Version 4 of 20 December 2022
|Important. Read these instructions carefully before use.
Keep for future use.
José Galán Merino St. 6
Module 7. 41015
|ReHand is a class I medical device.
The following information is protected in accordance with the Intellectual Property Law.
Instructions for use for professionals ReHand
Revision Level: version 4
Revision Date: December 20th 2022
MEDICAL PURPOSE: ReHand is a therapeutic exercise programme for the wrist-hand-finger segment conditions, either traumatic, orthopaedic or neurological pathology. These exercises are performed directly on a tablet device, through movements and exercises performed while touching the Tablet touchscreen. ReHand is based on the latest scientific evidence about home exercise and the sensorimotor system approach, providing a therapeutic exercise programme monitored by the healthcare professional. The programme is continuously adapted to the patient depending on their condition and the evolution of their performance.
Before use, a trained healthcare professional should have confirmed that ReHand is right for you and your specific health situation.
ReHand offers structured therapy for patients with wrist-hand-finger segment conditions, either traumatic, orthopaedic or neurological pathology. The application has no measuring, diagnostic or therapeutic decision-making functions and therefore corresponds to a Class I medical device according to the Medical Device Regulation (Annex VIII, Chapter III, classification rules 6.3, Rule 11).
These instructions are intended to help the healthcare professional -hereinafter referred to as the health professional or prescriber- to start the prescription, treatment and monitoring with ReHand. Likewise, the app presents explanatory videos at the beginning of each exercise and audio instructions, so we recommend using the app with the volume of the Tablet device turned on and watching the videos before performing each exercise. In case your doubts are not solved with this document, please contact us at [email protected].
WARNING: Read these instructions carefully before using ReHand. To prevent its misuse, it is necessary to obtain a prescription from a healthcare professional so the exercise program can be properly adapted to the patient’s condition and monitored.
ReHand programme can be carried out remotely at home or face-to-face in-room , with or without the direct supervision of a healthcare professional, but always under their indication and prescription.
1. The concept of ReHand
ReHand is composed of two systems: REHAND APP is the tool used by the patient and REHAND DASHBOARD is the one used by the healthcare professional.
ReHand is a therapeutic exercise programme for wrist-hand-finger segment trauma, orthopaedic or neurological conditions.
ReHand complements conventional therapies, e.g. pharmacotherapy, physiotherapy, occupational therapy or hand therapy. For example, ReHand can be used to reduce waiting time before the start of face-to-face (either in the clinic or at home as a complement to face-to-face therapy), or to continue the treatment after the end of face-to-face therapy.
WARNING: We advise you to tell your patient that if he/she feels pain or excessive fatigue while performing the exercises or after the use of ReHand, stop the exercise and consult you.
The specific exercises of the programme for each patient are prescribed by their healthcare professional. These exercises are performed directly by touching and tapping the touch screen of a tablet device. This enables: the continuous adaptation of the exercises to the evolution of the patient’s abilities, the integration of a multisensory perspective in the exercise, and finally, to have an additional option for the visualisation of the patient’s exercise performance. The exercises contain video, audio and text instructions.
ReHand provides the patient with graphical data about their performance in their therapy and their adherence rate, including motivational messages for the patient in order to achieve optimal adherence levels. In addition, ReHand allows the patient to fill in the clinical questionnaires and scales that their healthcare professional has set up for them.
Progress reports can be downloaded both by the patient from the ReHand app and by the clinician from the ReHand Dashboard.The ReHand programme can be performed at home or in the clinic, with or without the direct supervision of a doctor, physiotherapist or therapist. Unless otherwise instructed by a healthcare professional, the ReHand exercises must be performed daily, at least three days a week. The daily execution time of the exercise programme is usually between 20-30 minutes (time per therapy unit). The duration of use depends on the type of condition and is therefore determined by the health care professional, but the duration of use is usually a maximum of 3 months.
Therapeutic exercise is the core of ReHand’s action, which also seeks to integrate the sensorimotor system approach through multisensory feedback to achieve an effect not only peripherally on the injured tissue, but also at the level of the central nervous system. Furthermore, the continuous adaptation of each of the exercises to the patient’s capabilities allows, on the one hand, to include a challenging and motivating component in the execution of the therapeutic exercise and, on the other hand, that the exercise is continuously adapted to the patient’s capabilities at each moment of his or her recovery.
ReHand, by providing the patient with a therapeutic exercise programme, falls within the guidelines and updated scientific evidence for the treatment of these disorders, with a multitude of clinical trials demonstrating the positive effect of therapeutic exercise programmes on these disorders. Thus, ReHand’s exercises have been designed following this evidence, and have undergone previous clinical trials, demonstrating their effectiveness.
ReHand Dashboard consists of a web dashboard for the healthcare professional whose functionalities allow the prescription of the exercise programme, the organisation of their patients and their follow-up. It has a therapeutic exercise programme generator where healthcare professionals configure the programme for patients according to their condition and give them access to ReHand, allowing patients to access their specific programme in the app. In addition, ReHand Dashboard has a monitoring system that allows the healthcare professional to track the patient’s progress and exercise performance.
2. Intended Use
The indication for ReHand is wrist-hand-finger conditions in patients over 18 years old. The scope of the indication includes:
1. HAND, WRIST AND CARPAL FRACTURES
2. ELBOW PATHOLOGY
3. NERVE PATHOLOGY
4. SOFT TISSUE PATHOLOGY
5. DISLOCATIONS, CONTUSIONS ANS SPRAINS
6. RHEUMATIC PATHOLOGY
7. NEUROVEGETATIVE PATHOLOGY
9. WOUNDS AND BURNS
10. NEUROLOGICAL PATHOLOGY
According to the results of the clinical trials conducted and the existing scientific evidence, its use would preliminarily lead to an early improvement in clinical variables such as functional ability, dexterity or strength. It has also shown improvements in other related variables, such as early return to work and fewer physiotherapy, rehabilitation or surgery consultations.
WARNING: The exercise programmes provided by the ReHand app should only be performed in a safe and suitable environment.
3. Technical requirements for use and contraindications
3.1 Technical requirements of the app
In order to access the contents and resources of the Platform and all its new features, we recommend using updated browsers and operating systems. ReHand app must be used on a tablet device with an operating system equal to or higher than Android 6.0.1 and equal to or higher than iOS 14.0. Dashboard must be used on devices with a stable internet connection and sufficient capacity to support browsers above the following versions: Chrome 80, Edge 80, iOS Safari 14 or Chrome Android 80; and on browser versions above the previous ones.
If you use Chrome, Edge, or iOS Safari, as browsers it is very important that you update them to their latest version. We cannot ensure proper operation of the Platform if they are not up to date. You may experience problems if you access from an outdated version of your browser.
ReHand app must be used on a tablet device with a screen larger than 7” and a stable Internet connection in order not to limit the functionalities of the application.
In order to keep all functionalities and security systems of the ReHand app in optimal condition, the user must update the application whenever it is offered. The application requires enough storage space to function correctly.
ReHand app should not be used if any of the following contraindications exist, unless the prescriber´s clinical judgement recommends an exercise programme such as those included in ReHand app, either at-home autonomously or face-to-face supervised.
The use of ReHand is not recommended for the following diagnoses (contraindications according to ICD-10):
M00 Pyogenic arthritis;
M01 Direct infections of joint in infectious and parasitic diseases classified elsewhere;
M02 Postinfective and reactive arthropathies;
C41.9 Malignant neoplasm of bone and articular cartilage, unspecified;
C71 Malignant neoplasm of brain;
C79.4 Secondary malignant neoplasm of other and unspecified parts of nervous system;
C79.5 Secondary malignant neoplasm of bone and bone marrow;
C79.9 Secondary malignant neoplasm of unspecified site;
D68 Other coagulation defects;
I80 Phlebitis and thrombophlebitis;
H54.0 Blindness, both eyes
Acute inflammation or fever
Do not use ReHand app if you have acute inflammation or fever, such as rheumatic fever, sepsis, bacterial infections or purulent arthritis.
Severe or acute disease of the cardiovascular system
Do not use ReHand app if you have a serious or acute disease of the cardiovascular system such as acute myocardial infarction, acute ischaemic heart disease, high blood pressure with heart failure or hypertensive crisis.
Lung or respiratory tract disease
Do not use ReHand app if you have a lung or respiratory tract disease such as pneumonia or pulmonary embolism.
Do not use ReHand app if you have a tumour disease such as malignant neoplasm of bone, articular cartilage or internal organs.
