ABSTRACT
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.
ABSTRACT
OBJECTIVE: To assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. DESIGN: A multicenter assessor-blinded, parallel, 2-group controlled trial. SETTING: Trauma and rehabilitation services of 4 hospitals. PARTICIPANTS: Six hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). INTERVENTIONS: The experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. MAIN OUTCOME MEASURES: The primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). RESULTS: The experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=-1.64; 95% confidence interval, -2.64 to -0.65) and physiotherapy sessions (mean difference=-8.52, 95% confidence interval, -16.92 to -0.65) compared to the control group. CONCLUSIONS: In patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients' functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.
Subject(s)
Mobile Applications , Soft Tissue Injuries , Telerehabilitation , Humans , Wrist , Exercise TherapyABSTRACT
QUESTION: In people who have undergone surgical carpal tunnel release, do sensorimotor-based exercises performed on the touchscreen of a tablet device improve outcomes more than a conventional home exercise program prescribed on paper? DESIGN: Randomised, parallel-group trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Fifty participants within 10 days of surgical carpal tunnel release. INTERVENTION: Each participant was prescribed a 4-week home exercise program. Participants in the experimental group received the ReHand tablet application, which administered and monitored exercises via the touchscreen. The control group was prescribed a home exercise program on paper, as is usual practice in the public hospital system. OUTCOME MEASURES: The primary outcome was functional ability of the hand, reported using the shortened form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were grip strength, pain intensity measured on a 10-cm visual analogue scale, and dexterity measured with the Nine-Hole Peg Test. Outcomes were measured by a blinded assessor at baseline and at the end of the 4-week intervention period. RESULTS: At Week 4, functional ability improved significantly more in the experimental group than the control group (MD -21, 95% CI -33 to -9) on the QuickDASH score (0 to 100). Although the mean estimates of effect on the secondary outcome also all favoured the experimental group, none reached statistical significance: grip strength (MD 5.6 kg, 95% CI -0.5 to 11.7), pain (MD -1.4 cm, 95% CI -2.9 to 0.1), and dexterity (MD -1.3 seconds, 95% CI -3.7 to 1.1). CONCLUSION: Use of the ReHand tablet application for early rehabilitation after carpal tunnel release is more effective in the recovery of functional ability than a conventional home exercise program. It remains unclear whether there are any benefits in grip strength, pain or dexterity. TRIAL REGISTRATION: ACTRN12618001887268.
