A. Suero-Pineda1, P. Rodriguez2, M. Rodríguez-Piñero Durán3, M.Á. García Frasquet3, M.I. Nieto Díaz de los Bernardos3, A. Galván Ruiz3, C. Echevarría Ruiz de Vargas3, M.D. Cortés Vega3
1University of Seville, Physiotherapy Department, Seville, Spain, 2FISEVI, Sevilla, Spain, 3Andalusian Public Health System, Sevilla, Spain

Background: The pathology affecting the wrist, hand and finger segment has a high incidence, and large social and healthcare costs are generated, mainly due to productivity loss. Therapeutic exercise programs are essential in the conservative and post-surgical treatment of these pathologies. Exercises are conventionally performed during face to face sessions and at the patient´s home guided by paper sheet. These methods are inefficient due to the lack of control of the evolution and adherence to the treatment. According to the literature, touch-screens of tablet devices have shown a large potential for the treatment of these pathologies and apps are claimed by specialized hand therapists as an accessible and needed format to establish therapeutic exercise programs. ReHand is a Tablet digital tool to prescribe and monitor exercise programs.

Purpose: To evaluate the clinical effectiveness of the ReHand tablet app for implementing home exercise programs.

Methods: A multicenter, controlled, longitudinal, prospective and blinded clinical trial is presented. Emergency, hand surgery, rehabilitation and physiotherapy services of six hospitals from Andalusian Public Health Service recruited 367 patients with wrist, hand and fingers pathology. The pathologies with the highest incidence were: distal radius fractures, metacarpal fractures, carpal fractures and surgically intervened carpal tunnel syndrome, Dupuytren and rhizartrosis. Patients were recruited in an early phase, no more than 7 days after surgery or after removal of immobilization, for the measurement by a blinded evaluator. Then, patients were included in one of the study groups: experimental group received access to ReHand app to perform a monitored home exercises program and control group received the conventional method employed: a home exercise program in paper with recommendations. Patients were sent home and received weekly follow up phone calls. At the beginning, at 4 weeks and 3 months the grip strength was evaluated using a Jamar dynamometer, dexterity using the Nine Hole Peg Test, pain (VAS) and the functional ability using the QuickDASH and PRWE scales.

Results: The experimental group (EG) showed improvements over the control group (CG) in all study variables.
At one month the EG obtained a statistically significant improvement against the CG in: pain (mean difference (MD) of the EG -1.14 points, MD CG: -0.45, p=0.006), dexterity (MD EG -11.89 seconds, MD CG: -6.88 seconds, p= 0.001) and functional ability measured with the QuickDASH (MD EG -26.73 points, MD CG: -17.78 points, p= 0.005).
At 3 months: pain (mean difference (MD) of GE -2.48 points, MD GC: -1.65, p=0.005), grip strength (MD of GE +23.22lb, DM GC: +19.69, p=0.01) and functional ability measured with the QuickDASH (MD of GE -43.36, MD GC: -29.69, p= 0.000) and the PRWE (MD GE -42.20, DM GC: -32.09, p= 0.005).

Conclusion(s): These results show that the ReHand tablet app is more effective than conventional treatment.

Implications: This results implies an enhancement of patient care and clinical results through an innovative tele-rehabilitation tool developed under physiotherapists supervision.  

Funding, acknowledgements: This study was supported by the Innovation Projects Grant #AP-0149-2017 of the Health Council of Andalusian Government.

Keywords: App, Innovation, Tele-rehabilitation

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? Yes
Institution: Virgen Macarena and Virgen del Rocio University Hospitals, Seville. Spain.
Committee: Virgen Macarena and Virgen del Rocio University Hospitals Ethics Committee.
Ethics number: Dictamen 201742413356

All authors, affiliations and abstracts have been published as submitted.

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