The link between the healing process and functional outcomes in the surgically repaired digital f... more The link between the healing process and functional outcomes in the surgically repaired digital flexor tendon is poorly understood. This clinical note describes those gray-scale and power Doppler (PD) ultrasound parameters that can be used to document longitudinal change in the morphologic and dynamic properties of the surgically repaired zone II flexor digitorum profundus (FDP) tendon. The method is supported by ultrasound data obtained from three participants at five points in time post-surgically (two, four, six, 12 and 18 weeks). Longitudinal documentation of the ultrasound properties of echogenicity, defect size, tendon excursion and power Doppler signal is feasible and has the potential to explore the possible link between changes in the structural status of surgically repaired flexor tendons and associated clinical outcomes.
Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surger... more Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results We identified five major themes: 1) the ‘Significant Impact’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; 2) ‘Waiting and Paying’ – the enacting, rel...
Background: Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common, disabling condition, aff... more Background: Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common, disabling condition, affecting substantial numbers of working and older-age people. It is the single commonest site affected by OA yet its unique characteristics, distinct from general hand OA, have received little individual attention – far less than hip and knee OA. In particular, little is known from patients’ perspectives about the impact of thumb CMC OA. Furthermore, international guidelines recommend splinting as a non-surgical, non- pharmacological treatment option for CMC OA; however, evidence supporting splinting in people with thumb CMC OA is sparse and inconsistent. The aims of this research were to: 1) explore the impact of thumb CMC OA from the perspective of people living with the condition; 2) investigate the effectiveness of splinting interventions for thumb CMC OA. Methods: Three main studies were conducted: 1) a pragmatic qualitative study exploring the impact of thumb CMC OA in 30 individual ...
Introduction: Despite the high prevalence of thumb base osteoarthritis (OA), little is known abou... more Introduction: Despite the high prevalence of thumb base osteoarthritis (OA), little is known about the patient perspective. This study aimed to explore the impact of thumb base OA from the perspective of people with the condition in the New Zealand context. Methods: In this pragmatic qualitative study, semi-structured interviews and solicited diaries were conducted with 30 adults with thumb base OA. The holistic health lens of the Te Whare Tapa Whā framework was adopted. Data were thematically analysed using an inductive approach. Results were interpreted using the Health Impact Model. Key results: Five inter-related levels of impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and altered sense of self. Impact at each level was influenced by personal and environmental factors. An unmet need was identified – participants desired more information about the condition and how they can help themselves. Conclusion: Thumb base OA has a significant impact on all aspects of health. Important functional restrictions as well as other aspects of health important to patients are not captured in currently used outcome measures for thumb base OA. Patient information about the condition is lacking. Key practice points: Clinical practice and research need to account for the mental, social and spiritual impact of thumb base OA. Additional questions specific to thumb base OA may improve the sensitivity of outcome measures. Easily-available evidence-based patient information is likely to reduce the impact of thumb base OA.Peer Reviewe
Splinting for thumb carpometacarpal osteoarthritis: protocol for a feasibility randomised control... more Splinting for thumb carpometacarpal osteoarthritis: protocol for a feasibility randomised controlled trial Background: Evidence for the use of splints to reduce pain and improve function and quality of life in thumb carpometacarpal osteoarthritis (CMC OA) is sparse and poor despite recommendations by international guidelines. Objective: To outline the protocol for a study designed to determine the feasibility of conducting a fully powered pragmatic randomised controlled trial (RCT) comparing soft splint vs no splint for thumb CMC OA. Methods: The proposed pragmatic, assessor-blinded, and partial participant blinded parallelgroup feasibility RCT will recruit 30 adults with thumb CMC OA and randomise to: splint intervention or usual care control. Randomisation will be stratified by hand dominance. Primary feasibility outcomes are recruitment rate over a 4-month period, retention rate at 6 months, intervention acceptability, and rate of adverse events. Study costs, intervention fidelity, and clinical outcomes will also be evaluated. Measurements will be collected at baseline, 4 weeks, and 6 months post-initiation of treatment. This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001639213. Major Findings: N/A Conclusions: If shown to be effective, soft off-the shelf splints would be a good first-line nonpharmacological, non-surgical option for thumb CMC OA as prescribed by health professionals or accessed directly by patients. This feasibility study will inform a future, fully powered RCT as evaluated by success of the recruitment strategy; assessment time and acceptability; implementation and evaluation of 'usual care'; and intervention procedures and adherence.
ObjectiveFirst carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part o... more ObjectiveFirst carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets.MethodsIn this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face‐to‐face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact ...
To examine the effectiveness of splinting for reducing pain and improving function and health-rel... more To examine the effectiveness of splinting for reducing pain and improving function and health-related quality of life (HR-QoL) in people with thumb carpometacarpal osteoarthritis (CMC OA).
