Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention

doi:10.1016/j.puhe.2018.05.016

Public Health

Volume 162, September 2018, Pages 135-146

https://doi.org/10.1016/j.puhe.2018.05.016 Get rights and content

Highlights

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We included 17 articles after screening 933 eligible articles.
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Hand injuries were associated with work limitation.
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Direct and indirect costs related to treatments account for a major healthcare burden.
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Limited evidence exist on estimates of long-term cost from disability.
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Disparities exist in the hand injury research in low- and middle-income countries.

Abstract

Objectives

Hand injuries result in major healthcare costs from lack of productivity and disability. With rapid industrialization, the incidence of hand injuries is expected to rise in low- and middle-income countries (LMICs). However, estimates of burden and validated outcome tools are needed for effective resource allocation in the management of these injuries.

Study design

We conducted a systematic review to evaluate the burden of hand injuries in LMICs according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

Methods

We searched PubMed, Scopus, Embase, Cochrane Library, PAIS International, African Index Medicus, Global Health, IMMEMR, IMSEAR, Wholis and Bdenf, Lilacs, Scielo, WPRIM, and WHO International Clinical Trials Registry Platform to detect eligible articles with no restrictions on length of follow-up, type of hand injury, or date.

Results

We included 17 articles after screening 933 eligible articles based on title, abstract, and full-text screening. There was significant heterogeneity and low quality of evidence. All included articles suggest that hand injuries were associated with work limitations for the majority of patients, and residual pain can further limit their activities. Direct and indirect costs related to treatment account for a major healthcare burden with limited evidence on estimates of long-term cost from disability.

Conclusions

The present systematic review highlights the paucity of high-quality data on the epidemiology, management, and burden of hand injuries in LMICs. The data are heterogeneous, and comprehensive metrics are lacking. Because hand injuries can account for a significant proportion of injury-related disability, reducing the overall burden of hand injuries is of utmost importance.

Introduction

Injury to the hand leads to major healthcare costs and high economic burden from lack of productivity, disability, and mental health problems.¹ According to the Global Burden of Disease (GBD 2015) study,² ‘injuries’ collectively account for 10.12% disability-adjusted life years (DALYs), which is greater than tuberculosis (2%), HIV/AIDS (2.84%), and malaria (2.68%) combined. Although the GBD study does not categorize injuries based on location or part of the body involved, population-based estimates from developed countries show that hand and wrist injuries account for approximately 28–29% of all injury-related visits to emergency departments.³ A recent review of data from several developed countries, including the United States, China, and Sweden, among other countries, estimated that the median total cost of an acute hand injury is approximately US $6951.⁴ With rapid industrialization and dependence on mechanized production, the burden of injuries, in particular hand injuries, poses a challenge for global health in developed and even more in developing countries.

In comparison to other injuries, hand injuries are peculiar in nature because optimal management requires a unique skill set, and the majority of economic burden results from disability rather than mortality.¹ For instance, when accounting for loss of productivity, hand and wrist injuries result in higher costs compared to lower limb or hip fractures and even brain injuries at a population level.¹ From a conceptual standpoint, the rise in occurrence and severity of these injuries in low- and middle-income countries (LMICs) is to be expected in the light of rapid industrialization. Since the majority of hand injuries are preventable and often occur in young and otherwise healthy members of the workforce,5, 6 population-based data that can guide decision-making and evidence-based practice can have a profound impact on the economy of LMICs.

We conducted a systematic review to analyze the existing literature on the burden of hand injuries in LMICs to guide proper allocation of resources and preventive strategies.

Section snippets

Literature search

We conducted this systematic review according to the checklist suggested by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA).⁷ We did not register a review protocol before the completion of the study. An informationist performed the database search using the following terms: ‘arm,’ ‘upper extremity,’ ‘hand,’ ‘cost of illness,’ ‘burden of disease,’ ‘quality of life,’ ‘developing countries,’ ‘less developed country,’ and ‘low income country’. The database search

Literature search

The initial search after de-duplication revealed 933 unique titles which we then screened by title and abstract (Fig. 1). Fifty articles were considered eligible based on title and abstract screening and were selected for evaluation based on the full text article. No relevant additional studies were identified by screening the reference lists of included studies. We excluded 33 studies for which only the abstracts were available (n = 1) or there was no relevant data (n = 28) or were not written

Discussion

For this systematic review, only 17 articles met the inclusion criteria, highlighting the paucity of data on hand injuries in LMICs. Available data provide evidence that hand injuries, regardless of etiology, are associated with considerable burden in developing countries, especially for patients who suffer financial hardships due to days missed from work or direct medical costs. Moreover, the literature also shows that patients with hand injuries have low quality of life scores as reported by

Ethical approval

This is a systematic review of already published materials. The study conforms to the Declaration of Helsinki.

