Clinical decision making in the assessment and treatment of closed hand fractures: A scoping review

IF 0.9 Q4 REHABILITATION
Katia Fournier, Lily Li, Donna L Kennedy
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Abstract

Closed hand fractures represent a significant proportion of emergency department attendances, result in substantial health service utilisation and have a detrimental effect on quality of life. Increasingly, hand therapists in the United Kingdom provide first line fracture treatment. However, the knowledge and skills required to work in such an extended scope capacity have not been elucidated or standardised. This literature review synthesises and reports evidence for the knowledge requisite of clinicians to make evidence-based treatment decisions for patients with hand fractures. A systematic search was undertaken, using Embase, MEDLINE, PsychInfo and CINAHL electronic databases. Inclusion criteria were English language, full research reports of studies assessing of the reliability or validity of the decision-making process in hand fracture treatment published between 2013 and 2023. Data were summarised narratively. 15 studies met inclusion criteria; most assessed decision making for metacarpal fractures. Studies on imaging ( n = 4) suggested the reliability of plain radiograph interpretation of hand fracture characteristics such as angulation is good and similar across various levels of experience. Agreement between surgeons and therapists in choosing surgical or nonsurgical treatment was generally good, but factors influencing decision making remained unclear. No evidence was identified that explored clinical assessment knowledge (subjective or objective patient factors) or the specific competencies required to treat hand fractures. There is limited evidence for the knowledge and skills required of clinicians for the competent assessment and treatment of hand fractures. Stakeholder consensus work is required to develop robust competencies and standardise practice.
评估和治疗闭合性手部骨折的临床决策:范围界定审查
闭合性手部骨折在急诊科就诊人数中占很大比例,导致大量医疗服务的使用,并对生活质量产生不利影响。在英国,越来越多的手部治疗师提供一线骨折治疗。然而,从事此类扩展工作所需的知识和技能尚未得到阐明或标准化。这篇文献综述综合并报告了临床医生为手部骨折患者做出循证治疗决策所需的知识证据。我们使用 Embase、MEDLINE、PsychInfo 和 CINAHL 电子数据库进行了系统检索。纳入标准为2013年至2023年期间发表的评估手部骨折治疗决策过程可靠性或有效性的研究报告全文。对数据进行了叙述性总结。15项研究符合纳入标准;其中大部分研究评估了掌骨骨折的决策过程。关于影像学的研究(n = 4)表明,手部骨折特征(如成角)的平片判读具有良好的可靠性,并且不同经验水平的研究结果相似。外科医生和治疗师在选择手术或非手术治疗方面的一致性普遍较好,但影响决策的因素仍不明确。目前还没有发现任何证据可以探讨临床评估知识(患者的主观或客观因素)或治疗手部骨折所需的特定能力。关于临床医生胜任评估和治疗手部骨折所需的知识和技能,目前证据有限。需要利益相关者达成共识,以制定出强有力的能力要求并规范实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hand Therapy
Hand Therapy REHABILITATION-
CiteScore
1.60
自引率
10.00%
发文量
13
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