Review

Hand Therapy
2023, Vol. 28(4) 133–143
Effectiveness of occupational therapy-led © The Author(s) 2023
Article reuse guidelines:
computer-aided interventions on function sagepub.com/journals-permissions
DOI: 10.1177/17589983231209678
journals.sagepub.com/home/hth
among adults with conditions of the hand,
wrist, and forearm: A systematic literature
review and meta-analysis

Margo Sheerin1,2 , Ann-Marie Morrissey2, Rose Galvin2, Damien Ryan1, Leonora Carey1
and Katie Robinson2

Abstract
Introduction: Upper extremity injuries are common, and often treated by occupational therapists. The need to evaluate
the effectiveness of occupational therapy interventions to guide practice is pertinent. This systematic review and meta-
analysis investigate the effectiveness of occupational therapy-led computer-aided interventions among adults with con-
ditions of the hand, wrist, and forearm.
Methods: A systematic literature search of five databases was undertaken for randomized studies examining occupational
therapy-led computer-aided interventions for the treatment of hand, wrist, and forearm conditions. The primary outcome
was function, with secondary outcomes of pain, grip and pinch strength. The quality of the included studies was inde-
pendently assessed using the Cochrane Risk of Bias V2 tool. Meta-analyses were completed.
Results: Three randomized controlled trials were included with 176 participants. One study reported on app use on a
tablet and two studies reported on computer gaming. Participants had a variety of hand and wrist diagnoses, treated both
conservatively and operatively. There is limited evidence demonstrating that computer-based interventions are as effective
as other occupational therapy-led interventions in improving function, pain, grip and pinch strength post-intervention,
including small effect size following meta-analysis: grip strength (Fixed Effects Model, SMD 0.13, 95% CI 2.63; –2.36, I2 = 0%)
and pinch strength (Fixed Effects Model, SMD –0.12, 95% CI 1.25; -1.50, I2 = 11%).
Conclusions: Limited evidence was found to support the use of computer-aided interventions for adults with a hand, wrist
or forearm injury. Further high-quality research is recommended inclusive of a broader range of technologies and a broader
range of clinical and patient-reported outcome measures.

Keywords
Hand, wrist, computer-aided, occupational therapy, hand therapy

Date received: 17 July 2023; accepted: 9 October 2023

Introduction
Hand and upper extremity injuries are a common oc-
currence,1 affecting all age groups. According to the 1
Occupational Therapy, University of Limerick Hospitals Group, Tyone,
National Centre for Health Statistics in America, 26% of Tipperary
injury-related emergency department presentations na- 2
School of Allied Health, University of Limerick EHS, Limerick, Ireland
tionwide were in relation to the hand and upper ex-
tremity.2 Conditions and injuries of the hand can have Corresponding author:
Margo Sheerin, Department of Occupational Therapy, University of
serious consequences, affecting a person’s ability to Limerick Hospitals Group, Nenagh General Hospital, Tyone, Nenagh, Co.
function and carry out daily activities including self-care, Tipperary E45 PT86, Ireland.
work, and leisure activities, and may lead to mood Email: margo.sheerin@hse.ie
134
disorders and trauma-related stress.3–5 Occupational
therapists are key healthcare professionals in the provision
of care to people with an upper limb condition with studies
demonstrating the effectiveness of occupational therapy
for those with chronic hand conditions,6 after hand in-
jury,7 and after hand surgery.8 To improve patient out-
comes, occupational therapists draw on a diverse range of
intervention types to achieve patient goals, including
exercise programmes,9 splinting and orthosis provision,10
occupation-based intervention,11 joint protection pro-
grammes,12 and more recently technology and computer-
aided interventions.
A serial, cross-sectional analysis of United States of America
nationally representative data from the National Health and
Nutrition Examination Survey (NHANES) found the preva-
lence of computer use among adults increased from 29% to 50%
between 2003 and 2016 and from 15% to 53% for those aged
65 years and over.13 Reduced uptake of technology use among
older adults has been a focus of attention in recent years,
however, a recent Canadian study found internet use increased
from 32% to 68% among those aged 65 and older between
2007 and 2016.14 The use of technology in healthcare settings
has grown in recent years and has been proven as an effective
method of delivering healthcare rehabilitation to populations
including stroke, Parkinson’s disease, chronic pain, and mus-
culoskeletal conditions.15–17 Video gaming has been used to
provide a distraction for those with chronic and acute pain18,19
and as a means of providing health education.20 In a systematic
review including 38 randomized controlled trials investigating
the role of video gaming in improving health-related outcomes
for a variety of physical and psychological conditions, the
authors found there is potential for video games to improve
health outcomes including psychological therapy outcomes,
physical therapy outcomes, and health education outcomes.21
Computer-aided interventions are diverse and include the
use of gaming and applications on tablets, touchscreens, and
smartphones. This diversity lends itself to the use of stimu-
lating and interesting programmes and has the potential of
being more widely accessible, not only in clinics and hospitals
but in homes. From a clinician’s perspective, computer-aided
interventions offer the opportunity for ‘real time’ grading of
exercises and activities, data analysis, interesting content, and
improving function.15,22,23 Adherence to therapy programmes
has long been problematic in healthcare with low adherence
associated with poorer functional outcomes24–26 and disuse,
stiffness and disability in those with a hand condition.25 Home
exercise programmes provided by clinicians such as occu-
pational therapists, physiotherapists, and surgeons, have been
proven to be effective in the rehabilitation of upper limb
conditions.27–30 However, studies have reported that up to
65% of patients are not adhering to their prescribed upper
extremity home exercise programme.31,32 Whilst these pro-
grammes are typically paper-based, there is a growing body of
Hand Therapy 28(4)
evidence reporting the benefits and acceptability of computer
use to help increase adherence.33 Alongside adherence, the
potential for improved function and accessibility to treatment
has been reported in the literature. A randomized controlled
trial demonstrated that a tablet application ‘ReHand’ improved
functional outcomes in participants post carpal tunnel release
at 4 weeks.34 In a recent cross-sectional cohort study partic-
ipants’ use of a smartphone app to complete an exercise
programme and to access information about their condition
was assessed using the Mobile Application Rating Scale
(MARS) questionnaire.35 The authors found the Hand Ther-
apy app was perceived as ‘above average’, with a score of
3.5 overall out of five, and mean scores found to be above
average for the subsets of engagement, aesthetics, function-
ality, and subjective quality of the app on the MARS ques-
tionnaire. In a two-arm trial of two occupational therapy
interventions on hand disability among people with early
diffuse cutaneous systemic sclerosis, participants in a home-
based ‘App Alone’ group improved equally to the ‘intensive
group’ of in-person occupational therapy at 18 weeks.36 Whilst
the use of technology in treating a variety of conditions such as
stroke and Parkinson’s Disease is reported to improve patient
outcomes and as a mechanism for providing health education,
few have investigated its role in injuries and conditions of the
upper limb, particularly within occupational therapy literature.
Computer and smartphone use is prevalent across all age
groups, and are relatively inexpensive devices that can be
made available in clinics or used in the delivery of home hand
therapy programmes. Given the prevalence of upper limb
conditions and the need to provide evidenced based diverse
interventions, the purpose of this review is to locate and
