Sheerin Margo, O'Riordan Cliona, Conneely Mairead, Carey Leonora, Ryan Damien, Galvin Rose, Morrissey Ann-Marie
Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland.
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Aust Occup Ther J. 2024 Feb;71(1):175-189. doi: 10.1111/1440-1630.12905. Epub 2023 Oct 4.
This systematic review and meta-analysis examines the effectiveness of occupational therapy interventions for adults with conservatively managed conditions of the hand, wrist, and forearm.
Searches were carried out in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, MEDLINE (OVID), EMBASE, and PubMed. Grey literature was searched for via Google Scholar. A systematic literature search was undertaken for randomised studies that examined occupational therapy interventions for treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of occupational performance, satisfaction with occupational performance, pain, and quality of life. Meta-analyses were completed, and GRADE was used to determine the certainty of evidence.
Twelve studies with 1429 participants were identified. Interventions included combinations of occupation-based intervention, assistive device provision, education, orthosis provision, and exercise programmes for arthritis, carpal tunnel syndrome, and fracture and tendon injuries of the hand, wrist, and forearm. Occupational therapy resulted in an improvement of function (REM, SMD -0.27, 95% CI -0.00 to -0.53, I = 69%, low certainty evidence) (p = 0.05), occupational performance (REM, SMD 0.83, 95% CI 1.61-0.06, I = 91%, low certainty evidence) (p = 0.04), satisfaction with occupational performance (REM, SMD 0.74, 95% CI 1.42-0.05, I = 89%, low certainty evidence) (p = 0.03), and pain reduction (FEM, MD -1.35, 95% CI -0.84 to -1.86, I = 0%, moderate certainty evidence) (p < 0.00001).
Further high-quality research is recommended to determine the effects of occupational therapy interventions on specific upper limb conditions, inclusive of a broader range of clinical and patient reported outcome measures.
本系统评价和荟萃分析探讨了职业治疗干预措施对保守治疗的手部、腕部和前臂疾病成人患者的有效性。
检索了护理及健康领域数据库（CINAHL）、Cochrane对照试验中心注册库（CENTRAL）、Cochrane系统评价数据库、医学在线数据库（MEDLINE，OVID平台）、荷兰医学文摘数据库（EMBASE）和美国国立医学图书馆生物医学文献数据库（PubMed）。通过谷歌学术搜索灰色文献。对研究职业治疗干预措施治疗手部、腕部和前臂疾病的随机研究进行了系统的文献检索。主要结局指标为功能，次要结局指标包括职业表现、对职业表现的满意度、疼痛和生活质量。完成了荟萃分析，并采用GRADE方法确定证据的确定性。
共纳入12项研究，1429名参与者。干预措施包括基于活动的干预、辅助器具提供、教育、矫形器提供以及针对关节炎、腕管综合征、手部骨折及肌腱损伤、腕部骨折及肌腱损伤和前臂骨折及肌腱损伤的运动方案。职业治疗导致功能改善（随机效应模型，标准化均数差-0.27，95%置信区间-0.00至-0.53，I²=69%，低确定性证据）（p=0.05）、职业表现改善（随机效应模型，标准化均数差0.83，95%置信区间1.61至0.06，I²=91%，低确定性证据）（p=0.04）、对职业表现的满意度提高（随机效应模型，标准化均数差0.74，95%置信区间1.42至0.05，I²=89%，低确定性证据）（p=0.03）以及疼痛减轻（固定效应模型，均数差-1.35，95%置信区间-0.84至-1.86，I²=0%，中等确定性证据）（p<0.00001）。
建议开展进一步的高质量研究，以确定职业治疗干预措施对特定上肢疾病的影响，包括更广泛的临床和患者报告结局指标。
