[Physical therapy, orthosis and occupational therapy in medical and surgical rheumatologic hand diseases]

Hand pathology can cause functional disability and deterioration in the quality of life by altering the grip and therefore, it requires a complex approach by a multidisciplinary team, including physiotherapists and occupational therapists. Orthoses are an important part of the treatment of these pathologies. A thorough understanding of the pathogenesis of lesions and their risk of progression to deformities is required for an appropriate use. Their fabrication by a specialized therapist and also their monitoring assure a good compliance. Their effectiveness depends on the patient adherence, for which information and education are essential. The role of physiotherapist is to establish a personalised rehabilitation program, including passive and active exercises and also the prevention of joint stiffness. The main goal after surgery is to initiate an early active motion in order to decrease the risk of adhesions without compromising the suture by the use of a splint. The role of occupational therapist is important all along the treatment period, from the early rehabilitation to the moment of return to home environment. The literature search shows that there is a lack of good methodological clinical studies in order to assess the effectiveness and the costs of this medical treatment.