Katie Loomis MA, OTR/L, CHT(she/her/hers)

Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79–0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33–0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.

Study Design. This study was a scoping review.

Background. Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment.

Purpose of the Study. This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility.

Methods. Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility.

Results. Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians.

Conclusion. Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.

Keywords. Ultrasound imaging; Sonography; Upper extremity; Musculoskeletal; Scoping review

Background. Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.

Objective. To explore therapists’ perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.

Methods. Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.

Results. SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.

Conclusion. In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Keywords. Qualitative research, occupational therapy, musculoskeletal diseases, return to work

Background. While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus.

Purpose. This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting.

Study Design. This was a consensus paper via the modified Delphi approach.

Methods. A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist’s research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel.

Results. The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient’s unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention.

Conclusions. The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.

Keywords. Thumb carpometacarpal osteoarthritis; Assessment; Treatment

This multimethod study identified four themes within the therapist-patient relationship that affect the provision of holistic and collaborative care. Therapists developed a complex relationship with their patients, leading to high scores on measures of adherence and engagement. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care to produce effective outcomes.

Purpose. Holistic and collaborative treatment planning and patient care are essential components of best practice occupational therapy (OT). This approach to care must consider patient factors and therapeutic techniques, but success will also be dependent on the therapist-patient relationship itself. There has been limited examination of this relationship within OT settings, particularly related to core concepts such as engagement and adherence. This study identified factors within the therapist-patient relationship that impacted the provision of holistic and collaborative services within an outpatient setting.

Design. A multi-method study design was used to obtain quantitative and qualitative data to describe therapists’ perspectives of their patients’ adherence and engagement, and the relative role of therapist-patient relationship. The study participants were a convenience sample of four OTs working at a hospital-based outpatient upper extremity rehabilitation clinic.

Method. Data were collected over three months. A series of weekly group interviews (n = 13) were conducted using a semi-structured guide. Interviews explored the interaction between therapist and patient roles within the therapeutic environment, including balances of power and barriers/facilitators to therapeutic engagement and adherence. Therapists completed surveys following visits from a sub-sample of patients receiving treatment during the study period (n = 16). Specifically, the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) were used to assess therapists’ perspectives of patient adherence and engagement. Descriptive statistics were generated from the survey data. Principles of constructivist grounded theory were used to analyze interview transcripts through an iterative process of initial and focused coding until saturation was reached. Themes connecting the codes were created by the primary coder. Two additional researchers who conceptualized the study and conducted the interviews engaged with the coder in iterative discussions to refine the qualitative themes and situate these findings within the context described by the quantitative results.

Results. Therapists consistently rated their patients highly on SIRAS and RTES measures. SIRAS scores averaged 14.4/15 (SD: 1.0, range: 10-15) and RTES scores averaged 42.5/45 (SD: 3.4, range: 23-45). These high scores may have been facilitated by complex and dynamic interactions across multiple factors within the therapist-patient relationship. Four themes emerged from therapist interviews: (1) Power within the therapist-patient relationship was fluid, often impacted by patient preference, personal contexts, and medical environment restrictions; (2) engagement was reciprocal and co-constructed between the therapist and patient; (3) therapist-patient interaction modulated emotional states to influence mutual engagement; and (4) the therapist-patient relationship is defined by different spatial and temporal contexts within the therapy process.

Conclusion. This study found that, in a highly engaged and adherent treatment setting, the therapist-patient relationships were complex, intimate, and dynamic, and extended beyond patient education and physical interventions. Careful management of this relationship was central to facilitating active patient participation and engagement.

Keywords. arm, outpatients, rehabilitation