Rehabilitation of persistent poor hand function after trauma: A systematic review of randomised controlled trials

Hand trauma is common, and can be functionally limiting and psychologically distressing. Hand dysfunction that is persistent after trauma can be troublesome to manage. Patient-reported outcome measures (PROMs) are useful in assessing hand function, and an improvement has been associated with an increase in health-related quality of life. Hand therapy is important for managing patients with residual poor hand function after trauma, but minimal evidence exists to support commonly used treatments. This review aimed to evaluate the evidence for interventions, outcome measures, and the implications for future research in hand therapy.

A systematic review with narrative synthesis was conducted. Randomised controlled trials of residual hand dysfunction after trauma were included. The primary outcome measures were PROMs validated in hand trauma. Secondary outcomes included symptoms of hand dysfunction or validated tests that evaluate hand function.

19 studies were included. Occupation-based interventions showed moderate strength of effect in improving hand function in terms of PROMs. Mirror therapy, robot-aided rehabilitation, orthotic management of the stiff hand, and oedema-reducing therapies were also evaluated. The findings were limited by a high risk of bias and lack of robust methodology in the included studies. PROMs were inconsistently utilised, along with a variety of other outcome measures.

No firm recommendations for practice can be made based on the evidence included in this review. Well designed, multicentre trials are needed to generate more robust evidence. Standardisation of outcome measures and reporting, and the use of PROMs aligned with patient priorities will be crucial for advancing research in hand therapy.