Funding

None declared.

Conflicts interests

None declared.

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Nursing care after hand replantation based on Roy's adaptation model: A case report
2024, International Journal of Orthopaedic and Trauma Nursing
Hand injuries are very complex and worrying in terms of hindering activities of daily living, functionality and self-care skills. Hand injuries are caused by traumatic events, resulting in a partial or complete loss. The focus of acute treatment is surgical replantation.
In this study, nursing care and nursing experiences of a patient who was replanted as a result of hand trauma were discussed in the light of the Roy Adaptation Model.
The male patient admitted to the emergency room due to traumatic amputation was a 49-year-old farmer. He lost his hand to an agricultural tool while working the land and was taken to the hospital within 4 h. He was taken up for emergency surgery for replantation. He has a history of diabetes mellitus. Nursing follow-up and interventions were applied by evaluating the data according to four adaptation modes (physiological needs, self-concept, role function and interdependence) within the scope of the Roy Adaptation Model.
and Suggestions: Patients experience difficulties (loss of function, financial problems, loss of role, psychological traumas) due to disability after injury. Therefore, nurses should know the underlying physiological risks, complications, and interventions to recognize and respond to situations that cause the loss of the reattached limb. Nursing models can identify patients' needs and problems, prevent complications, provide quality care, and manage the process. This study discussed the postoperative nursing care of a patient based on Roy's Adaptation Model.
The impact of socioeconomic status on hand injury severity
2022, Hand Surgery and Rehabilitation
Socioeconomic status (SES) is an important factor affecting different aspects of human health, including self-care and healthcare service use. The relation between SES and hand injury severity is not well defined; therefore, the present study aimed to investigate the relation between SES and hand injury severity. This cross-sectional descriptive and analytical study included 215 patients with hand injury. Demographic, clinical, and SES-related factors were collected by questionnaire. Injury severity was assessed on Hand Injury Severity Score (HISS). Statistical analysis used the Student t-test, chi-square test and a multinomial regression model to calculate the odds ratio (OR) of each predictive factor. Mean age was 38.02 ± 13.49 years (range, 12–80 years). 73.5% of the participants were men. Patients with low SES were significantly more likely to develop severe hand injury (OR = 5.25 and 9.25 at HISS levels 3 and 4, respectively). In addition, there was a significant association between being born in rural areas and severe (HISS level 3, OR = 2.63) or major (HISS level 4, OR = 2.63) hand injury. Also, major (HISS level 4) hand injuries were significantly more prevalent in patients living in rural areas (OR = 4.23) and those injured in road accidents (OR = 1.98) or practicing sports (OR = 3.51). The study concluded that patients with low SES were 5−10-fold more likely to suffer from severe and major hand injuries, and thus provided valuable information for Iranian policymakers to take preventive measures for hand injuries. It is recommended to improve postoperative care in patients with low SES who underwent hand surgery, take the necessary measures to decrease the incidence of road accident injuries, facilitate early referral of patients with hand injury to trauma centers, and improve postoperative follow-up until full recovery.
III
La catégorie socio-professionnelle (CSP) est un facteur important qui affecte différents aspects de la santé, y compris les soins personnels et l'utilisation des services de santé. Le lien entre la CSP et la gravité des lésions de la main n'est pas clairement défini, c'est pourquoi la présente étude visait à examiner la relation existante entre la CSP des patients et la gravité des lésions de la main. Cette étude transversale, descriptive et analytique a été réalisée sur un échantillon de 215 patients souffrant de lésions de la main. Les facteurs démographiques, cliniques et ceux liés aux CSP des participants ont été recueillis à l'aide d'un questionnaire. De plus, la gravité des blessures de la main des patients a été évaluée à l'aide du Hand Injury Severity Score (HISS). Enfin, une analyse statistique a été réalisée à l'aide du test t (test de Student), du test du χ² (test du khi2) et au modèle de régression multinomiale afin de calculer les Odds Ratios (OR) de chaque facteur