The use of static progressive and serial static orthoses in the management of elbow contractures after complex fracture dislocation injuries: A pediatric case study.

INTRODUCTION: Contractures are the most common complication after traumatic injury to the elbow. Although evidence supporting the use of static progressive and serial static orthoses to help recover range of motion after these complex injuries is growing, there is currently a paucity of literature exploring its efficacy in pediatric populations. CASE DESCRIPTION: The following case study presents the results of the use of static progressive and serial static orthoses with a young patient who presented with both elbow extension and flexion contractures after a complex fracture dislocation injury. RESULTS: A noted and consistent improvement in both elbow extension and flexion can be observed after commencement of the static progressive and serial static orthoses. These results are consistent with the literature exploring the efficacy of these orthoses with adult populations with traumatic elbow injuries. DISCUSSION: Further studies evaluating the use of static progressive and serial static orthoses in the management of elbow contractures after traumatic injuries in pediatric populations is needed to establish best practices with this particular patient population.

A client-centered approach for thumb carpometacarpal joint osteoarthritis pain: Two case studies.

DESIGN: Case study. INTRODUCTION: Hand therapists are often called upon to provide treatment for thumb carpometacarpal joint osteoarthritis. PURPOSE: These 2 case studies present a client-centered approach in the selection of orthoses and joint protection strategies for patients with thumb carpometacarpal joint osteoarthritis. At baseline, the participants presented with pain, decreased active range of motion, decreased pinch strength, and limitations in activity and participation. METHODS: The outcome measures utilized at study entry and 6 weeks included the pain Visual Analog Scale, the Australian Canadian Osteoarthritis Hand Index, the Disabilities of the Arm, Shoulder and Hand questionnaire, the Canadian Occupational Performance Measure, active range of motion measured with goniometry, and pinch strength measured with a pinch gauge. The Canadian Occupational Performance Measure facilitated the client-centered approach by identifying occupational performance issues and rating the participant's performance and satisfaction for each. Each participant was prescribed a different orthotic design, received client-centered joint protection instruction, and evidence-based exercises. RESULTS: After 6 weeks, both clients had decreased pain and improvement in their activities, participation, and satisfaction. DISCUSSION: Using a client-centered approach can help therapists to carefully consider a patient's occupational needs when designing and fabricating orthoses and customizing their joint protection education for carpometacarpal joint osteoarthritis. CONCLUSION: Focusing rehabilitation strategies on that which is most important to the client should be considered to optimize their occupational performance.

Effects of client-centered multimodal treatment on impairment, function, and satisfaction of people with thumb carpometacarpal osteoarthritis.

STUDY DESIGN: Prepost design. INTRODUCTION: Previous research regarding the non-surgical treatment of thumb carpometacarpal joint osteoarthritis has been based on protocol driven research designs that primarily examined impairment level changes. Exploration is therefore needed to determine the benefits of individually prescribed orthoses, joint protection and assistive device education programs that are based on the activities the person needs to regularly perform. PURPOSE OF THE STUDY: The primary objective of this study was to examine the effect of client-centered multimodal treatment on activity, participation, impairment, and satisfaction of people with thumb carpometacarpal joint osteoarthritis. METHODS: A total of 60 participants completed the study that used a prepost design. The Canadian Occupational Performance Measure (COPM) was used to identify the participants' performance and satisfaction concerning their self-identified occupational performance issues. Additional outcome measures that were used included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, total active range of motion (TAROM), lateral pinch strength, and the visual analog scale for pain. All participants completed a client-centered 6-week program that consisted of the use of an orthosis, joint protection, and assistive device education as well as exercises. RESULTS: At 6 weeks after initiation of treatment, pain, pinch strength, TAROM, the DASH questionnaire and the performance and satisfaction scales of the COPM had significantly improved. The changes in pain, TAROM, and the performance and satisfaction scales of the COPM were all greater than the minimal clinically important difference. The changes in pain and lateral pinch strength were significantly associated with changes in activity and participation. DISCUSSION: This study demonstrated that a multimodal, client-centered treatment approach resulted in statistically and clinically significant improvement in pain, TAROM and performance and satisfaction as measured by the COPM. The improvement in pain was associated with the participants' improved ability to engage in activities assessed by the DASH. CONCLUSIONS: Our results support the use of client-centered treatment strategies that are targeted to control pain during meaningful activity when working with patients with thumb carpometacarpal joint osteoarthritis therapists. LEVEL OF EVIDENCE: 4.