The impact of therapy-led hand clinics for the treatment of acute hand injury: A cluster non-randomised controlled trial

Purpose To evaluate the effectiveness of therapy-led conservative management of acute hand injury in adults when compared to medical-led, care as usual. Design Cluster non-randomised trial. Setting Four intervention sites and one control site, acute hospitals providing emergency care for hand injuries. Participants Adults (18 years +) with acute hand injuries, such as hand fracture, mallet, volar plate and central slip injuries. Intervention The intervention group had access to therapy-led hand therapy management of their hand injury, compared to care as usual. Main measures Standardised outcome tools measuring function, health-related quality of life, pain, and occupational value and competence were completed at baseline, 8 weeks and 6 months. Results A total of 133 participants were recruited (intervention, n = 67; control, n = 66). Baseline demographics of participants were similar between groups. There was no statistically significant between-group differences in the primary outcome of QuickDASH function at 8 weeks (mean difference −0.05; 95% CI −6.41 to 6.3; p = 0.99) or 6 months (mean difference −1.74; 95% CI −6.35 to 2.87; p = 0.46), or in the secondary outcomes at each time point. However, the difference in scores across time was statistically significant for the primary outcome ( p < 0.001), and a number of secondary outcomes. The intervention group had a significantly lower number of onward referrals ( p < 0.001) and a reduced number of healthcare contacts. Conclusion No statistically significant differences were detected between groups on primary or secondary outcomes, suggesting comparable functional recovery between therapy-led and medical-led pathways, while requiring fewer healthcare contacts and onward referrals. Greater utilisation of therapy-led pathways is indicated in the management of hand injury. Registration ClinicalTrials.gov (NCT06399614).