How should interventions to treat hand oedema be delivered? An online Delphi Consensus Method.

Introduction: Hand oedema (swelling) is a common consequence of hand trauma or surgery, but there is little agreement on how interventions to treat hand oedema should be delivered in practice. The purpose of this study was to engage a group of self-identified hand therapy experts to develop consensus on how four commonly used oedema management treatments should be implemented, which could be used in clinical practice or future clinical trials. Method: A web-based Delphi study was conducted with eight volunteer hand therapists who met the pre-defined eligibility criteria for an 'expert' and were members of the British Association of Hand Therapists (BAHT). An a priori level of agreement was set at 75%. Interventions requiring consensus were decided on as a result of a previous national survey of practice and consisted of compression, elevation, massage and kinesiology tape. Results: A total of 25 items were discussed across 3 rounds. This ranged from 23 items in round 1, to three items in round 3. In round 1, consensus was reached on 7/23 (30%) items. The required 75% consensus was reached on 14 items in round 2 and 1/3 items achieved consensus in round 3. Massage was the only treatment that required a third round. Discussion: Consensus was reached on intervention description for three of the four modalities including the materials used (what), method of application including duration and frequency (when and how much) and tailoring or modifications. Two questions relating to massage did not reach the required consensus threshold and a majority agreement was accepted. The small panel size is a limitation and may affect the credibility of the consensus reached.

Effectiveness of edema management techniques for subacute hand edema: A systematic review.

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.

Effects of sensory reeducation programs on functional hand sensibility after median and ulnar repair: a systematic review.

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.