prédictif. D'après les résultats, l'âge moyen des participants était de 38,02 ± 13,49 ans, avec une fourchette d'âge de 12 à 80 ans. En outre, 73,5 % des participants étaient des hommes. Les patients issus d’une CSP moins favorisée étaient significativement plus susceptibles de développer des blessures sévères (OR = 5,25 et 9,25 aux niveaux 3 et 4 du HISS, respectivement). De plus, il y avait une relation significative entre le fait d'être né en zone rurale et les blessures de la main graves (niveau 3 du HISS, OR = 2,63) ou majeures (niveau 4 du HISS, OR = 2,63). De même, les lésions majeures (niveau 4 du HISS) étaient significativement plus fréquentes chez les patients vivant dans des zones rurales (OR = 4,23), ceux victimes d'un accident de la route (OR = 1,98) et ceux qui font beaucoup de sport (OR = 3,51). La présente étude a conclu que les patients issus d’une CSP défavorisée sont 5 à 10 fois plus susceptibles de subir des blessures de la main graves et majeures selon le HISS. Par conséquent, cette étude a fourni des données précieuses aux responsables politiques de santé iraniens, leur permettant de prendre des mesures de prévention. Il est également recommandé d'améliorer les soins postopératoires chez les patients venant d’une CSP défavorisée et ayant subi une chirurgie de la main. Il est de plus indispensable de prendre les mesures nécessaires afin de prévenir et réduire les accidents de la route, de faciliter la prise en charge des patients souffrant de lésions de la main vers des centres de traumatologie et d'améliorer le suivi postopératoire des patients jusqu'à leur rétablissement complet.
III
Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial
2020, Journal of Physiotherapy
In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper?
Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis.
Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers.
Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper.
The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation.
Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength.
In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments.
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Postoperative Management of Hand Surgery in the Low- and Middle-Income Countries
2019, Hand Clinics
Citation Excerpt :
Visiting a local industry to evaluate current practices and meet with medical staff can be beneficial in influencing change to reduce or prevent work-related injuries. Furthermore, improving work-related public awareness and incorporating behavioral and environmental modifications make up the primary prevention for hand injuries.28 Another opportunity for a visiting therapist to impact the community is to visit orphanages to better understand the community and develop trust between themselves and the local medical staff and patients.
Teaching Hand Surgery in the Developing World: Utilizing Educational Resources in Global Health
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Only 17% of these workers reported the use of protective gloves.9,14 Lack of a workers’ compensation system, prohibitive cost of care, and lack of health insurance systems in LMICs further complicate treatment and outcomes from these traumatic injuries.9 One study from an urban referral hospital in Kenya demonstrated a similar trend.
How international are the editorial boards in the field of hand research? A cross-sectional study of leading subspecialty hand journals
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View all citing articles on Scopus

¹: C.S. and Z.I. are co-first authors.

View full text

Review PaperHand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention

Highlights

Abstract

Objectives

Study design

Methods

Results

Conclusions

Introduction

Section snippets

Literature search

Literature search

Discussion

Ethical approval

Funding

Conflicts interests

Injury

J Saf Res

Health Policy (Amsterdam, Netherlands).

Am J Surg

J Hand Surg

Afr J Emerg Med

Lancet (London, England)

Surgery

Injury

Injury

Injury

J Am Coll Surg

Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study

J Bone Jt Surg Am Vol

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Lancet (London, England)

The epidemiology of hand injuries in The Netherlands and Denmark

Eur J Epidemiol

Interventions to prevent injuries in construction workers

Cochrane Database Syst Rev

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

PLoS Med

The level of evidence pyramid: indicating levels of evidence in Plastic and Reconstructive Surgery articles

Plast Reconstr Surg

Does disability correlate with impairment after hand injury?

Clin Orthop Relat Res

Review Paper
Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention