Swelling after a hand injury or surgery is a normal part of the healing process.
Prolonged swelling impacts joint and soft tissue mobility and function appearance of the hand. These factors can delay a patient's recovery, return to work and daily activities, resulting in more frequent out-patient appointments. Assessment of swelling offers valuable information to the treating therapist about the effectiveness of interventions. Objective measures are particularly important in the current economic climate to ensure that interventions can be justified. Measures need not only to be reliable but also responsive to clinically important change over time.
The treatment of hand swelling is a constant challenge for therapists where the objective is to reduce the swelling quickly and effectively and focus therapy on more functionally related goals, such as return to work and usual activity. There is no consensus on the most effective method of treating hand swelling after trauma or surgery. With the introduction of novel therapeutic techniques and modalities to treat swelling, there is a need to assess the efficacy of these when compared to standard treatment.
key research questions
This four-year NIHR/ HEE funded programme of research covered four interlinking projects, the aims of which were to:
- Review the quality and quantity of evidence on how hand swelling is measured and treated
- Identify and describe current methods of measuring and treating hand swelling in the UK and develop consensus on best practice
- Establish what is the best method of measuring hand swelling
- Establish the best way of treating hand swelling.
research design and outputs
To address these objectives, we undertook a number of different studies. Two systematic reviews were completed which tell us which methods of assessing hand swelling have the best psychometric data, and which treatments have the best quality evidence. We conducted a survey of clinical practice amongst UK based hand therapists and compared the results of this with those of the systematic reviews. This highlighted that the assessments and treatments with the highest level of evidence are not those which are most commonly used in practice. A standardised treatment programme was established through consensus development with experts in the field of hand therapy.
An observational study identified the most responsive methods of assessing hand swelling. These include a clinician-derived assessment and a patient-rated outcome measure. These outcome measures were used in a pilot randomized controlled trial comparing two commonly used treatments for hand swelling to establish if a newer method of reducing swelling shows potential when compared to standard treatment.
The results of these studies inform clinical practice on how hand swelling should be assessed and treated in the future.
Miller LK, Jerosch-Herold C, Shepstone L. Clinical assessment of hand oedema: A systematic review. Hand Therapy. 2017;22(4):153-164. doi:10.1177/1758998317724405
Miller LK, Jerosch-Herold C, Shepstone L. Effectiveness of edema management technqiues for subacute hand edema: A systematic review. Journal of Hand Therapy. 2017;30(4):432-446. doi https://doi.org/10.1016/j.jht.2017.05.011
the research team
Principal investigator: Leanne Miller NIHR/HEE Clinical Doctoral Research Fellow, MSc, BSc (Hons) Occupational Therapy, Accredited Hand Therapist.
Patient and Public Involvement in Research: (PPIRes) Project Manager Jacqueline Romero and members of the patient advisory committee; Pauline Spedding, Chris Dell, Ann Dibben and Jon Craigie.
Leanne Miller was funded by a NIHR/HEE Clinical Doctoral Research Fellowship (2015-2019).
Christina Jerosch-Herold was funded by an NIHR Senior Research Fellowship (2013-2017).
The content of this webpage presents independent research funded by the National Institute for Health Research (NIHR) and Health Education England. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.