Abstract
The first article in this issue is by Paula Minchin and Michelle Spiros from Dublin, Ireland, and it deals with the conservative management of mallet finger injury in Irish hospitals. They surveyed emergency and therapy departments in 29 acute hospitals in order to describe the management of mallet injuries including initial treatment, splint choice, referral patterns, ongoing management protocols and outcome audits. Their findings identify differences in length and methods of immobilization as well as delays in referral and disruption to treatment, which, although do not necessarily have a negative impact on outcome, have implications for resources and the patients’ experience. While their study may not be generalizable to other health-care settings or countries, this study is an excellent example of how surveys of this kind can help identify areas for service improvement. They also provide important contextual background on what current care consists of, which in turn may help inform the design of future clinical studies on treatment effectiveness.
Paula Errera Magnani and colleagues from the University of São Paulo, Brazil present the results of a study of the relationship between patient-reported outcome and total active motion after flexor tendon repair. The authors used the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire, one of the most widely used and validated instruments available to hand therapists. Similar to other published studies investigating the relationship between patient-rated outcome and physical impairment measures, the authors found only weak-to-moderately strong correlations between these outcomes. Their work adds to the growing body of evidence that supports the notion that clinical assessment of body function and body structure alone does not adequately reflect the impact of hand disease or trauma on the individual and the need for measures of activity and participation, such as the DASH to be included to give a comprehensive assessment of outcome.
In an age where the use of mobile technology is so much a part of our everyday lives, developments on how this can be applied to telehealth are very timely. Emily McMullen from Oxford, UK shares her experiences of using SKYPE as a technology for free video-calling to provide remote treatment and consultation to a patient returning to live and work in Africa following specialist surgical treatment for a complex hand injury in the UK. The specialist team were able to support both patient and the local therapists in the ongoing rehabilitation of his injuries. The scope to extend this work to provide remote consultations to patients even living closer to home is highlighted and we will no doubt see further developments in this field.
Our final article is by Judith Falconer from Chicago, Illinois, who presents an overview of the literature on osteoarthritis from the perspective of a disease which results from microtrauma that is mediated by physical activity. This is of particular relevance to hand therapists who often find themselves needing to advise patients on joint protection and pacing but also opens up possibilities for considering new interventions designed to prevent some of the ensuing pain and disability that so often accompanies this disease.