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How should we treat painful sensitivity in the hand? An international e-Delphi study.
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- Author(s): Hebert, Andrea; MacDermid, Joy; Harris, Jocelyn; Packham, Tara
- Source:
Journal of Hand Therapy; Jan2024, Vol. 37 Issue 1, p12-21, 10p- Subject Terms:
- Source:
- Additional Information
- Abstract: Evidence synthesis suggests allodynia resulting from neuropathic pain has few interventions with clear effectiveness. As research continues to build this needed evidence base, expert consensus recommendations can address the conflicting approaches within current hand therapy practice. This study aimed to develop consensus recommendations for the clinical management of allodynia from an international panel of hand therapists. This was an international e-Delphi survey study. We recruited international hand rehabilitation experts to participate in an e-Delphi survey. Consensus was defined as 75% or more of participants agreeing with a recommendation, and at least 3 rounds of consensus building were anticipated. Experts were identified from 21 countries, and clinical vignettes describing a spectrum of patients with painful sensitivity in the hand were provided to elicit treatment recommendations. Initial recommendations were summarized, and consensus sought for clinical practice recommendations. Sixty-eight participants were invited, with 44 more added through peer nominations. Fifty-four participants from 19 countries completed the initial survey and were invited to participate in all subsequent rounds. Over 900 treatment suggestions were provided from the initial vignettes across domains, including sensory, physical, and functional interventions, education, and cortical representation techniques: 46 ultimately reached consensus. However, important discrepancies in justification (eg, why allodynia should be covered) and implementation of techniques (eg, desensitization, sensory reeducation) were identified as the consensus exercise progressed. Experts recommend individually tailored programs to treat allodynia using a variety of physical/movement, sensory-based, and "top-down" approaches; this is highly aligned with contemporary theories, such as the Neuromatrix Model of Pain. However, consensus was not reached on the justification and implementation of some of these approaches, reflecting the lack of a taxonomy and supporting evidence for tactile stimulation approaches in the current literature. Trials directly comparing the effectiveness of these approaches are needed. • This study did not reach consensus on definitions for desensitization and sensory reeducation. • There is a persistent gap in the hand therapy taxonomy for tactile stimulation interventions. • Consensus methods compiled comprehensive treatment recommendations for allodynia in the hand. • Research is needed on tactile stimulation and cortical retraining approaches to reduce allodynia. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of Hand Therapy is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Abstract:
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