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Background: The Boston Carpal Tunnel Questionnaire (BCTQ) is a patient-reported outcome measure (PROM) used to measure symptom severity and function in carpal tunnel syndrome (CTS). Despite its wide use, investigation of its measurement properties using modern psychometric methodologies is limited., Methods: Completed BCTQ data collected routinely in the Canterbury carpal tunnel clinic was used to investigate the structural validity and measurement properties of the BCTQ through application of a Rasch model analytic approach., Results: A total of 600 patients with electrodiagnostically confirmed CTS in their right hand were randomly selected from the database and analyzed. Mean age was 48.8 y, and 73% were women. Initial analysis showed that the 19 items could not be reliably added up to form a single linear construct. All subsequent analyses were done by subscale only. The Symptom Severity Subscale (SSS) displayed a large amount of local dependence. This could be accommodated through the creation of four clinically derived testlets, allowing for the ordinal SSS raw score to be transformed to a linear measure. The Functional Status Subscale (FSS) displayed a number of issues regarding its psychometric integrity. These include scale and item fit, targeting, differential item functioning, and dimensionality., Conclusions: This study shows that a single total score generated across all BCTQ items is not psychometrically valid, and that the SSS and FSS subscales should be treated separately. We propose a modified scoring system for the SSS, resulting in a linear measure that can be used in the analysis of future and existing datasets., (© 2021 Wiley Periodicals LLC.)

Study Design: Grounded theory., Introduction: The broader perspective of health offered by the World Health Organization's International Classification of Functioning, Disability and Health has had a significant bearing on how we view the measurement of health outcomes after surgical or therapy interventions for peripheral nerve disorders affecting the hand. The value of the patient's perspective is now recognized and outcomes which reflect this are being advocated in the clinical management and support of this population., Purpose of the Study: This qualitative study sought to explore the lived experience of a hand nerve disorder and in particular the impact on body structure/function, activities, and participation., Methods: In depth, one-to-one interviews with 14 people with a range of hand nerve disorders were conducted. Constructivist grounded theory methods were used to collect and analyze the data. Patients were also given the option of taking photographs to visually represent what it is like to live with a nerve disorder, to bring with them for discussion during the interview., Results: The impact of hand nerve disorders forms part of a wider narrative on adaptation. A process of "struggling" and then "overcoming" was experienced. This was followed by an interior aspect of adaptation described as "accepting." This gave rise to participants "transforming," being changed as a result of the journey that they had been on., Conclusions: This study provides an explanatory theory on the adaptive process following a hand nerve disorder which may inform future patient-therapist interactions., (Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Study Design: Systematic review., Introduction: Prolonged hand edema can have detrimental effects on range of motion and function. There is no consensus on how best to manage traumatic subacute edema. This is the first systematic review which examines the clinical effectiveness of edema treatments on hand volume., Purpose of the Study: The purpose of this systematic review was to examine the evidence of effectiveness of treatments for sub-acute hand edema., Methods: A literature search of AMED, CINAHL, Embase, and OVID MEDLINE (from inception to August 2015) was undertaken. Studies were selected if they met the following inclusion criteria: randomized controlled or controlled trials in adults who have subacute swelling after a recent upper limb musculoskeletal trauma or cerebral vascular attack or after surgery. Two independent assessors rated study quality and risk of bias using the 24-point MacDermid Structured Effectiveness Quality Evaluation Scale (SEQES)., Results: Ten studies met the inclusion criteria. Study quality ranged from 23 to 41 out of 48 points on the SEQES. A total of 16 edema interventions were evaluated across the studies. Due to heterogeneity of the patient characteristics, interventions, and outcomes assessed, it was not possible to pool the results from all studies. Therefore, a narrative best evidence synthesis was undertaken. There is low to moderate quality evidence with limited confidence in the effect estimate to support the use of manual edema mobilization methods in conjunction with standard therapy to reduce problematic hand edema., Conclusion: Manual edema mobilization techniques should be considered in conjunction with conventional therapies, in cases of excessive edema or when the edema has not responded to conventional treatment alone; however, manual edema mobilization is not advocated as a routine intervention., Level of Evidence: 2b., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period., Methods/design: In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed., Discussion: This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions.

