Eligibility criteria

Experimental study designs (randomised controlled trials [RCTs]), quasi-experimental, cohort studies and case–control studies from January 2008 to September 2018, with a language restriction of English, were included. Studies undertaken before 2008 were not included because a literature review had been performed up to 2008 (Toemen & Midgley 2010). Eligible studies met the following inclusion criteria: adult human participants older than 20 years and younger than 59 years of age. Those younger than 20 years were not included because of skeletal immaturity (De Sanctis et al. 2014), and very few individuals sustain metacarpal fractures after the age of 59; thus, no participants older than 59 years were included (Nakashian et al. 2012). Studies that report on post-surgical and conservative hand rehabilitation interventions include functional and/or non-functional exercises, other hand rehabilitation modalities/treatments/exercises and home education (could include advice, home education and home exercises [HEs]). Studies measuring outcomes which included, but were not limited to, hand function, health-related quality of life, disability, digital range of motion (ROM), grip strength and fine motor dexterity were included. Studies investigating thumb metacarpal fractures, associated tendon injury, infections, nerve injury or pre-existing osteoarthritis or rheumatoid arthritis were excluded, as were studies investigating second to fifth metacarpal fractures with a concurrent fracture of the phalangeal bones, carpal bones, distal radius and ulna.

A comparison was made according to the fracture site and amongst the varieties of hand rehabilitation programmes used: hand therapy modalities, exercises, immobilisation and home education, after surgical and conservative management. All control-intervention forms were included, and no limitations were applied.