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Objective: To evaluate whether, in patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app reduces the consumption of face-to-face resources and improves clinical recovery, compared to a conventional home exercise program prescribed on paper. Design: Pragmatic, multicentre, parallel, two-group, controlled clinical trial with blinded assessor. Participants and setting: Eighty-one patients with traumatic bone and/or soft tissue injuries of the hand, wrist and/or fingers recruited in four hospitals of the Andalusian Public Health System. Interventions: The experimental group received a home exercise program using a touchscreen tablet application and the control group received a home exercise program on paper. Both groups received the same treatment of face-to-face physiotherapy. Primary outcome: Number of physiotherapy sessions. Secondary outcomes were the duration of physiotherapy and clinical variables such as functional ability, grip strength, pain and manual dexterity. Results: The experimental group required fewer physiotherapy sessions (MD -11,5 sessions; 95% CI -21.4 to -1.4), showed a shorter duration of physiotherapy (MD -3.8 weeks, 95% CI -7 to -1) and had better recovery of grip strength, pain and dexterity compared to the control group. Conclusions: In patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app in combination with face-to-face physiotherapy reduces the consumption of face-to-face resources and improves clinical recovery, compared to conventional home exercise program prescribed on paper.

BACKGROUND: Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new de- livery systems are needed to solve lack of adherence. AIM: To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN: A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING: Community health centers in rural southern Spain. POPULATION: Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS: Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the Care- Hand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS: The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS: A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb fu

Background: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. Objective: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. Methods: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. Results: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the anal

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 hea

Background: Therapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)- related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA. Methods: The project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up. Discussion: This study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient’s status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effe