synthesise current available evidence regarding the effec-
tiveness of occupational therapy led computer-aided inter-
ventions for adults with a condition or injury of the hand, wrist,
or forearm in relation to function, pain, and strength outcomes.
Methods
The review protocol was registered on PROSPERO
(CRD42022371593). There were no deviations from the pre-
registered protocol. This systematic review was conducted
and reported in accordance with the Preferred Reporting Items
for Systematic Review and Meta-Analysis (PRISMA)
2015 statement37,38 (Supplementary Material 1). The meth-
odology for the review was informed by the Cochrane
Handbook for Systematic Reviews of Interventions.39
Search strategy
Searches were carried out in CINAHL, Cochrane Central
Register of Controlled Trials (CENTRAL), MEDLINE
(OVID), EMBASE, and PubMed in November 2022. No
restriction on the studies’ publication date was applied and
Sheerin et al.
databases were searched from the date of inception. MeSH
terms and associated keywords were used covering the
topics of hand, wrist, forearm, occupational therapy, hand
therapy, computer, tablet, and application use. The reference
lists of all eligible studies were hand-searched for further
relevant studies. A search strategy example is provided in
Supplementary Material 2.
Inclusion criteria
Population. Studies involving adults (18 years of age or
more) with a hand, wrist, or forearm condition or injury, for
example, fractures, tendon injury, nerve injury, and carpal
tunnel syndrome were included in this review. The con-
dition or injury had to impact primary or secondary out-
comes (described below) to be included in this review.
Intervention. Interventions provided by an occupational
therapist using computer-aided interventions. Computer-
aided interventions include computer-based exercise pro-
grams, gaming, video, or applications such as those found
on smartphones or computer tablets.
Comparator. Usual care or another active intervention was
compared to occupational therapy computer-aided inter-
vention within this review.
Outcomes. The primary outcome was functional ability post
occupational therapy intervention, measured using a vali-
dated scale, such as the Disabilities of the Arm, Shoulder
and Hand (DASH).40 Secondary outcomes include pain and
grip and pinch strength utilising outcome tools such as the
Visual Analogue Scale41 and Jamar dynamometer (J. A.
Corporation, New Jersey, USA).
Study Design. All randomized controlled trials (RCTs),
quasi-RCTs, controlled before and after studies, and in-
terrupted time series (ITS) designs were included.
Exclusion criteria
Studies were excluded if the population reported on was less
than 18 years of age; if participants had a hand condition
specific to complex medical complaints, for example, cere-
brovascular accident (CVA); where the primary presentation
was not concerning the hand, wrist, or forearm; studies
targeting the shoulder or elbow and not the distal upper limb;
where the primary treating clinician providing intervention is
not an occupational therapist; and technologies which are not
typically readily accessible within homes and clinics, such as
virtual reality and robotics. Observational studies were ex-
cluded as well as experimental studies that did not randomize
participants to intervention and control groups.
135
Study selection and data extraction
References generated from the search were exported to
Endnote software, where duplicates were removed. Two
authors (MS and AMM) independently screened all studies
by title and abstract for eligibility. Eight studies were se-
lected by the reviewers as meeting inclusion criteria and
underwent full text review. Conflict regarding eligibility
arose for two of the articles and a third author (KR) was
consulted. A final decision was made by the third author
following discussion with all three authors. Figure 1 details
the process of identifying studies.
Data were extracted from included studies by one reviewer
(MS). A second author (AMM) independently checked 20%
of the data extracted and confirmed accuracy and appropri-
ateness. The information extracted included authors, year of
publication, country, setting, study sample size, study design,
outcome measures, and period of follow-up. Data were entered
into a prepared Microsoft Excel document. The information
extracted included authors, year of publication, country, set-
ting, study sample size, study design, outcome measures, and
period of follow-up. RevMan V.5.4.1 software was used to
analyse the data for the meta-analysis. For the primary out-
come of function, meta-analysis could not be completed. For
continuous data, mean differences with 95% CIs were reported
or standardised mean difference (SMD) and 95% CI were
calculated where different methods of measurement were used.
Heterogeneity was explored across the included studies by
examining the participants’ details, the content and duration of
interventions, outcomes, and duration of follow-up. Hetero-
geneity was further explored visually, by inspecting the forest
plots and the associated Chi2 and I2 statistics. The I2 statistic
was interpreted using a guide by Deeks and colleagues,42 as
strict cut-offs are no longer recommended.
Quality assessment
The Cochrane Risk of Bias Tool 2.0 43 was used to assess
the risk of bias in the included studies (Table 1). This tool
assesses the risk of bias across five domains: the random-
ization process, deviations from intended interventions,
missing outcome data, measurement of the outcome, and
selection of the reported result. Quality assessment was
carried out independently by (MS and AMM) and then as a
group, with any discrepancies discussed and decisions made
by majority. Study protocols were used where available to
guide quality assessment.
Dealing with missing data
Study data were not available regarding functional out-
comes in one paper and the authors were contacted.44 No
response was received.
136 Hand Therapy 28(4)

Figure 1. Prisma flow diagram.

Table 1. Cochrane Risk of Bias Tool 2.0 Summary of included studies methodological quality.

Domain 1: Domain 2: Deviations Domain 3: Domain 4: Domain 5: Overall

Randomisation from the intended Missing Measurement of the Selection of the Risk of
Author Year process interventions outcome data outcome reported result Bias

Blanquero 2020 Low Some concern Low Low Some concern Some
et al. concern
Ganjiwale 2019 Some concern Some concern Low Some concern Some concern Some
et al. concern
Jarus et al. 2000 Some concern Some concern Some concern Some concern Some concern Some
concern

Results Three randomized trials were included in this review.44–46

The database search yielded 2006 results which were re-
duced to 1412 when duplicates were removed. A total of
eight abstracts were identified for full-text review. Fol-
lowing full-text review, five articles were excluded for
reasons of incorrect outcome, incorrect population, and
intervention not delivered by an occupational therapist.
These studies were based in Spain, India, and Israel, and
included a total of 176 participants. Two of the studies
included participants with a variety of bone and soft tissue
diagnoses of the wrist, hand, and fingers, including frac-
ture of the radius, ulna, scaphoid, phalanges, metacarpals;
carpal tunnel syndrome; finger dislocation; sprains and
strains; and traumatic amputation.44,45 The third study
Sheerin et al.
focused exclusively on people with traumatic fractures of
the wrist. All interventions took place in occupational
therapy clinics or rehabilitation outpatient departments.
The ages of participants varied from 18 to 80 years of age.
The studies reported on 108 men and 78 women, repre-
senting 58.06% male and 41.94% female participants. See
Table 2 for study details.
In relation to intervention type, one study reported on
app use on a touchscreen tablet,45 whilst the remaining two
studies reported on computer gaming using a modified
joystick. Intervention length varied from 2 weeks to 6 weeks
across the three studies. Time spent on computer-based
interventions was 15 min up to 30 min. One study45 re-
ported on the intervention group exclusively completing an
individualised home exercise programme on a tablet app for
the entire 20 to 30-min session compared to a control group
completing paper-based activities; whilst the two other
studies describe 15 to 20 min computer-based activities in
addition to other modalities including whirlpool, Ther-
aplast, massage, or passive movements over a session of
30 min44 and 50 min.46 Only one of the intervention pro-
grammes reported on was completed by the participants in
their homes using a ReHand app.45
Risk of bias findings
All studies received an overall rating of ‘Some Con-
cern’ of risk of bias when assessed using the Cochrane
Risk of Bias Tool 2.0. One study 46 was assessed as
having ‘some concern’ of risk of bias across all five
domains; similar to the Ganjiwale et al. 44 trial rated as
‘some concern’ of risk of bias in five domains. In
contrast, Blanquero et al. 45 trial was deemed to have a
‘low risk’ of bias across three of the domains: the
randomization process, missing outcome data, and
measurement of the outcome.
Functional outcomes
Across the included studies, two of three evaluated function
as an outcome44,45 using standardised outcome tools: the
QuickDASH40 and the Functional Independence Measure
(FIM).47 Blanquero et al. report a greater short-term im-
provement of functional ability as measured by the
QuickDASH when assessed at week two (MD-12, 95%CI
–22; –3). At week four the mean difference favoured the
intervention group however did not clearly show the effect
was beneficial (MD –11, 95% CI –25; 3). Ganjiwale et al.
compared an intervention group receiving conventional
occupational therapy and video gaming using a modified
joystick to conventional occupational therapy alone.
Findings suggest both groups were comparable regarding
functional independence as measured by the Functional
Independence Measure (FIM). Meta-analysis was not
137
possible as data on the FIM was not available and was not
received having contacted the authors. Overall, one study
showed short-term significant differences in function, with
two studies demonstrating no long-term difference in
function.
Grip and pinch strength outcomes
Grip strength was measured across all three studies. Gan-
jiwale et al. reported results between intervention and
control groups were comparable regarding grip strength
using a Jamar hand dynamometer (J. A. Preston Corpora-
tion, New Jersey, USA). Jarus et al. completed a ran-
domized controlled trial with an intervention group
receiving treatment with a computer using a computer game
“Revenge of Doh” (Taito Corporation, Tokyo, Japan) and a
control group received treatment with a brush machine
alongside conventional therapeutic approaches for both
groups. Results show significant improvement in grip
strength for participants in both intervention and control
groups, with no significant differences between groups.
Overall, two studies reported no difference in strength with
one study reporting better strength in the intervention
group. Meta-analyses demonstrated non-significant findings
between groups in relation to grip strength (Fixed Effects
Model, SMD 0.13, 95% CI 2.63; -2.36, I2 = 0%) post-
intervention (Figure 2).
Pinch strength outcomes
Pinch strength was measured across two studies.44,45 Meta-
analyses demonstrated improvement in pinch strength
(Fixed Effects Model, SMD –0.12, 95% CI 1.25; –1.50, I2 =
11%) post-intervention (Figure 3).
Pain outcomes
Blanquero et al. was the only included study to assess pain
as an outcome. Using a visual analogue scale of 0–10 cm,
mean estimates favoured the intervention group at week two
and week four.
Other reported outcomes
Other benefits reported by Blanquero et al. include partici-
pants in the intervention group returning to work sooner and
demonstrating a reduction in healthcare usage. Jarus et al.
reported on the range of motion and level of oedema, with
significant improvement in both intervention and control
groups [48]. The authors utilised a Treatment Interest visual
analogue scale to assess participants’ interest in their pre-
scribed treatment. The computer-aided group showed sig-
nificantly more interest in treatment than did the brush
machine group.

