Fernando Joep Jannick, Fowler Christy, Graham Tanya, Terry Kim, Grocott Patricia, Sandford Fiona
Department of Hand Therapy, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK.
Hand Ther. 2024 Jun;29(2):52-61. doi: 10.1177/17589983241227162. Epub 2024 Jan 28.
Dupuytren's Disease is a fibroproliferative disorder of the hand, with a heterogenous pathogenesis, ranging from early-stage nodule development to late-stage digital contractures. Hand therapy intervention is not routinely provided pre-operatively. The objective of this systematic review was to explore the efficacy of hand therapy interventions provided for pre-operative Dupuytren's Disease.
A systematic review was undertaken of the databases CENTRAL, CINAHL, OVID Medline and OVID EMBASE, PubMed, BNI, Web of Science, with grey literature and reference searches conducted from database inception to April 2022, and confirmed in August 2023. Included studies required non-surgical intervention and outcome data on individuals with Dupuytren's Disease who have not had surgical intervention. Two reviewers conducted the searches, independently assessed eligibility and completed methodological quality assessments. Data were summarised narratively.
Seventeen studies were selected for final inclusion. Interventions included Extracorporeal Shockwave Therapy (ESWT), Corticosteroid Injection (CSI), Splinting, Massage and Stretching, Ultrasound Therapy (US), Temperature Controlled High Energy Adjustable Laser (THEAL). ESWT positively maintained or improved pain, active range of motion (AROM), Disabilities of the Arm Shoulder, and Hand (DASH) scores, and grip strength. US positively maintained or improved ROM and grip. Splinting positively maintained or improved ROM, CSI positively improved nodule size. Cross Frictional Massage positively impacted AROM and THEAL improved pain and DASH scores.
Outcomes from therapeutic interventions for pre-operative management of Dupuytren's Disease were largely positive. However, there is a need for further high-quality research into these interventions to understand their full potential for the management of Dupuytren's Disease.
杜普伊特伦挛缩病是一种手部纤维增生性疾病，其发病机制多样，涵盖从早期结节形成到晚期手指挛缩的过程。术前通常不常规进行手部治疗干预。本系统评价的目的是探讨针对术前杜普伊特伦挛缩病进行手部治疗干预的疗效。
对CENTRAL、CINAHL、OVID Medline和OVID EMBASE、PubMed、BNI、Web of Science等数据库进行系统评价，并从数据库建立至2022年4月进行灰色文献和参考文献检索，并于2023年8月进行确认。纳入的研究要求有针对未接受手术干预的杜普伊特伦挛缩病患者的非手术干预措施和结局数据。两名评价者进行检索、独立评估纳入资格并完成方法学质量评估。数据采用叙述性总结。
最终纳入17项研究。干预措施包括体外冲击波疗法（ESWT）、皮质类固醇注射（CSI）、夹板固定、按摩与拉伸、超声疗法（US）、温控高能可调激光（THEAL）。ESWT能有效维持或改善疼痛、主动活动范围（AROM）、手臂、肩部和手部功能障碍（DASH）评分以及握力。US能有效维持或改善关节活动度和握力。夹板固定能有效维持或改善关节活动度，CSI能有效改善结节大小。交叉摩擦按摩对AROM有积极影响，THEAL能改善疼痛和DASH评分。
术前管理杜普伊特伦挛缩病的治疗干预措施的结果大多是积极的。然而，需要对这些干预措施进行进一步的高质量研究，以了解它们在管理杜普伊特伦挛缩病方面的全部潜力。