The link between the healing process and functional outcomes in the surgically repaired digital f... more The link between the healing process and functional outcomes in the surgically repaired digital flexor tendon is poorly understood. This clinical note describes those gray-scale and power Doppler (PD) ultrasound parameters that can be used to document longitudinal change in the morphologic and dynamic properties of the surgically repaired zone II flexor digitorum profundus (FDP) tendon. The method is supported by ultrasound data obtained from three participants at five points in time post-surgically (two, four, six, 12 and 18 weeks). Longitudinal documentation of the ultrasound properties of echogenicity, defect size, tendon excursion and power Doppler signal is feasible and has the potential to explore the possible link between changes in the structural status of surgically repaired flexor tendons and associated clinical outcomes.
Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surger... more Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results We identified five major themes: 1) the ‘Significant Impact’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; 2) ‘Waiting and Paying’ – the enacting, rel...
Background: Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common, disabling condition, aff... more Background: Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common, disabling condition, affecting substantial numbers of working and older-age people. It is the single commonest site affected by OA yet its unique characteristics, distinct from general hand OA, have received little individual attention – far less than hip and knee OA. In particular, little is known from patients’ perspectives about the impact of thumb CMC OA. Furthermore, international guidelines recommend splinting as a non-surgical, non- pharmacological treatment option for CMC OA; however, evidence supporting splinting in people with thumb CMC OA is sparse and inconsistent. The aims of this research were to: 1) explore the impact of thumb CMC OA from the perspective of people living with the condition; 2) investigate the effectiveness of splinting interventions for thumb CMC OA. Methods: Three main studies were conducted: 1) a pragmatic qualitative study exploring the impact of thumb CMC OA in 30 individual ...
Introduction: Despite the high prevalence of thumb base osteoarthritis (OA), little is known abou... more Introduction: Despite the high prevalence of thumb base osteoarthritis (OA), little is known about the patient perspective. This study aimed to explore the impact of thumb base OA from the perspective of people with the condition in the New Zealand context. Methods: In this pragmatic qualitative study, semi-structured interviews and solicited diaries were conducted with 30 adults with thumb base OA. The holistic health lens of the Te Whare Tapa Whā framework was adopted. Data were thematically analysed using an inductive approach. Results were interpreted using the Health Impact Model. Key results: Five inter-related levels of impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and altered sense of self. Impact at each level was influenced by personal and environmental factors. An unmet need was identified – participants desired more information about the condition and how they can help themselves. Conclusion: Thumb base OA has a significant impact on all aspects of health. Important functional restrictions as well as other aspects of health important to patients are not captured in currently used outcome measures for thumb base OA. Patient information about the condition is lacking. Key practice points: Clinical practice and research need to account for the mental, social and spiritual impact of thumb base OA. Additional questions specific to thumb base OA may improve the sensitivity of outcome measures. Easily-available evidence-based patient information is likely to reduce the impact of thumb base OA.Peer Reviewe
Splinting for thumb carpometacarpal osteoarthritis: protocol for a feasibility randomised control... more Splinting for thumb carpometacarpal osteoarthritis: protocol for a feasibility randomised controlled trial Background: Evidence for the use of splints to reduce pain and improve function and quality of life in thumb carpometacarpal osteoarthritis (CMC OA) is sparse and poor despite recommendations by international guidelines. Objective: To outline the protocol for a study designed to determine the feasibility of conducting a fully powered pragmatic randomised controlled trial (RCT) comparing soft splint vs no splint for thumb CMC OA. Methods: The proposed pragmatic, assessor-blinded, and partial participant blinded parallelgroup feasibility RCT will recruit 30 adults with thumb CMC OA and randomise to: splint intervention or usual care control. Randomisation will be stratified by hand dominance. Primary feasibility outcomes are recruitment rate over a 4-month period, retention rate at 6 months, intervention acceptability, and rate of adverse events. Study costs, intervention fidelity, and clinical outcomes will also be evaluated. Measurements will be collected at baseline, 4 weeks, and 6 months post-initiation of treatment. This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001639213. Major Findings: N/A Conclusions: If shown to be effective, soft off-the shelf splints would be a good first-line nonpharmacological, non-surgical option for thumb CMC OA as prescribed by health professionals or accessed directly by patients. This feasibility study will inform a future, fully powered RCT as evaluated by success of the recruitment strategy; assessment time and acceptability; implementation and evaluation of 'usual care'; and intervention procedures and adherence.
ObjectiveFirst carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part o... more ObjectiveFirst carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets.MethodsIn this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face‐to‐face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact ...
To examine the effectiveness of splinting for reducing pain and improving function and health-rel... more To examine the effectiveness of splinting for reducing pain and improving function and health-related quality of life (HR-QoL) in people with thumb carpometacarpal osteoarthritis (CMC OA).
Uploads
Papers by Miranda Buhler