Introduction Allodynia is a type of neuropathic pain defined as pain due to a stimulus which does not normally provoke pain. There is little research and conflicting advice. The purpose of this thesis is to provide a summary of the current state of hand therapy knowledge. To accomplish this, a review of the hand therapy literature related to allodynia was conducted, along with the collection of expert opinion utilizing the Delphi survey technique. Methods International hand therapy experts were invited to participate in a classical Delphi study. Mixed methods were used to summarize each round and inform any subsequent questioning. Thematic analysis was used to look for patterns of meaning within the written responses. A consensus level of 75% was decided upon a priori for all final recommendations. Results Forty-three hand therapists from 15 countries contributed to the fourth and final round. Through the consensus process definitions related to allodynia, and assessments and treatments for allodynia, were explored and recommendations generated. Two themes were identified 1) assessment and treatment decisions depend on the client’s presumed underlying mechanisms contributing to the allodynia as well as psychosocial and functional status, and 2) whether the area of allodynia should be touched or not. Discussion and conclusions The literature and our survey results are mixed on whether it is beneficial to touch an area of allodynia. Other aspects related to allodynia such as functional or psychosocial impact are rarely addressed in the literature but were highlighted in our survey. This thesis contributes to the knowledge by presenting: 1) a summary of the current literature, 2) a new consensus definition of hypersensitivity, 3) experts’ recommendations for assessment and treatment of allodynia of the hand and factors to consider when utilizing these, and 4) recommendations for future research, practice, and education. / Thesis / Master of Science Rehabilitation Science (MSc) / Allodynia is when pain is caused by something that would normally not be painful such as a light touch or mild temperatures. It occurs when nerves become overly sensitive, and if this happens in the hand, it can limit how people use their hand and cause distress. There is little research to guide therapists and conflicting advice in textbooks on how to treat this. To help fill this gap, we conducted four online surveys with hand therapy experts. We found that expert therapists recommended assessments and treatments that look at how the person with allodynia is functioning and managing the pain. However, they disagreed on whether the painful area should be touched or not. This is important as it influences the advice given to clients and how treatment is delivered. More research is needed to compare approaches and to figure out what factors may influence how people with allodynia may respond to different treatments.

Introduction: Les neuropathies focales (NF) peuvent entraîner de l’hypoesthésie tactile et de la douleur neuropathique spontanée (névralgie). La méthode de rééducation sensitive de la douleur décrite par Spicher et collaborateurs (MRSD) propose un traitement innovant des symptômes sensitifs des NF. Objectifs : Chez des patients présentant une hypoesthésie tactile et de la névralgie à la main découlant d’une NF : 1) Décrire l’utilisation de la MRSD, 2) Vérifier son applicabilité, 3) Vérifier s’il y a une corrélation entre la durée requise de traitement et les caractéristiques cliniques initiales (hypoesthésie tactile, intensité douleur) des patients. 4) Décrire les changements dans l’hypoesthésie tactile et la douleur suite à la MRSD, et 5) Vérifier s’il y a une corrélation entre ces changements de sensibilité tactile et de la douleur. Méthodologie: Une étude par série de cas rétrospective a été effectuée à partir des données de patients collectées au Centre de Rééducation Sensitive de Fribourg (Suisse) entre juillet 2004 et Octobre 2018. Résultats: Sur 58 patients inclus dans l’étude, 42 ont complété la MRSD avec une durée requise moyenne de traitement de 124 ±104 jours. Cette durée de traitement était corrélée (rSpearman=.395) avec la sévérité des symptômes sensitifs (hypoesthésie tactile, douleur) avant la thérapie. On observe une diminution importante (p<.001) de l’hypoesthésie tactile et de la douleur entre le début et la fin du traitement. La diminution de l’hypoesthésie était modérément corrélée (rSpearman=.336) avec la diminution de la douleur. Conclusion: La MRSD est applicable au traitement de l’hypoesthésie tactile avec névralgie à la main découlant d’une NF. / Introduction: Focal neuropathies (FN) can lead to tactile hypoesthesia and spontaneous neuropathic pain (neuralgia). The Somatosensory Rehabilitation Method described by Spicher and collaborators (SRM) proposes an innovative approach to treating sensory symptoms in patients with FN. Objectives: In patients with tactile hypoesthesia and hand neuralgia arising from FN: 1) Describe the use of SRM, 2) Verify its applicability, 3) Determine if there is a correlation between the duration of treatment and patients’ clinical characteristics (tactile sensitivity and pain intensity) before therapy. 4) Describe changes in tactile hypoesthesia and pain measures subsequent to treatment with SRM, and 5) Determine if there is a correlation between changes in tactile sensitivity and changes in pain intensity in patients treated with SRM. Methodology: A retrospective case series study was carried out using data from patients admitted to the Somatosensory Rehabilitation Centre of Fribourg (Switzerland) from July 2004 and October 2018. Results: Of 58 patients included in the study, 42 completed SRM until the end of the therapy with an average duration of treatment of 124 ± 104 days. The duration of treatment was moderately correlated (rSpearman= 0.395) with the severity of sensory symptoms (tactile hypoesthesia and pain intensity) before therapy. There was a significant decrease (p <.001) in tactile hypoesthesia and pain intensity between the beginning and the end of treatment. The decrease in tactile hypoesthesia was moderately correlated (rSpearman=0 .336) with the decrease in pain. Conclusion: SRM can be used for treating tactile hypoesthesia and hand neuralgia arising from FN.