Failure to Compensate: Patients With Nerve Injury Use Their Injured Dominant Hand, Even When Their Nondominant Is More Dexterous.
Benjamin A Philip, Madeline R Thompson, Nathan A Baune and 2 others
PMID 34728192WHAT IT FOUND
Most patients with dominant hand nerve injury continued using that hand, even when their non-dominant hand was more dexterous.
This suggests therapists should explicitly assess and train non-dominant hand use for patients whose dominant hand function is permanently impaired.
Key findings
01Patients with an injured dominant hand used it at a typical rate, despite the non-dominant hand often being more dexterous.
0277% of the right-handed participants with dominant hand injury had greater dexterity in their non-dominant hand.
03Compensation with the non-dominant hand was driven only by the severity of dominant hand dexterity loss, not by therapy or other factors.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was underpowered for its original hypothesis (n=48 vs planned 192) due to funding limits, though post-hoc analysis suggested the effect size was larger than expected. It was a cross-sectional design, so it could not determine if therapy caused changes or if patients simply did not change. The study was single-site, and therapists at that site reportedly did not emphasize compensation, which may explain the lack of therapy effect. The Block Building Task only measures precision reach-to-grasp, which may not reflect hand usage in all daily activities.
Declared interests
The authors declared no conflicts of interest. The study was supported by non-U.S. government and N.I.H. extramural grants.
The easy way to misread this
Do not conclude that therapy is ineffective because no association was found. The study was not designed to test therapy efficacy, the therapists did not emphasize compensation, and the cross-sectional design cannot prove causation.