Full-Length PaperTargeted sensorimotor retraining in the clinical setting: Improving patient outcomes following distal upper extremity injury
Introduction
Wrist fractures, in particular distal radius fractures, are a common injury sustained in the adult population.1 It is well established that distal radius fractures and other distal upper extremity (elbow-wrist-hand) injuries can result in significant long-term functional limitations.1, 2, 3, 4 Recent studies have also found that wrist sensorimotor function is significantly reduced following distal radius fracture in comparison to uninjured wrists.1, 2, 3,5
Sensorimotor control includes sensations that are both conscious and unconscious and includes neuromuscular control, joint position sense, and kinesthesia.5, 6, 7, 8 Sensorimotor control is not a new concept in musculoskeletal rehabilitation. Yet it was Hagert’s (2010) review that highlighted the theoretical importance of sensorimotor control in relation to the wrist, thus setting a new standard for wrist rehabilitation. Published studies indicate that sensorimotor impairments are evident following a wrist injury and directly impact functional capabilities.2,3,5, 6, 7 More specifically, sensorimotor function of the wrist directly impacts joint neuromuscular control and joint stability, both fundamental components of hand and wrist function.2,7,9
Valdes’ scoping review in 2014 and Karagiannopoulos and Michlovitz’s clinical review in 2016 both provided further support for including sensorimotor control in rehabilitation following upper limb injury. However, the clinical importance of sensorimotor rehabilitation following distal upper extremity injury remains in its infancy and is reliant on theoretical principles and clinical research on other joints, including the shoulder, ankle, and knee.3,5 Clinically, there are a small number of single case reports and small cohort studies indicating the clinical benefits of a sensorimotor approach following various wrist injuries.3,6,8,10
Despite the lack of strong clinical research into the benefits of sensorimotor retraining following distal upper extremity injury, current literature is encouraging hand therapy clinicians to incorporate both early and late phase sensorimotor retraining in rehabilitation.6,7
This research has applied the theoretical benefits of sensorimotor rehabilitation programs into the clinical setting. The research aims to identify if completion of a sensorimotor group rehabilitation program following distal upper extremity injury results in improved clinical and patient-rated outcome measures (PROM). To the best of our knowledge, this is the first large study applying the concepts to clinical practice.
The primary aim of this study is to measure the benefits in clinical and patient-rated outcomes following participation in a group-based intervention for sensorimotor rehabilitation following distal upper extremity injuries.
Section snippets
Study design and setting
This prospective cohort study utilized a convenience sample of patients referred for group rehabilitation following injury. The sample is 93 consecutive patients who consented to the participation and completed the 8 weeks group program. The study was conducted from August 2017 through to March 2019 at the Royal Melbourne Hospital and was approved by the Melbourne Health Human Research Ethics Committee (QA2017117).
Participants
Eligibility criteria were patients who had sustained a distal upper extremity
Clinical measures
A paired samples t-test found there were significant differences in 12 different clinical-outcome measures pre and post participation in the sensorimotor group. JPS was the only clinical-outcome measure with a moderate effect size. Clinical outcomes are listed in Table 2 below.
Paired t-test
Grip strength and POT results were both statistically significant with a small effect size. However, grip strength outcomes were below the MCID of 6.5 kg, and POT results were below the MDC of 4.4 kg. Tripod pinch
Discussion
To date, sensorimotor rehabilitation following distal upper extremity injury has shown clinical benefits; however, published studies have been limited to single cases or small cohorts. To the best of our knowledge, this is the first large cohort study, applying the theoretical knowledge of the importance of sensorimotor control of the wrist into the clinical setting. The results from this study suggest that a group-based sensorimotor control approach to rehabilitation can improve both
Conclusion
A sensorimotor approach is gaining momentum in the rehabilitation of patients following a wrist injury. This sensorimotor group rehabilitation program is an efficient approach to rehabilitation and shows promise in improving clinical and patient-rated outcome measures following distal upper extremity (elbow-wrist-hand) injury. Further research with a control group is required to further investigate the full effectiveness of this program.
Quiz: # 819
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.
The study design is
- a.
case series
- b.
RCTs
- c.
retrospective cohort
- d.
prospective cohort
- a.
- # 2.
The greatest clinical change was seen in
- a.
grip strength
- b.
L-T stability
- c.
joint position sense
- d.
supination ROM
- a.
- # 3.
Who is credited with initially popularizing the concept of sensorimotor control, especially as regards
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Cochrane Database Syst Rev
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Disclaimers: The views and information presented in this manuscript are views of the authors and do not reflect or represent an official position of the organization.
Sources of support: nil financial support or equipment was received as part of this study.
Level of evidence: 2b (Oxford Center for Evidence-Based Medicine).
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As awarded by the Australian Hand Therapy Association.