Title: A study to examine the treatment of sub-acute hand oedema post trauma.
Funder: Health Education England

Abstract: Background: Oedema (swelling) post hand surgery or trauma is a natural part of the body's healing mechanism. However, oedema that persists into the sub-acute phase has the potential to cause long term joint stiffness and functional complications. The management of swelling is a constant challenge for hand therapists where the objective is to reduce this oedema as effectively, and as quickly as possible in order to focus therapy on more functional related goals, such as grip strengthening or work hardening. Prolonged swelling will have an impact on joint range of motion, soft tissue mobility, quality of scar tissue formation, function, strength, and aesthetics of the hand. These factors may delay a patient's recovery, meaning frequent and increased out-patient appointments, delaying return to work, difficulties with activities of daily living, and meaningful participation in functional roles. The proposed project would not only have benefits to patients' physical recovery post-injury but could also have further reaching economic impacts, in terms of reducing costs to the patient, the NHS, and society. The proposed intervention also enables patients themselves to take an active role in their rehabilitation and become experts of their own condition which is a key priority for the health service [1]Aims: This programme of research aims to i) establish the existing knowledge base on the assessment and treatment of hand oedema post-trauma or surgery from the literature and clinicians; ii) establish the most responsive clinican derived and patient rated outcome measure in assessing hand oedema and iii) establish the clinical efficacy of using Kinesiology tape as a treatment for sub-acute hand oedema. These aims will be achieved through 4 work packages. Plan of investigation: i) a structured literature review to explore the effectiveness of how oedema is currently assessed and treated in the hand; ii) a web based survey and Delphi Consensus method conducted with UK hand therapists to define the elements of a standardised oedema management package (frequency, duration); iii) an observational follow-up study to determine the most responsive clinician derived outcome measure and patient rated outcome measure in measuring oedema of the hand; iv) a pilot randomised controlled trial to compare Kinesiology tape with standard treatment in sub-acute hand oedema. Potential benefits to on-going improvement of health and social care: Potential benefits to patients' physical recovery post-injury and further reaching economic impacts in terms of reducing costs to the patient, the NHS and society.

Lay abstract: Swelling after hand surgery or trauma is a natural part of the body's healing. Swelling that persists after the first few weeks has the potential to cause long term joint stiffness, prolonging recovery, delaying return to work and resulting in difficulties with everyday activities. Swelling is currently treated with compression which has been questioned as too aggressive and prolonging the swelling. Elastic tape is becoming more popular in treating swelling. This is applied to the hand and designed to lift the skin allowing more room for the fluid to drain. No previous research has compared the compression versus lifting method.

Research activity codes: 6.3 MEDICAL DEVICES
Health categories: MUSCULOSKELETAL;INJURIES AND ACCIDENTS