Table 2. Summary of included studies characteristics.
Study author
(s), year of
publication,
country Title Diagnosis
Blanquero et al. Feedback-guided exercises
2020 performed on a tablet
Spain touchscreen improve return to
work, function, strength and
healthcare usage more than an
exercise program prescribed on
paper for people with wrist,
hand or fingeriInjuries: a
randomised trial
Ganjiwale et al. Occupational therapy
2019 rehabilitation of industrial setup
India hand injury cases for functional
independence using modified
joystick in interactive computer
gaming in anand, Gujarat
Jarus et al. 2000 From hand twister to mind
Isreal twister: Computer aided
treatment in traumatic wrist
fracture
138
Follow up
Participants Intervention and control groups time points Outcome measures
Wrist, hand and/or fingers with N = 74, Intervention group: Home Baseline, Return to work
bone and soft tissue injuries intervention exercise programme on 2 weeks, (calendar days);
including: Fracture of radius, group (n = 40), ReHand app, 20–30 min. 4 weeks QuickDASH; grip
ulna, scaphoid, phalanges, control group Control group: Home strength; pinch
metacarpals; carpal tunnel (n = 34) exercise program on paper, strength; and pain
syndrome, dislocation of the 20–30 min twice daily (VAS)
finger, sprains and strains,
traumatic amputation
Hand injury due to fracture, N = 65, Intervention group: Baseline, Functional
crush injury, or tendon injury. intervention Conventional therapy for Post 15 independence
Tendon repair group (n = 33), 15 min then video gaming for sessions measure (FIM); Grip
(n = 53, 81.5%), plating control group 15 min daily for 6 days per (2– strength; and pinch
(n = 5), conservative (n = 32) week for 2 weeks with a 3 weeks) strength
management (n = 3) modified joystick. Control
group: Conventional therapy
for 30 min for 6 days per week
for 3 weeks
Post traumatic wrist fracture N = 47, Both groups: Treatment 3 times Baseline, Grip strength;
with reduced range of intervention per week for 5 weeks. 50 min Weekly goniometer;
movement and grip strength, group (n = 23), per session with 10 min for volumeter;
and oedema 88% ( n = 41) had control group whirlpool, 10 min massage and 5 weeks treatment interest;
distal radius fracture; and of (n = 24) passive exercise, 10 min and attitude
these 61% (n = 25) had colles theraplast, 10 min computer questionnaire
fracture. 12% had fractured OR brush machine supination/
ulna or carpal bones or mixed pronation, and 10 min
fractures computer OR brush machine
palmar flexion-dorsiflexion
movements, with intervention
group using the computer and
control group using the brush
machine
Hand Therapy 28(4)
Sheerin et al.
Figure 2. Grip strength post-intervention.
Figure 3. Pinch strength post-intervention.
Discussion
This systematic review aimed to locate, describe, and an-
alyse the current evidence regarding the effectiveness of
occupational therapy-led computer-aided interventions for
adults with a condition or injury of the hand, wrist, or
forearm. Following a comprehensive search of five data-
bases, only three articles met the inclusion criteria. Across
the three trials, one evaluated the use of an application on a
touchscreen tablet and two evaluated a computer-based
intervention using a modified joystick with forearm,
wrist, hand, and fingers targeted movements to complete
games. Participants’ ages ranged from 18 to 80 years and
represented both males (58%) and females (42%). Re-
garding the primary outcome of function, two studies
evaluated function as an outcome with one study showing a
short-term significant difference in function, while both
showed no significant long-term difference in function. Two
of the studies demonstrated no difference in grip strength
between groups whilst one study showed significantly better
strength in the intervention group. Two studies measured
pinch strength and meta-analysis revealed improvement for
intervention groups. Mean estimates favoured the inter-
vention group regarding pain reduction, however confi-
dence intervals were too imprecise to indicate a truly
beneficial effect. Despite non-conclusive findings, inter-
vention and control groups had similar outcomes. Thus, the
current review has added to the knowledge base that
computer-based interventions have the potential to be as