Bleeding tendency, history of increased bleeding or use of anticoagulant medication
Do not use ReHand app if you have a bleeding tendency, a history of increased bleeding or if you are using anticoagulant medication.
Psychiatric or cognitive conditions
Do not use ReHand app if you have psychiatric or cognitive conditions or are undergoing treatment, such as psychosis.
Severe visual impairment
Do not use ReHand app if you have severe visual impairment or blindness.
Complete lack of voluntary motor activity in the shoulder abductor and finger extensor muscles
Do not use ReHand app if you have a complete lack of voluntary motor activity (against gravity) in the shoulder abductor and finger extensor muscles.
High levels of spasticity of the wrist, hand or fingers
Do not use ReHand app if you have a high level of spasticity that prevents autonomous control of active wrist, hand or finger movements.
High baseline pain levels
Do not use ReHand app if you have high levels of baseline pain.
Severe neuropathic pain not controlled with pharmacological treatment
Do not use ReHand app if you have severe neuropathic pain that is not controlled with pharmacological treatment.
Other conditions not listed here may also be unsuitable for the exercise programmes included in the ReHand app. Therefore, before use, prescribers should clarify whether the exercises used in the ReHand app exercise programmes can be performed safely. If not, a contraindication exists.
If the disease has not stabilised with medical treatment, the prescriber should determine the best time to start the exercise programme.
ReHand is not barrier-free and is not suitable for visually impaired users.
4. Important safety instructions and serious incidents
4.1 Important safety instructions
WARNING: To avoid potential harm, both the prescriber and the patient must read and follow at all times the instructions provided by ReHand in this document.
WARNING: Before starting an exercise, the exercise instructions on video and in written form must be followed carefully at all times. They include essential information to perform the exercise correctly. If doubts still exist, the exercise should be stopped and consulted with the prescriber in charge.
WARNING: The therapist should guide the patient through the exercises in order to adapt the ReHand therapy to the range of motion, tolerance and speed according to the state of recovery.
WARNING: The patient must at all times answer honestly the scales and questionnaires received within the ReHand app.
WARNING: Never share your ReHand account with others. Failure to do so could lead to problems.
4.2 Reporting serious incidents
Any serious incident involving ReHand (damage, injury, etc.) should be reported to us by writing directly to [email protected] and to the competent authority in the member state where you are established.
5. Initial setup
5.1 ReHand Dashboard
Once the initial account setup is complete, you will be able to use the ReHand Dashboard.
5.2 ReHand app
Once the initial account setup is complete, your patient will be able to use the ReHand app.
6. ReHand Systems
ReHand consists of two modules. Firstly, ReHand app is an application (Android and iOS) for Tablet devices, used by patients to perform therapeutic exercise through movements by touching the touch screen, previously adapted to each patient according to their condition, the time of recovery and the physiognomy of the hand. On the other hand, ReHand Dashboard is a Dashboard that allows the healthcare professional to: 1) prescribe specific exercise programmes to their patients, and; 2) organise and monitor them through clinical questionnaires.
The functionalities of both modules are described below.
6.1 Prescription System (ReHand Dashboard)
6.1.1 Access to ReHand Dashboard
When starting a treatment with a patient, it is necessary to first make the patient’s prescription to ReHand. To do this, the Dashboard can be accessed from a smartphone, tablet or computer through the following link: https://rehand.net/dashboard (the following link is outside the trusted domain).
6.1.2 Programme generation
Once you access the Dashboard, click on the “+ button” in the lower right corner of the screen. To generate a new exercise programme, click on “New patient”.
Once clicked, you will be taken to a screen where you can choose which exercise programme to include, which hand is to be treated, and select whether the patient has a tablet or not.
By clicking on any of the hands, a list of all available exercise programmes will appear. You can select multiple programmes if required by the patient.
When you accept the steps and confirm your selection, you will be taken to a screen where the exercises included in the exercise and dosage programme will be displayed. You can edit the programme if you wish.
Once you have confirmed the exercises included in the exercise programme, the generation process is finished. This has resulted in an access code, which allows access to the ReHand app for the first time.
6.1.3 Code submission
The healthcare professional can email the code to the patient by clicking the ¨Send access to my patient” button.
