Development of a clinical hand rehabilitation guideline for second to fifth metacarpal fractures in South Africa
Loading...
Date
2023
Authors
Keller, Monique Marié
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
In countries, such as South Africa, with limited resources and inequities in their healthcare delivery services optimal hand rehabilitation is essential in their quest to enable individuals sustaining second-to-fifth metacarpal fractures to return without delay to pre-injury functioning and to work safely. Sub-optimal hand rehabilitation service delivery impacts the already strained South African healthcare system, where individuals may return to hospitals or clinics with associated complications leading to time off from work and thus negative socioeconomic consequences (Poolman et al, 2005). Second to fifth metacarpal fractures are generally sustained as a result of motor vehicle accidents, trauma and violence, and in most cases, where the hand makes contact with an object. A fracture of the neck of the fifth metacarpal is one of the most frequent of the hand injuries to be sustained. The problem is that there are no guidelines and best-evidence information available to guide clinical practice which leaves a gap in the knowledge base in this respect. The result is that owing to the individual’s hand not being optimally managed, there would then be a possible delay in returning to work, and more seriously, disability and dysfunction. Three research phases were undertaken to achieve the aim of developing a clinical hand rehabilitation guideline for adults, male and female, between the ages of 20 and 59 years, after conservative and surgical management following a single or multiple second to fifth metacarpal fractures. The first phase included a systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) principles.
The second phase involved a two-staged feasibility study and a cross-sectional study, and included healthy adult participants who met the inclusion criteria. The participants donned two gloves with force sensing resistors (FSR) attached with glue to the finger pads which allowed the finger and grasp forces to be measured. The basic and instrumental activities of daily living (ADL) were performed in a laboratory. The FSR testing phase allowed for the inclusion of grasp types in the guideline, as well as the categorisation of ADL tasks into light, moderate and heavy task categories. The categorisation of ADL tasks allowed the clinicians to give advice, according to the timelines for bone healing, about returning to pre-injury tasks. The third phase involved an eDelphi method, with consideration being given to the Conducting and Reporting of DElphi Studies (CREDES), with recommendations included. In this case, the experts participated in a three-round eDelphi method to reach consensus and to further develop and finalise the clinical hand rehabilitation guideline. The guideline methodology was developed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. After three phases of the study, with the final phase being the eDelphi method, expert consensus was reached on 32 recommendations. A hand rehabilitation guideline consisting of the 32 recommendations was developed by the researcher to inform this research’s clinical guideline which is presented in the format of the European Society of Cardiology (ESC).
Description
Thesis (Ph.D. (Physiotheraphy))--University of the Free State, 2023
Keywords
Second to fifth metacarpal fractures, activities of daily living, force sensor resistor, clinical guidelines, hand rehabilitation, grasps, South Africa