Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand.

BACKGROUND: Range of motion (ROM) is an outcome measure commonly used when treating acute and chronic hand injuries and conditions. Increased adoption of telehealth service provision in hand therapy practice, influenced by the advent of COVID-19, has led to the need for a valid and reliable approach to measure the range of motion of the digits of the hand when providing hand therapy services using telehealth. PURPOSE: To determine if performing manual goniometry during a livestream teleconsultation is reliable and clinically useful to measure the range of motion of the fifth digit when providing hand therapy services using telehealth. STUDY DESIGN: Clinical measurement, repeated-measures study. METHODS: According to a measurement protocol, 12 independent raters (who currently provide hand therapy services) each obtained several screen-based goniometric range of motion measurements of the fifth digit at 2-time points. Raters were surveyed on the clinical utility of the telehealth-based goniometry approach. Measures of relative and absolute reliability were calculated to evaluate test-retest and inter-rater reliability. Free-text responses were analyzed using content analysis. RESULTS: Inter-rater reliability was excellent for all flexion and extension measures (intraclass correlation coefficient [ICC] ≥ 0.89) but poor for the arc of motion (ICC ≤ 0.67). Test-retest reliability was poor (ICC ≤ 0.43). No statistically significant differences between test and retest measurements were observed (P ≥ 0.24). The overall coefficient of variation indicated good precision (14.69%). Measurement error (≤6.07º) and limits of agreement (≤6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations. CONCLUSIONS: This study suggests that performing manual goniometry during a livestream teleconsultation is unreliable for measuring the range of motion of the fifth digit. However, when combined with patient-reported and functional outcomes, this approach may be suitable to facilitate a range of motion assessment for certain functions of telehealth service provision in hand therapy practice.

Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation.

STUDY DESIGN: Retrospective cost-of-illness study. INTRODUCTION: Injuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable. PURPOSE OF THE STUDY: To estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network. METHODS: Using 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway. RESULTS: Two hundred and twenty-six individuals (n 1/4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively. DISCUSSION: Findings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates. CONCLUSION: Surgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.

Profile and cost of sport and exercise-related hand and wrist injuries with Emergency Department presentation.

OBJECTIVES: Injuries to the hand and wrist from sport and exercise are common and costly. This cost-of-illness analysis was performed to estimate the economic implications of hand and wrist injuries that were sustained as a result of participation during sport or exercise. PERSPECTIVE: Cost estimates were calculated from resource use in the emergency, inpatient and outpatient settings from the perspective of one public healthcare service. SETTING: Alfred Health, a large public health service with two emergency departments located in Victoria, Australia. METHODS: This descriptive epidemiological study used ICD-10 diagnostic codes and electronic billing records to identify 778 potential cases for inclusion. Electronic medical records were screened and reviewed to extract demographic and patient care journey data. RESULTS: 692 individuals, (n=761 individual zone of injuries), were included. Australian Rules Football (ARF) was the largest contributor to injuries (20.2%) followed by riding bicycles (15.9%. The total cost of all injuries was $790,325, with a median cost per case of $278 [IQR $210-$282] in the Emergency Department n=692, $3328 [IQR $2242-$6441] in the inpatient setting n=76 and $630 [IQR $460-$870] in the outpatient setting n=244. CONCLUSIONS: Hand and wrist injuries sustained from sport and exercise contribute to a significant financial burden on the healthcare system. Future research that considers the costs that occur outside of the public healthcare service is required estimate the burden associated with these injuries comprehensively. Injury prevention programs may mitigate the observed injury trends.

Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.

BACKGROUND: Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. OBJECTIVE: This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. MATERIALS AND METHODS: A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. CONCLUSIONS: Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden.