Shawn C. Roll, Mark E. Hardison; Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review. Am J Occup Ther 2016;71(1):7101180010. https://doi.org/10.5014/ajot.2017.023234
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© 2021 American Occupational Therapy Association
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update 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 hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.
For treatment of patients with CTS, the strongest evidence exists for use of night or full-time splinting combined with stretching or tendon or nerve gliding activities.
Whether directed by a therapist or completed as an HEP, exercise is a vital component of recovery after distal radius fracture.
Early activity motion is recommended for patients after fixation of distal radius fracture, surgical repair of flexor or extensor tendon injuries, and surgical tendon transfer.
Although no evidence strongly supports any one type of splinting, splinting is recommended for improvement in functional activities for patients with swan neck deformities and mallet finger; no evidence supports the use of splints for boutonniere deformity or Dupuytren’s contracture.
There is a paucity of studies evaluating the use of occupation-based interventions and outcomes for MSDs of the distal UE, indicating a need for research in this area to support the distinct value of occupational therapy.
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