Introduction: This is the first systematic review looking at the effectiveness of sensory re-education programmes on functional sensibility which focuses purely on clinical trials of adult patients with median and ulnar nerve injuries., Methods: A literature search of AMED, CINAHL, Embase and OVID Medline (from inception to July 2011) was undertaken. Studies were selected if they met the following inclusion criteria: controlled trials (with or without randomization) of sensory re-education, including early and late phase, in adults with median and/or ulnar nerve repair. Two independent assessors rated study quality and risk of bias using the 24 point MacDermid Evaluation Tool., Results: A total of seven articles met the inclusion criteria representing five separate studies Study quality ranged from 13 to 33 out of 48 points on the Evaluation Tool. Due to heterogeneity of the interventions and outcomes assessed it was not possible to pool the results from all studies. There is limited evidence to support the use of early and late SR programmes., Conclusion: Further trials are needed to evaluate the effect of early and late sensory re-education which are adequately powered, include validated and relevant outcomes and which are reported according to CONSORT (Consolidated Standards of Reporting Trials) guidelines., Level of Evidence: 2b., (Copyright © 2012 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Sensory relearning (SR) first described in the 1970s by Wynn-Parry and Dellon has evolved over the last 20 years as a result of new insights into cortical plasticity. It has eluded precise definition, and a detailed description of its "key ingredients" is rarely documented in published studies investigating effectiveness. The purpose of this two-part study was to define SR and describe the content of an SR program in the treatment of peripheral nerve disorders of the hand. The first part included a review of current published evidence and a survey of clinical practice. The second part comprised a Delphi method to develop consensus on the definition and indicative content of an SR program with a view to evaluating its clinical effectiveness in future trials. The Web-based survey of SR practices among European hand therapists was undertaken first. A total of 70 respondents returned their questionnaires representing 10 European-member countries. Frequencies and percentages were used to summarize the responses. The results confirmed that both classical and novel techniques for SR are being used by hand therapists. Classical methods, such as retraining of tactile gnosis through graded textures, shapes, and objects, were more frequently used than newer methods, such as mirrors or sensory substitution, which have been advocated as part of early-phase retraining and were developed in the last 10 years. An internet-mediated Delphi method with seven experts from four European countries yielded consensus on a definition of SR and its indicative content. Further work is needed to ensure that this can be translated into feasible treatment programs that can be evaluated in future trials., Level of Evidence: IV, Consensus study., (Copyright © 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal., Methods: A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77) or hand therapy with night-splinting (n = 77). Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat., Results: 148 (96%) patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703), total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172) or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315) at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes., Conclusions: No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to patients having to wear a device, the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur., Trial Registration: The trial was registered as an International Standard Randomised Controlled Trial ISRCTN57079614.

Background: Objective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS). However a range of outcome measures are used and there appears to be no consensus on which measure of motor function effectively captures change. The purpose of this systematic review was to identify the methods used to assess motor function in randomized controlled trials of surgical interventions for CTS. A secondary aim was to evaluate which instruments reflect clinical change and are psychometrically robust., Methods: The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical interventions for CTS. Data on instruments used, methods of assessment and results of tests of motor function was extracted by two independent reviewers., Results: Twenty-two studies were retrieved which included performance based assessments of motor function. Nineteen studies assessed power grip dynamometry, fourteen studies used both power and pinch grip dynamometry, eight used manual muscle testing and five assessed the presence or absence of thenar atrophy. Several studies used multiple tests of motor function. Two studies included both power and pinch strength and reported descriptive statistics enabling calculation of effect sizes to compare the relative responsiveness of grip and pinch strength within study samples. The study findings suggest that tip pinch is more responsive than lateral pinch or power grip up to 12 weeks following surgery for CTS., Conclusion: Although used most frequently and known to be reliable, power and key pinch dynamometry are not the most valid or responsive tools for assessing motor outcome up to 12 weeks following surgery for CTS. Tip pinch dynamometry more specifically targets the thenar musculature and appears to be more responsive. Manual muscle testing, which in theory is most specific to the thenar musculature, may be more sensitive if assessed using a hand held dynamometer - the Rotterdam Intrinsic Handheld Myometer. However further research is needed to evaluate its reliability and responsiveness and establish the most efficient and psychometrically robust method of evaluating motor function following surgery for CTS.

Introduction Assessment of oedema after trauma or surgery is important to determine whether treatment is effective and to detect change over time. Volumetry is referred to as the ‘gold standard’ method of measuring volume. However, this has practical limitations and other methods are available. The aim of this systematic review was to evaluate the psychometric properties of alternative methods used to assess hand oedema. Methods A search of electronic bibliographic databases was undertaken for any studies published in English reporting the psychometric evaluation of a method for measuring hand oedema, in an adult population with hand swelling from surgery, trauma or stroke. The Consensus‐based Standards for the Selection of health Measurement Instruments (COSMIN) checklist was used to evaluate the methodological quality. Results Six studies met the inclusion criteria. Three methods were identified assessing hand oedema: perometry, visual inspection and the figure-of-eight tape measure, all were compared to volumetry. Four different psychometric properties were assessed. Studies scored fair or poor on COSMIN criteria. There is low-quality evidence supporting the use of the figure-of-eight tape measure to assess hand volume. The perometer systematically overestimated volume and visual estimation had poor sensitivity and specificity. Discussion The figure-of-eight tape measure is the best alternative to volumetry for hand oedema. Benefits include reduced cost and time while having comparable reliability to the ‘gold standard’. Further research is needed to compare methods in patients with greater variability of conditions and with isolated digit oedema. Visual estimation of hand oedema is not recommended. [ABSTRACT FROM AUTHOR]