Feedback-guided Exercises Performed on a Tablet Touchscreen Improve Return to Work, Function, Strength and Healthcare Usage More Than an Exercise Program Prescribed on Paper for People with Wrist, Hand or Finger Injuries: a Randomised Trial.

Question: In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Design: Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Intervention: Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. Outcome measures: The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Results: Compared with the control group, the experimental group: returned to work sooner (MD -18 days, 95% CI -33 to -3); required fewer physiotherapy sessions (MD -7.4, 95% CI -13.1 to -1.6), rehabilitation consultations (MD -1.9, 95% CI -3.6 to 0.3) and plastic surgery consultations (MD -3.6, 95% CI -6.3 to -0.9); and had better short-term recovery of functional ability and pinch strength. Conclusion: In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. (C) 2020 Australian Physiotherapy Association. Published by Elsevier B.V.