Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences.

Introduction: For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods: An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results: A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion: The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.

A case report on the use of vibration to improve soft tissue extensibility after major trauma.

This report presents a case where vibration training to the arm alone, as opposed to whole-body vibration, was used to aid rehabilitation to a serious traumatic injury. An improvement in soft tissue extensibility to a major traumatic wound to the wrist and forearm has been noted in a therapy plan including vibration under stretch. After 12 weeks of intensive therapy, a considerable improvement was seen in both the active extension of the wrist and the composite extension of all fingers. This may highlight the use of vibration, as an adjunct to therapy, to specific areas of the human body for improving outcome from traumatic injury. LEVEL OF EVIDENCE: IV.