The strongest evidence supports postsurgical early active motion protocol s and splinting for various conditions .
Very few studies have examined occupation-based interventions .
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity .
It is imperative that practitioners underst and the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purpose ful occupations .
This systematic review provides an up date to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question , What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm , wrist , and h and ?
Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial
Background Dupuytren 's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired h and function . St and ard treatment involves surgical release or excision followed by post-operative h and therapy and splinting , however the evidence supporting night splinting is of low quality and equivocal . Methods A multi-centre , pragmatic , open , r and omised controlled trial was conducted to evaluate the effect of night splinting on self-reported function , finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy . 154 patients from 5 regional hospitals were r and omised after surgery to receive h and therapy only ( n = 77 ) or h and therapy with night-splinting ( n = 77 ) . Primary outcome was self-reported function using the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . Secondary outcomes were finger range of motion and patient satisfaction . Primary analysis was by intention to treat . Results 148 ( 96 % ) patients completed follow-up at 12 months . No statistically significant differences were observed on the DASH question naire ( 0 - 100 scale : adjusted mean diff . 0.66 , 95%CI - 2.79 to 4.11 , p = 0.703 ) , total extension deficit of operated digits ( degrees : adjusted mean diff 5.11 , 95%CI -2.33 to 12.55 , p = 0.172 ) or patient satisfaction ( 0 - 10 numerical rating scale : adjusted mean diff -0.35 , 95%CI -1.04 to 0.34 , p = 0.315 ) at 1 year post surgery . Similarly , in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes . Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving h and therapy and only splinted if and when contractures occurred . Given the added expense of therapists ' time , thermoplastic material s and the potential inconvenience to patients having to wear a device , the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur . Trial registration The trial was registered as an International St and ard R and omised Controlled Trial IS RCT
The strongest evidence supports postsurgical early active motion protocol s and splinting for various conditions .
Very few studies have examined occupation-based interventions .
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity .
It is imperative that practitioners underst and the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purpose ful occupations .
This systematic review provides an up date to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question , What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm , wrist , and h and ?