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Instructions for use ReHand 1.0
Revision Level: version 3
Revision Date: October 23rd 2020
Welcome to ReHand!
Before starting with the Instructions for Use, we welcome you to ReHand. ReHand is the result of the teamwork of professionals from different specialities (hand surgeons, physiotherapists, engineers, doctors, occupational therapists…) which will allow you to carry out the treatment prescribed by your healthcare professional and, at the same time, inform him/her of your performance and evolution.
These instructions are intended to assist the user in starting their treatment with ReHand. The app also includes explanatory videos at the beginning of each exercise and audio instructions, so we recommend that you use the app with the volume of your tablet turned on and watch 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 the app. To prevent its misuse, it is necessary to obtain a prescription from a health professional so the exercise program can be properly adapted to your pathology and your evolution can be monitored.
1. The concept of ReHand
REHAND APP is a rehabilitation app for the wrist, hand and finger segment that includes a battery of exercises that address the recovery of different functionalities of this segment, through a series of routes on the touchscreen of tablet devices. These routes through the screen are guided by circles, each one with a colour depending on the finger that makes contact with the screen. Prior to each exercise, there is a double adjustment that allows the exercise to be adapted to the size of the hand and to patient´s limitation.
WARNING: If you feel pain or excessive fatigue while performing the exercises or after using ReHand, stop the exercise and consult your healthcare professional.
Likewise, these exercises have a gamification system that makes the difficulty of the exercises increase as the patient obtains better scores when performing the exercises, increasing the speed of the exercises and decreasing the size of the circles. The exercises adapted to the limitation of each patient have been designed in accordance with current scientific evidence regarding the improvement of the functional limitation of the hand.
ReHand also has a page of questionnaires and scales, where the patient periodically receives a series of questionnaires and scales relating to parameters such as functional ability or pain and which allow an objective assessment of the patient’s evolution. In addition, ReHand has a progress page on which statistics and graphs of patient adherence/performance are displayed and messages are given based on these, allowing patient motivation and generating continuous feedback on their evolution. At the same time, these statistics are sent to the therapist, so that the professional can periodically monitor the evolution and performance of his/her patient from a distance.
2. Intended Use
ReHand´s indications are traumatic and orthopaedic hand-wrist-finger pathology.
1.- WRIST AND CARPAL FRACTURES.
2.- METACARPAL AND PHALANGES BONES FRACTURES.
3.- NERVE PATHOLOGY.
4.- NON-SURGICAL OPERATED SOFT TISSUE PATHOLOGY.
5.- SOFT TISSUE SURGERY.
6.- ELBOW PATHOLOGY.
7.- DISLOCATIONS, CONTUSIONS, SPRAINS IN THE WRIST, HAND AND FINGERS.
8.- POST-SURGICAL REHABILITATION.
9.- NEUROVEGETATIVE PATHOLOGY.
10.- RHEUMATIC PATHOLOGY.
Do not use the ReHand digital tool in the following cases:
— Any circumstance in which the exercise implies the interruption of the tissue healing process. Symptoms such as increased pain, erroneous movements, swelling or flushing, will be a determining factor in the interruption of the therapy.
— Presence of severe muscular or joint pain during the execution of your program or that is maintained beyond 24 hours after its execution.
— Acute infectious and inflammatory processes in the wrist-hand-finger segment undergoing therapy.
— Haematomas or other signs of traumatism appearance in the wrist-hand-fingers segment undergoing therapy.
— Presence of coagulopathies or circulatory disorders that have not been controlled by medical treatment.
— Presence of a tumor or history of unexplained weight loss, excessive night sweating, unexplained fatigue and/or pain that does not vary in any position, as long as it has not been controlled with medical treatment.
— Physical disability that compromises patient safety.
— Serious psychiatric disorders.
Do not use the ReHand digital tool in the cases set out above unless the patient has undergone a prior medical examination which concludes that, given the existence of any of them, a specific treatment is required.
The therapist must guide the patient in the performance of the exercises in order to adapt the ReHand therapy to the range of movement, tolerance and speed in accordance with the state of recovery.
WARNING: Supervised therapy (with the addition of ReHand practice in consultation or at home) may be necessary in the following cases, according to the clinical judgement of the prescribing health professional:
— Moderate median nerve compression
— Carpal Tunnel Syndrome
— Moderate radial nerve compression
— Complex regional pain syndrome (abnormal pain, stiffness, vasomotor symptoms)
— Ulnar nerve compression
— Carpal instability/subluxation
— Moderate adhesion formation or tendon scar
— Moderate tendon rupture
— Moderate tendinopathy
— Moderate trigger finger
— Age over 65
WARNING: Use ReHand responsibly. Use it only when you understand and master the program´s terminology.
4. Daily Program
1) Initial Instructions
Initially, once the user registers in the application, the following ‘Home’ page appears:
A pop-up will then automatically appear with a general video explaining how the application works, which can be found at the following link: https://youtu.be/aZiFc-81-5s
This video, which will no longer appear automatically, can be watched again in the ‘Account’ section along with the other videos explaining the exercises.
— Always follow the instructions given by ReHand and answer honestly the questionnaires received to improve your recovery.
— Never share your ReHand account with others.
— Update your application when a new version is released, updates may contain security enhancements.
— Do not use ReHand on devices lower than 4.4.4 on Android or 9.3 on iOS as it may affect the operation and performance of the application.
Afterwards, 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 ‘Home’ menu. When you click on it, the initial instructions are indicated, which follow one another as you click on the ‘next arrow’ button.
At the top of the ‘Home’ page there is a button to select the hand from which you wish to view the programmed exercises. If no exercise card appears on the screen, it is because there are no exercises configured for that selected hand.
Each exercise is represented by a card where the type 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 green tick.
Each red circle represents the level of the exercise you are in. Therefore, as you perform exercises with a good score, the level of the exercise increases. On the other hand, if you do the exercises with a low score, the level decreases.
To level up in the exercises, it is necessary to complete the speed bar, achieving a score greater than 90 in each repetition.
Finally, we recommend that you activate the sound while using the application. If you have any doubts or problems, please consult the ‘Typical errors’ section by clicking on the ‘Account’ button.
Furthermore, before carrying out the exercise, the following instructions are given, complementing the text with audio messages for execution.
1. START OF ADJUSTEMENT
When you click on an exercise card, you enter it and are given instructions on how to adjust the position. Before starting the adjustment, the patient is given the opportunity to watch a video explaining the procedure.
2. EXPLANATORY VIDEO
The correct way to perform the adjustment and the exercise is described in the explanatory video.
3. POSITION ADJUSTMENT
In the first adjustment, a gif is displayed that tells the patient how to adjust the position.
4. POSITION ADJUSTMENT II
In this first step, a position adjustment is performed, where the patient places a certain hand-finger segment on the tablet screen and this position is stored.
5. MOVEMENT ADJUSTEMENT GIF
In the second adjustment, a gif is displayed that tells the patient how to make the movement adjustment.
6. MOVEMENT ADJUSTMENT
In this second step a movement adjustment is made, where 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 stored, and will be used for the execution of the exercise.
7. 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.
8. EXERCISE RESULT
At the end of the exercise, the patient is informed of the score obtained in the exercise.
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 referring to it, the number of repetitions performed, and a dashed line at the top with the number of daily repetitions expected throughout the treatment.
From the number of expected and performed repetitions, the percentage of adherence is calculated and shown next to the feedback messages of the application itself.
5. Manufacturer´s data