapeutic interventions for pre-operative management of Dupuytren\'s Disease were largely positive. However, there is a need for further high-quality research into these interventions to understand their full potential for the management of Dupuytren\'s Disease.

UNASSIGNED: Musculoskeletal disorders affect over a third of the UK adult population and are a common reason for sick leave from work. The aims of this study were to describe the reported provision of work participation support for adults with hand and upper limb conditions by UK hand therapists, and to identify potential training needs in this area.
UNASSIGNED: A previous survey of the Australian Hand Therapy Association was adapted for the UK. The electronic questionnaire was distributed to members of the British Association of Hand Therapists. Eligible individuals were UK-based occupational therapists or physiotherapists whose role included the assessment and/or treatment of patients ≥18 years with hand or upper limb issues.
UNASSIGNED: There were 123 participants (17% response rate). The most frequently reported work participation interventions were discussing graded return to work and sign-posting patients to speak with their doctor. The Allied Health Professionals Health and Work Report and Fit Note were not regularly used, and respondents reported low levels of confidence in issuing these documents. Barriers to providing work recommendations included a perceived lack of time, skills, knowledge and training. Facilitators included the patient discussing work as a rehabilitation goal.
UNASSIGNED: Development opportunities for UK hand therapists include increasing patient awareness that they can ask for work-related advice and documentation, promoting existing health and work training, developing hand therapy-specific resources, and ensuring access to electronic Fit Notes. International opportunities include the continuation of this survey with a focus on generating exemplar work participation strategies to inform further research.

OBJECTIVE: To describe the theoretical development and structure of an occupation-based intervention for people with a surgically repaired distal radius fracture.
UNASSIGNED: The Early Daily Activity (EDA) intervention uses the performance of strategically selected daily activities as the primary rehabilitative strategy. Occupation-based interventions are recommended for hand injury rehabilitation but are often poorly described and lack explicit theoretical underpinnings. The EDA-intervention was developed from exploratory research that informed the theory and structure. The theoretical principles are that daily activity performance is (i) safe within defined parameters (ii) appropriately self-determined (iii) produces high ranges and amounts of therapeutic movement, and (iv) builds psychosocial competencies.
METHODS: The EDA-intervention is designed to be commenced within 2 weeks of surgery. There are three key components. The first is activity-specific education to emphasise the safety, benefits, and therapeutic actions of activity performance. A set of parameters for defining safe activities is described to support education. The second component is patient-therapist collaboration to select a range of daily activities that provide a \'just-right\' challenge. Collaboration occurs at regular intervals throughout the rehabilitation period to incrementally increase the challenge of activities. The third component is performance of activities at-home targeted at improving range of movement and function.
CONCLUSIONS: The EDA-intervention can be used by hand therapists, but it has not yet undergone effectiveness evaluation. A planned study will explore clinician readiness to adopt the EDA-intervention, inform iterative changes to the protocol and the design of feasibility and effectiveness studies.