Efectividad clínica de la app Rehand en la rehabilitación de la afectación de muñeca, mano y dedos

La función de la mano es crucial para las actividades de la vida diaria, ya que su realización generalmente requiere de interacciones precisas entre mano y objetos. Así, su afectación, frecuentemente generada por lesiones traumáticas óseas y de tejidos blandos del segmento muñeca-mano-dedos, origina un problema tanto para el individuo como para la sociedad, fundamentalmente por la limitación que genera en los ámbitos laboral y social. De todas las lesiones que llegan a los departamentos de urgencias, el 29% son de mano. En un estudio de base poblacional llevado a cabo en Países Bajos, se observó que las lesiones de mano y muñeca en este país tenían un coste anual estimado de 740 millones de dólares americanos, constituyéndose así como la lesión más costosa. Esta gran carga económica para la sociedad, junto con la creciente industrialización y mecanización, hace que la investigación para mejorar el manejo y la rehabilitación de las lesiones de mano sea una prioridad en los países desarrollados y en vías de desarrollo. En condiciones musculoesqueléticas de las extremidades superiores, los programas de ejercicio domiciliario ofrecen una rehabilitación efectiva, mejorando parámetros como la actividad, el dolor, la funcionalidad o la fuerza, y ayudando a reducir los costes asociados. Asimismo, se ha demostrado que complementar la rehabilitación del paciente con determinadas tecnologías tiene la capacidad de aumentar la efectividad de la terapia convencional. Las aplicaciones para Tablet han sido propuestas previamente para la rehabilitación de la función motora del miembro superior, con el objetivo de usar la amplia pantalla táctil de estos dispositivos para estimular la reorganización cortical mediante tareas guiadas por feedback y orientadas a objetivos concretos. La presente tesis doctoral, a través de los tres artículos que conforman la tesis por compendio, gira en torno a un único eje de actuación. Tras la patología traumática y ortopédica del segmento muñeca-mano-dedos, ¿Existe una modalidad de ejercicio terapéutico que, a través de la tecnología, pueda optimizar la recuperación de estas patologías, bien como única forma de tratamiento o como complemento al tratamiento presencial? Así, el objetivo general de investigación fue evaluar el efecto de un formato tecnológico innovador de tratamiento mediante ejercicios guiados por feedback a través de las pantallas táctiles de dispositivos Tablet, sobre la recuperación tras la patología traumática y ortopédica del segmento muñeca-mano-dedos. Este objetivo general se aborda segmentadamente en cada uno de los artículos que conforman la tesis. Así, el primer artículo analiza de forma global y práctica las líneas de investigación actuales y futuras acerca de la aplicación y el beneficio del ejercicio sobre la lesión ósea y del tejido blando en el segmento muñeca-mano. El segundo artículo evalúa si, en pacientes con lesión ósea y del tejido blando en el segmento muñeca-mano-dedos que genere una limitación de la funcionalidad, la intervención mediante ejercicios guiados por feedback a través de las pantallas táctiles de dispositivos Tablet, en comparación con los programas convencionales de ejercicio en papel, ambos utilizados como complemento a la terapia presencial, genera un beneficio clínico y en la gestión de costes. El tercer artículo analiza específicamente a pacientes con una patología ortopédica representativa por su alta incidencia como es la liberación quirúrgica del túnel carpiano, evaluando si la intervención mediante ejercicios guiados por feedback a través de las pantallas táctiles de dispositivos Tablet, en comparación con los programas convencionales de ejercicio en papel, ambos utilizados como única forma de tratamiento, genera un beneficio clínico

Dispositivo vibratorio portátil de escaso tamaño optimizador del entrenamiento muscular

La presente invención tiene por objeto un dispositivo vibratorio portátil de escaso tamaño que transmite una vibración con una frecuencia y amplitud determinadas a la región del paciente a ejercitar, aumentando su efecto sobre los receptores y la muscula

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial

Question In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Design Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Intervention Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. Outcome measures The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Results Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. Conclusion In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments

The effects of a mobile app-delivered intervention in people with symptomatic hand osteoarthritis: a pragmatic randomized controlled trial

BACKGROUND: Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new de- livery systems are needed to solve lack of adherence. AIM: To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN: A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING: Community health centers in rural southern Spain. POPULATION: Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS: Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the Care- Hand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS: The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS: A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA. CLINICAL REHABILITATION IMPACT: mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcome

An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial.

Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F1.62,85.67=9.163; P.05). Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974. RR2-10.1186/s13063-020-04713-4

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

Background: Therapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)- related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA. Methods: The project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up. Discussion: This study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient’s status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care. Trial registration: ClinicalTrials.gov NCT04263974. Registered on 7 March 2020. Date of last update 15 April 2020. Ethics committee code: PI_RH_2018.Junta de Andalucía, Fundación Progreso y Salud AP-0149-201