Purpose eHealth and mHealth approaches are increasingly used to support cancer survivors. This review aimed to examine adherence, acceptability and satisfaction with Internet-based self-management programmes for post-surgical cancer rehabilitation and to identify common components of such interventions. Methods Nine electronic databases were searched from inception up to February 15, 2020, for relevant quantitative and qualitative studies evaluating Internet-based cancer rehabilitation interventions. Studies were required to include an exercise or physical activity–based self-management intervention and a measure of adherence, acceptability or user satisfaction with the programme. Two independent reviewers performed all data extraction and quality assessment procedures. Data were synthesized using a narrative approach. Results Six hundred ninety-six potential papers were identified and screened. Eleven met the inclusion criteria. Interventions had wide variations in levels of adherence, but the majority were reported as being acceptable to the users. Increased acceptability and user satisfaction were associated with interventions which were seen as time and cost-efficient, requiring acquisition of minimal or no new skills, which used coherent language, or which provided tailored information. The majority contained behaviour change components such as goal setting. Conclusions Despite high levels of heterogeneity between studies, Internet-based approaches may be an acceptable method for the delivery of self-management interventions in post-surgical cancer rehabilitation. Implications for Cancer Survivors There is a need for further studies exploring factors associated with increased user engagement and usage of digital interventions in cancer rehabilitation settings. These findings should be used to help develop interventions prior to testing their effectiveness in adequately powered randomized controlled trials.

Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.

Complex Regional Pain Syndrome (CRPS) typically affects the hand following trauma. It is characterised by pain, altered sensation, motor disturbance, oedema, functional limitation and psychological disturbance. There is no definitive curative treatment for CRPS and controversy exists regarding the most effective combination of interventions for the treatment of this syndrome (Siddiqui et al 2001). A study was commissioned in 2006 to explore the therapeutic interventions being implemented with patients with CRPS in the UK. Sixty therapists at the British Association of Hand Therapists annual conference consented to participate in focus group discussions. Categories were established to identify all therapeutic modalities currently used by participants. Therapists utilised the following therapeutic techniques: functional activity, exercise, education, support, sensory re-education, desensitisation, stress loading, pressure garments, mirror visual feedback, splints and psychological strategies, amongst others. The identified interventions were then reviewed against evidence in the recent literature. There is insufficient evidence to support the use of a single set of multidisciplinary interventions (Stanton-Hicks et al 2002) to address the primary long-term goals of functional restoration and pain relief. This study has, however, highlighted that this is achieved through the treatment of individual symptoms, using multiple therapeutic interventions and algorithms in a multidisciplinary approach.

Background The use of working wrist splints is extremely common in the management of adults with RA and splints are recommended in treatment guidelines, yet there is limited and often conflicting evidence as to their effectiveness. Additionally, literature reviews published to date have not examined the full breadth of the literature, most have been unsystematic in their approach and frequently fail to adequately report results or present conflicting interpretation of the same studies. Consequently there is no clear guidance for clinicians on the effectiveness and use of working wrist splints in RA. When attempting to answer questions of effectiveness, the statistical combination of numerical effects as is common in systematic reviews, could be criticized as lacking context and explanation. Similarly, qualitative studies can only provide insight to develop an understanding of lived experiences. Theories generated from these insights however, can be examined for evidence of their effect in the quantitative literature and a deeper understanding of the impact of splinting can be gained through a combined synthesis of the breadth of literature available. This mixed methods systematic review aimed to evaluate the evidence for the effectiveness of working wrist splints in the management of pain, function and quality of life in people with RA. By including evidence from diverse study types this review aims to provide a much richer and meaningful answer to the question; are working wrist splints effective in the management of patients with RA? Objectives To evaluate the effectiveness of working wrist splints in the treatment of people with rheumatoid arthritis. Methods A mixed methods systematic literature review was conducted. Ten electronic databases were searched for both quantitative and qualitative studies. Quantitative studies provided evidence for the effectiveness of working wrist splints amongst people with RA and qualitative studies provided contextual evidence of experiences and perceptions of working wrist splints for people with RA. Experimental studies were evaluated using the van Tulder (1) and the Cochrane Risk of Bias tools (1) and summarized using best evidence synthesis. A narrative approach to data synthesis from the quantitative studies was used. A meta-ethnographical approach was used to synthesize qualitative evidence. Quantitative and qualitative syntheses were then combined. Results Twenty two studies were included (n=1404 participants) 9 RCTs, 4 quasi-experimental studies, 3 observations studies, 4 surveys and 2 qualitative studies. There is strong quantitative evidence, supported by conclusions drawn from qualitative literature, that working wrist splints reduce pain,. There is moderate evidence that grip strength is improved and dexterity impaired with the use of a working wrist splints, and insufficient evidence of the effect of working wrist splints on upper limb function due to conflicting results in the literature. Conclusions Working wrist splints are effective in reducing pain a...

I refer to the interesting and useful article by Lecomber and Faulkner [1]which appeared in the November 1993 issue of the BJR. However, some statements on the subject of the radiographic technique used and the consequent radiographic quality appear to be incorrect. They state that the use of a bisected angle technique “will produce an isometric image on the film free from distortion”. If it is agreed that distortion means a different degree of magnification of the image from one part to another then with any angle (excepting only 0 or 180 degrees) between film and tooth no manipulation of the central ray angulation will produce an undistorted image.