6.2 Treatment System (ReHand app)
6.2.1 Initial instructions
Once the patient is registered in the application, the following “Program” page appears:
A pop-up appears with a warning of a new initial scale that can be found in the “Scales” section.
An information icon is also available on the top left of the “Program” menu. When you click on it, the initial instructions are shown. They will be displayed as you click on the ‘next arrow’ button.
At the top of the “Program” page there is a button to select the hand you wish to view the programmed exercises for. If no exercise card appears on the screen, this means there is no exercise configured for that selected hand.
Each exercise is represented by a card where the type of exercise and hand to be treated is reflected in an image. The name of the exercise appears immediately below, followed by the finger/area.
To keep track of the repetitions made during the day, the crosses represent the number of daily repetitions to be made. As each repetition is performed, each cross changes to a blue tick.
Each blue circle represents the level of the exercise you are in. Therefore, as exercises with a good score are performed, the level of the exercise increases. On the other hand, if exercises with a low score are performed, the level decreases.
To level up in the exercises, it is necessary to achieve a score greater than 90 for each repetition as the speed bar increases.
Finally, we recommend activating the sound while using the application. If the patient has any doubts or problems, we recommend consulting the “FAQs (Frequently Asked Questions)” section by clicking on the ‘Account’ button or to write to us at [email protected].
Furthermore, before carrying out the exercise, the following instructions are given, complementing the text with audio messages for execution.
A. START OF ADJUSTMENT
When clicking on an exercise card, the patient accesses the exercise and is given instructions on how to adjust the position. Before starting the adjustment, the patient is also given the opportunity to watch a video explaining the procedure.
B. EXPLANATORY VIDEO
The correct way to perform the adjustment and the exercise is described in the explanatory video.
C. POSITION ADJUSTMENT I
During the first adjustment, a gif explaining the patient how to adjust the position is displayed.
D. POSITION ADJUSTMENT II
In this first step, a position adjustment is performed. The patient has to place a certain hand-finger segment on the tablet screen so that this position is recorded.
E. MOVEMENT ADJUSTMENT GIF
During the second adjustment, a gif explaining the patient how to make the movement adjustment is displayed.
F. MOVEMENT ADJUSTMENT
In this second step a movement adjustment is made. The patient must perform three times the movement of the exercise in a non-painful parameter. This non-pain range, optimal for the execution of the exercise, is recorded, and will be used later for the execution of the exercise.
G. EXERCISE EXECUTION
The exercise is carried out by moving or tapping on the screen, in the range configured by the movement adjustment. The exercise is timed and a performance score is reported based on how well the exercise was performed.
H. EXERCISE RESULT
At the end of the exercise, the patient is informed of the score obtained in the exercise.
6.2.3 Activity and Progress Display
Clicking on the “Progress” icon shows the page of the work carried out, where all the exercises performed are represented in a progress chart over time and each colour block corresponds to one of those exercises. Clicking on the blocks displays the name of each exercise, the hand related to it, the number of repetitions performed, and a dashed line at the top, representing the number of daily repetitions expected throughout the treatment.
The percentage of adherence is calculated from the number of expected and performed repetitions, and shown next to the feedback messages of the application itself.
Clicking on the “Scales” button displays the screen with the scales and questionnaires available for completion. Initially you should select your dominant hand.
Once selected, you can answer the corresponding scale by clicking on the option that best represents your state.
By clicking on the “Account” button, the screen with the “Settings”, “FAQs” and “Video tutorials” sections will be displayed. In addition, you will be able to access the legal documents and the instructions for use.
By clicking on the “Settings” button, the patient can perform actions such as changing the current password, changing the language or adjusting the size of the exercise circles.
By clicking on the “FAQs” button, you will be shown a list of the most frequent situations that may cause questions during the use of the ReHand app. By clicking on each of the headings, you will be able to view the content.
C. Explanatory videos
By clicking on the “Explanatory videos” button, buttons with access to the explanatory videos will be displayed.
6.3 Monitoring System (ReHand Dashboard)
Finally, while treated with the ReHand App, the patient is monitored by the healthcare professional through the Dashboard, where graphs, questionnaires and the patient progress is displayed.
Patient follow-up can also be monitored through the generation of reports, where this data is summarised. These reports are generated from the Dashboard by the healthcare professional.
To generate the report, click on the “+ button” in the bottom right corner of the screen and then click on “Generate reports”.
A sample report is available here: