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Title: The assessment and treatment of sub-acute hand oedema after trauma or surgery
Author: Miller, Leanne
ISNI:       0000 0004 7962 7948
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2019
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Background: Hand oedema (swelling) is a common consequence of hand trauma or surgery. However, there is no consensus on the best practice for assessment or management and a lack of high quality evidence. This programme of research aims to address this knowledge gap. Methods: Systematic reviews were conducted on methods of assessing and treating hand oedema. An online survey established current practice of UK-based hand therapists. A subsequent Delphi with eight hand therapy experts led to consensus on a standardised oedema management programme. The relative responsiveness of two clinical and two patient-rated outcome measures were evaluated in an observational study. Finally, an assessor-blind pilot randomised controlled trial of kinesiology tape for sub-acute hand oedema tested the feasibility of methods, recruitment, adherence and acceptability of interventions. Results: There was limited, low to moderate quality evidence to support the use of one of 16 oedema interventions described in the literature. The survey of current practice identified 'standard care' as comprising compression, elevation and massage. The Delphi established consensus on the dose, method and instructions for interventions. The volumeter was identified as the most responsive method of measuring hand oedema. Finally, the pilot RCT identified issues with recruitment and retention. Conclusion: There is wide variation in the type and application of oedema treatments, and actual practice does not concur with best evidence. Manual oedema mobilisation may be applied in addition to conventional therapies in problematic oedema. However, this technique requires more consistent description. The volumeter is the most responsive measure for hand oedema, but the figure-of-eight tape should be considered as an alternative where immersion in water is not practical. The pilot trial confirmed that a definitive trial is warranted. However, strategies to maximise recruitment and retention in a full study need to be considered.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available