effective for this population as other occupational therapy-
led interventions or as part of a multi-modal approach.
It is important in light of these findings to consider
barriers and facilitators associated with the use of computer-
aided interventions. Treatment adherence is identified as
being of concern throughout an intervention, where patients
139
can lose motivation when treatments become monotonous
over time.48 Patient non-adherence to treatment pro-
grammes is directly related to poorer functional outcomes
and can limit treatment benefits, with the meta-analysis by
DiMatteo et al.49 reporting recovery as trebled in patients
who adhere to treatment recommendations when compared
to those who do not. One included study in the current
review assessed treatment interest and reported participants
had a significantly greater interest in the computer-based
intervention than standard treatment,46 this increased in-
terest may support treatment adherence. In a recent sys-
tematic review50 exploring interventions to aid therapy
adherence in people with an upper limb condition, the use of
audio-visual technology (DVD and videotape) and smart-
phone applications were found to be used increasingly with
this population. Of the three included studies in this review,
one is from the year 2000,46 however two of the studies are
recent, from 201944 and 2020.45 This may indicate this is a
growing area of investigation and the type of technology
being used and reported on may be richer and broader in the
coming years. The recent development of an online version
of the Strengthening and Stretching for Rheumatoid Ar-
thritis of the Hand program, mySARAH,51 a tailored,
progressive 12-weeks exercise program for people with
hand problems due to rheumatoid arthritis is one example of
the use of computers and handheld devices in delivering
therapeutic interventions, with initial evaluation indicating
mySARAH as feasible, acceptable, and beneficial to par-
ticipants.52 Computer-based interventions have the poten-
tial to offer diversity and stimulation to patients, in an
accessible format, to increase adherence, and psychological
and physical therapy outcomes.20,21,52
Controlled studies on the use of common gaming plat-
forms such as Nintendo Switch® and Leap® were not found
for the target population of this systematic review, despite
140
their potential alongside conventional occupational therapy
approaches in other health conditions. The use of tech-
nologies such as the Nintendo Switch® and virtual reality-
based upper extremity training in the post-stroke population
have been shown to improve functional and strength out-
comes53 and led to high satisfaction and compliance
rates54 when combined with conventional therapy.54,55
The use of an occupationally embedded computer-based
intervention for persons with traumatic brain injury eli-
cited significantly more upper limb range of motion versus
rote exercise.56 Gaming consoles such as Nintendo
Switch® and Leap® are relatively inexpensive and pro-
grammes involving their use could be implemented in a
person’s own home. Methodologically robust studies
evaluating a wider variety of gaming consoles and virtual
reality intervention in people with an upper limb condition
could add to the evidence base regarding gaming and
occupational therapy practice.
Despite a growing uptake of technology use among older
adults, an age divide in the use of technology is reported,
with lower usage among older adults compared to other age
groups. This is attributed to factors including sociodemo-
graphic differences in exposure to technology, motivation,
skills needed to use the Internet, and age-related onset of
health problems.14 Another barrier to the use of technology
in healthcare is the lack of access and associated costs for
some technologies. Therapists’ awareness of barriers and
facilitators to the use of technology in practice is pertinent
when implementing computer-aided interventions. The
Technology Acceptance Model (TAM) and subsequent
consolidated versions of the TAM in the Unified Theory of
the Acceptance and Use of Technology (UTAUT) may
assist therapists in understanding the processes underlying
the acceptance of technology, to predict the behaviour of use
and provide a theoretical explanation for the successful
implementation of technology with patients.57,58 The
