Effects of Core Stabilization on Hand Trauma Outcomes

Official title

The Effects of Core Stabilization Exercises on Functional and Emotional Status in Traumatic Hand Injuries

Overview

Hand injuries carry a high risk due to the constant demands for use and their complex functionality. These injuries often occur as a result of various incidents, including household accidents, occupational hazards, traffic collisions, and sports activities, and they are particularly common among male workers. The severity of hand injuries varies widely, ranging from simple soft tissue damage to serious tendon and nerve lacerations, as well as fractures. The extent of the injury can significantly affect the recovery process and the likelihood of patients regaining their previous functional abilities.There is a strong connection between hand injuries and their impact on both emotional status and functional capacity. Changes in the hand's appearance and restrictions in daily activities can lead to feelings of helplessness, frustration, and psychological stress. In particular, concerns about returning to work can further exacerbate psychological distress in workers. Core stabilization plays a crucial role in alleviating these negative effects. The core region not only ensures overall body stability but also directly influences hand function. Strengthening and stabilizing the core muscles enhance proper body movement, thereby improving upper extremity efficiency. This physical improvement also contributes to psychological recovery, as the ability to perform daily activities more comfortably enhances self-confidence and overall quality of life. Therefore, core exercises do not only improve functional outcomes but also support psychological well-being. This study will include 51 male patients diagnosed with traumatic hand injuries who meet the inclusion criteria. Assessments will be conducted on joint range of motion, grip strength, joint position sense, reaction time, hand function, activity and participation levels, quality of life, anxiety and depression scales, galvanic skin response, patient satisfaction, and core stability. These evaluations will be performed at two different time points: before rehabilitation and at the end of a six-week rehabilitation program. The study consists of three groups. The first group will participate solely in a standard hand rehabilitation program. The second group will perform supervised core stabilization exercises three times per week in addition to the standard hand rehabilitation program. In the third group, core stabilization exercises will be performed without the supervision of a physiotherapist, with patients following pre-recorded instructional videos alongside the standard rehabilitation program. For all groups, the hand rehabilitation program will take place five days a week for the first three weeks and three days a week for the following three weeks. Patients in the two groups performing core stabilization exercises will be trained in how to activate the transversus abdominis muscle and coordinate their breathing before starting the exercises. The exercises, including warm-up and cool-down phases, will be performed for ten repetitions per session, with each session lasting between 60 and 90 minutes. Additionally, patients will be assigned home exercises from the standard physiotherapy program, and adherence to these exercises will be monitored through checklists. Although the biomechanical relationship between core muscles and hand function has been explained in the literature, no rehabilitation program incorporating core stabilization exercises for hand injuries has been identified. Moreover, no studies have objectively assessed emotional changes following traumatic hand injuries. This study aims to make a significant contribution to the literature by examining the effects of core stabilization on hand function and emotional well-being.

Interventions

• Behavioral Standard Hand Rehabilitation Only
  Standard Hand Rehabilitation Program will be delivered over a total duration of six weeks. During the first three weeks, the program will be administered five days per week, and during the following three weeks, it will be performed three days per week. The rehabilitation program will include scar tissue massage, passive and active range of motion exercises for the fingers and wrist, sensory re-education, and edema control using retrograde massage and Coban wrapping. Joint mobilization technique
• Behavioral Supervised Core Stabilization + Standard Hand Rehabilitation
  The second group will receive the same six-week Standard Hand Rehabilitation Program as the control group (5 days per week for the first 3 weeks, and 3 days per week for the last 3 weeks). In addition, participants will perform a Supervised Core Stabilization Exercise Program three times per week for six weeks under a physiotherapist's supervision.The exercises will focus on activating the transversus abdominis and coordinating breathing to improve core stability.Each session will include a warm
• Behavioral Unsupervised Core Stabilization + Standard Hand Rehabilitation
  he third group will receive the same six-week Standard Hand Rehabilitation Program as the control group (5 days/week for 3 weeks, then 3 days/week for 3 weeks). They will also do an Unsupervised Core Stabilization Exercise Program three times a week for six weeks in the same clinic. Exercises will be the same as the supervised group but done alone using videos without a physiotherapist. The exercises will focus on activating the transversus abdominis and coordinating breathing to improve core st

Primary outcome measures

• Hand Function Assessment (Jebsen-Taylor Hand Function Test) [Time frame: Before treatment, week 6]
• Emotional State Assessment (Galvanic Skin Response Device) [Time frame: Before treatment, week 6]
• Core Stability Assessment (Stabilizer Biofeedback Device) [Time frame: Before treatment, week 6]

Secondary outcome measures (10)

• Range of Motion Assessment (Goniometer) [Time frame: Before treatment, week 6]
• Proprioception Assessment (Wrist Joint Position Sense Assessment with Goniometer) [Time frame: Before treatment, week 6]
• Reaction Time Assessment (Nelson Reaction Time Test) [Time frame: Before treatment, week 6]
• Activity and Participation Level Assessment (Disabilities of the Arm, Shoulder and Hand - DASH Questionnaire) [Time frame: Before treatment, week 6]
• Severity Evaluation of Hand Injuries (Modified Hand Injury Severity Score) [Time frame: Baseline (prior to surgery)]
• Quality of Life Assessment (SF-36) [Time frame: Before treatment, week 6]
• Anxiety Assessment (Beck Anxiety Inventory) [Time frame: Before treatment, week 6]
• Depression Assessment (Beck Depression Inventory ) [Time frame: Before treatment, week 6]
• Patient Satisfaction Assessment (Likert Scale) [Time frame: Before treatment, week 6]
• Gross / Fine Grip Strength Assessment (Dynamometer / Pinch meter) [Time frame: Before treatment, week 6]

Eligibility criteria

Inclusion criteria

• Having been diagnosed with a traumatic hand injury
• Having received surgical treatment appropriate to the type of injury
• Being a male individual between 20 and 50 years of age
• Having a moderate, severe, or major score according to the Modified Hand Injury Severity Score (MHISS)

Exclusion criteria

• Having a chronic illness such as neurological, rheumatological, diabetes, metabolic syndrome, or cardiovascular diseases
• Presence of infection

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Istinye University Bahcesehir Liv Hospital — Istanbul

Publications

• Abd-Elfattah HM, Aly SM. Effect of Core Stability Exercises on Hand Functions in Children With Hemiplegic Cerebral Palsy. Ann Rehabil Med. 2021 Feb;45(1):71-78. doi: 10.5535/arm.20124. Epub 2021 Feb 9. PMID 33557483
• Ayhan C, Unal E, Yakut Y. Core stabilisation reduces compensatory movement patterns in patients with injury to the arm: a randomized controlled trial. Clin Rehabil. 2014 Jan;28(1):36-47. doi: 10.1177/0269215513492443. Epub 2013 Jul 3. PMID 23823711

Identifiers

NCT: NCT07026747 · IstinyeUni-B.UYANIK.001

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