Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease

Engstrand, Christina; Krevers, Barbro; Kvist, Joanna

doi:10.1016/j.jht.2014.11.006

Cited by 20 publications

(21 citation statements)

References 29 publications

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“…In other studies, 19% of patients were not able to return to their job following nerve repair and at least 3 months of hand therapy (Meiners et al., 2005), and 42% of patients reported problems with self-care following surgery and hand therapy for Dupuytren’s contracture (Engstrand et al., 2009). Two papers exploring patients’ recovery found that patients valued engagement in occupation as a more important outcome than improvements in objective measures (Cheung et al., 2016; Engstrand et al., 2015). In fact, including a focus on occupation in hand therapy was shown to improve client motivation and success (Astifidis et al., 2009; Bates and Mason, 2014; Jack and Estes, 2010).…”

Section: Resultsmentioning

confidence: 99%

An occupational perspective in hand therapy: A scoping review

Burley

Tommaso

Cox

et al. 2018

British Journal of Occupational Therapy

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Introduction: There have been calls for the occupational therapy profession to realign with its values around occupation. However, the profession faces challenges in practice areas that have historically been underpinned by a biomechanical approach, such as hand therapy. The aim of this scoping review was to describe what is known about an occupational perspective in the hand therapy literature. Method: This scoping review utilised a recognised five-step approach. A search was conducted in four databases for papers published between 2005 and 2016. Numerical and thematic analyses were employed, using the Canadian Practice Process Framework as a theoretical framework. Results: Fifty papers were included in the scoping review. Six themes were identified: the centrality of occupation; inconsistencies in terminology; where in the occupational therapy process?; informal discussion as a key occupational strategy; occupational therapists' expectations of patients; and a bottom-up approach focusing on biomechanical strategies to implementing the plan. Conclusion: Whilst there has been some integration of an occupational perspective into hand therapy literature, there are still challenges. Inconsistent terminology, the lack of an occupational perspective throughout the occupational therapy process and a bottom-up approach to interventions all demonstrate the continuing tensions between the biomechanical approach and an occupational perspective.

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Section: Resultsmentioning

confidence: 99%

An occupational perspective in hand therapy: A scoping review

Burley

Tommaso

Cox

et al. 2018

British Journal of Occupational Therapy

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“…Dupuytren's disease (DD) is a common fibrotic disease confined to the hand that affects approximately 4% of the general UK and US populations [ 1 ]. The early stages of the disease are manifest as nodules that are typically quiescent for a period and then become active, progressing to cords and flexion deformities of the fingers in approximately 50% of patients [ 2 ] and result in loss of hand function [ 3 ]. Whilst the mainstay of treatment remains surgical excision (fasciectomy) of the diseased tissue or cords [ 4 ], approximately 40% of patients in the USA are treated by disruption of the cords using collagenase or needle fasciotomy [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Anti-Tumour Necrosis Factor Therapy for Dupuytren's Disease: A Randomised Dose Response Proof of Concept Phase 2a Clinical Trial

Nanchahal¹,

Ball²,

Davidson

et al. 2018

EBioMedicine

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BackgroundDupuytren's disease is a common fibrotic condition of the hand that causes irreversible flexion contractures of the fingers, with no approved therapy for early stage disease. Our previous analysis of surgically-excised tissue defined tumour necrosis factor (TNF) as a potential therapeutic target. Here we assessed the efficacy of injecting nodules of Dupuytren's disease with a TNF inhibitor.MethodsPatients were randomised to receive adalimumab on one occasion in dose cohorts of 15 mg in 0.3 ml, 35 mg in 0.7 ml, or 40 mg in 0.4 ml, or an equivalent volume of placebo in a 3:1 ratio. Two weeks later the injected tissue was surgically excised and analysed. The primary outcome measure was levels of mRNA expression for α-smooth muscle actin (ACTA2). Secondary outcomes included levels of α-SMA and collagen proteins. The trial was registered with ClinicalTrial.gov (NCT03180957) and the EudraCT (2015-001780-40).FindingsWe recruited 28 patients, 8 assigned to the 15 mg, 12 to the 35 mg and 8 to the 40 mg adalimumab cohorts. There was no change in mRNA levels for ACTA2, COL1A1, COL3A1 and CDH11. Levels of α-SMA protein expression in patients treated with 40 mg adalimumab (1.09 ± 0.09 ng per μg of total protein) were significantly lower (p = 0.006) compared to placebo treated patients (1.51 ± 0.09 ng/μg). The levels of procollagen type I protein expression were also significantly lower (p < 0.019) in the sub group treated with 40 mg adalimumab (474 ± 84 pg/μg total protein) compared with placebo (817 ± 78 pg/μg). There were two serious adverse events, both considered unrelated to the study drug.InterpretationIn this dose-ranging study, injection of 40 mg of adalimumab in 0.4 ml resulted in down regulation of the myofibroblast phenotype as evidenced by reduction in expression of α-SMA and type I procollagen proteins at 2 weeks. These data form the basis of an ongoing phase 2b clinical trial assessing the efficacy of intranodular injection of 40 mg adalimumab in 0.4 ml compared to an equivalent volume of placebo in patients with early stage Dupuytren's disease.FundingHealth Innovation Challenge Fund (Wellcome Trust and Department of Health) and 180 Therapeutics LP.

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“…A recent scoping review (Burley, Di Tommaso, Cox & Molineux, 2018) revealed that patients with hand injuries experienced occupational issues and found rehabilitation informed by an occupational perspective to be motivating (Bamford & Walker, 2010;Cheung, Clemson, O'Loughlin & Shuttleworth, 2016;Engstrand, Krevers & Kvist, 2015). Other themes from the scoping review included: the assumption that a bottom-up, biomechanical approach would improve occupational performance; a high focus placed on occupational outcome measures; and the use of informal discussion as an occupational strategy (Powell & Von Der Heyde, 2014;Weinstock-Zlotnick & Bear-Lehman, 2015).…”

Section: Introductionmentioning

confidence: 99%

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective

Burley

Cox

Tommaso

et al. 2018

Aus Occup Therapy J

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Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.

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Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease

Cited by 20 publications

References 29 publications

An occupational perspective in hand therapy: A scoping review

An occupational perspective in hand therapy: A scoping review

Anti-Tumour Necrosis Factor Therapy for Dupuytren's Disease: A Randomised Dose Response Proof of Concept Phase 2a Clinical Trial

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective

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