UTAUT model describes seven primary factors that influ-
ence an individual’s use of technology: (1) performance
expectancy; (2) effort expectancy; (3) social influence; (4)
facilitating conditions; (5) hedonic motivation; (6) price
value; and (7) habit.58 They found age, gender, and ex-
perience impacted some of these relationships.58 It is ad-
vantageous for occupational therapists to be aware of such
factors, including the barriers and facilitators in the im-
plementation of computer-aided interventions to ensure
correct and effective application.
Limitations were noted across the three included
studies. Limitations in Blanquero et al.45 study included
non-assessment of adherence to the exercise programs, in
addition to the study reporting on a wide variety of
condition types, reducing clarity regarding the interven-
tion effect for specific hand, wrist, or forearm conditions.
Limitations noted in the Ganjiwale et al.’s44 study include
the intervention group being reported as having sessions
Hand Therapy 28(4)
across a 2-week period, compared to a 3-week period for
the control group. This could have implications for the
outcomes as there was a significant difference in the length
of treatment time between groups. Jarus et al.46 did not
assess function or occupational performance, nor adher-
ence to the programs described.
Given the prevalence of upper limb conditions and the
need to evaluate and effectively report on occupational
therapy interventions, it is important to continue to expand
the evidence base through high-quality, methodologically
robust, trials. This review was limited by the sparsity of
randomized trials and the methodological quality of the
studies included in this review. Within the current review, it
was noted that not all studies assessed all outcomes primary
and secondary, for example, function. Furthermore, in one of
the studies that did assess function, the outcomes were not
fully reported on, with a lack of data availability to draw
conclusions or complete meta-analysis.44 The Template for
Intervention Description and Replication (TIDieR)59 is an
extension of item five of the CONSORT 2010 statement60
and item 11 of the Standard Protocol Items: Recommenda-
tions for Interventional Trials (SPIRIT) 2013 statement, and
its use can help improve the completeness of reporting
and the replicability of interventions reported on.61 This,
alongside utilisation of appropriate outcome measures, en-
compassing Core Outcome Measures in Effectiveness Trials
(COMET) standardised outcome sets, is key to adding
quality and value to future studies. A review of virtual reality
and gaming consoles which have demonstrated positive
findings for other populations with upper limb dysfunction,
such as CVA, could add to the occupational therapy evidence
base for those with a hand condition. Further research pri-
orities include the need for robust trials evaluating occupa-
tional therapy-led computer-aided interventions reported in
line with appropriate reporting guidelines.
Conclusion
Computer-aided interventions in occupational therapy
practice for those with a hand, wrist, or forearm condition
require further investigation. Generally, this review supports
the premise that occupational therapy-led computer-based
interventions using touchscreen and video games have
promising yet limited evidence to support their effective-
ness in terms of improvements in function, pain, grip, and
pinch strength when compared to conventional occupa-
tional therapy approaches. Gaming may be utilised to
complement hand therapy rehabilitation programmes where
appropriate, alongside other evidence-based approaches.
Acknowledgements
The authors thank the following people: The authors who kindly
responded to requests for data or information, Annette O’Driscoll
Sheerin et al.
for her guidance on occupational therapy practice for conditions of
the upper limb, and Shirley Reale for her support throughout
completion of this project.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with re-
spect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, au-
thorship, and/or publication of this article.
ORCID iD
Margo Sheerin  https://orcid.org/0000-0001-8980-7721
Supplemental Material
Supplemental material for this article is available online.
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