Journal Article Review, June 2019

Using a Touchscreen Tablet Application for Post-Carpal Tunnel Release Rehabilitation

Blanquero J et al: Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial. J Physiotherapy 2019; 65:81-87

Investigators in Seville, Spain, recently published their results from a prospective, blinded, randomized trial testing the efficacy of a novel touchscreen tablet-based vs. a traditional paper handout-based home rehabilitation program following carpal tunnel release.

Fifty patients who had recently undergone open carpal tunnel release first answered the Quick DASH questionnaire for functional ability (primary outcome). Secondary outcome measures performed were grip strength, pain measured on a visual analog scale, and dexterity using the Nine-Hole Peg test. The subjects were then randomized into two groups. The control group received printed instructions for a hand rehabilitation program that consisted of active motions of all joints of the treated upper limb with focus on finger and wrist movements. They were instructed to complete the 25-minute program at least five times weekly for four weeks. The experimental group performed their home exercise program guided by the ReHand tablet application. The app indicates the desired movement of the wrist or fingers and monitors compliance when the patient touches the screen in response to the requested movement. Investigators monitored compliance in the control group by making weekly phone calls and in the experimental group by electronic transfer of data from the tablet computer to a web management panel.

After four weeks of exercise, the outcomes measures were performed again but with the examiner blinded regarding which treatment the subject had performed.

RESULTS  The experimental and control groups were well matched with respect to age and sex, and both groups had similar baseline scores on all of the outcome measures.

After four weeks of home rehabilitation, the experimental group had statistically significantly improved Quick DASH scores compared to the control group with a mean difference of 21 points (95% confidence interval 33 – 9). Although the mean changes for grip strength, pain, and peg test favored the experimental group, none of these differences reached statistical significance.

DISCUSSION  The study showed that the innovative, touchscreen-based rehabilitation program improved self-reported functional ability compared to a traditional paper-based program. Because the app was inexpensive and safe, the authors concluded that at least when patients had access to their own tablet computer, that a mean improvement of 21 points in the Quick DASH score was clinically worthwhile, and an institution could conceivably loan a tablet to post-carpal tunnel release patients who did not have one.

The authors acknowledged that the noted significant improvement in functional ability could not clearly be attributed to diminished pain, increased strength, or improved dexterity; but since these secondary outcome measures trended to favoring the experimental over the control group, the improvement in functional ability was at least not at the expense of recovery on the three secondary outcomes.

The investigators also noted that by taking measurements only at the beginning and end of the rehabilitation program, the evolution of any benefits during the study or erosion thereafter remain unknown.

COMMENT  This was a carefully planned and executed study, elegant in its simplicity. For the growing percentage of the population that has familiarity with and access to tablet computers, apps such as ReHand may well have increasing value for home programs for common hand and wrist conditions, including distal radius fractures. I see the interactive nature of the recommended exercises and the opportunity to monitor and encourage compliance as positive factors in engaging patients in their recovery process. Applications such as ReHand are not particularly expensive. Patient travel- and clinic-visit time are expensive. When the patient already has access to a tablet computer, I expect that from both quality and cost perspectives we will see more of such offerings. Is the idea getting you thinking? I hope so.