Journal Article

A randomized clinical trial comparing early active motion programs: Earlier hand function, TAM, and orthotic satisfaction with a relative motion extension program for zones V and VI extensor tendon repairs

Foster, Michael, Ellis, Richard F., Myhr, Heidi, Wang, Amy, Kelly, Edel, Collocott, Shirley J.F.

2020

Overview

Randomized clinical trial with parallel groups. Early active mobilization programs are used after zones V and VI extensor tendon repairs; two programs used are relative motion extension (RME) orthosis and controlled active motion (CAM). Although no comparative studies exist, use of the RME orthosis has been reported to support earlier hand function. This randomized clinical trial investigated whether patients managed with an RME program would recover hand function earlier postoperatively than those managed with a CAM program. Forty-two participants with zones V-VI extensor tendon repairs were randomized into either a CAM or RME program. The Sollerman Hand Function Test (SHFT) was the primary outcome measure of hand function. Days to return to work, QuickDASH (Disabilities of Arm, Shoulder and Hand) questionnaire, total active motion (TAM), grip strength, and patient satisfaction were the secondary measures of outcome. The RME group demonstrated better results at four weeks for the SHFT score (P = .0073; 95% CI: −10.9, −1.8), QuickDASH score (P = .05; 95% CI: −0.05, 19.5), and TAM (P = .008; 95% CI: −65.4, −10.6). Days to return to work were similar between groups (P = .77; 95% CI: −28.1, 36.1). RME participants were more satisfied with the orthosis (P < .0001; 95% CI: 3.5, 8.4). No tendon ruptures occurred. Participants managed using an RME program, and RME finger orthosis demonstrated significantly better early hand function, TAM, and orthosis satisfaction than those managed by the CAM program using a static wrist-hand-finger orthosis. This is likely due to the less restrictive design of the RME orthosis. The RME program supports safe earlier recovery of hand function and motion when compared to a CAM program following repair of zones V and VI extensor tendons. •This randomized clinical trial compared relative motion extension to controlled active motion.•A relative motion extension program enabled earlier return to hand function.•Patients were more satisfied with a relative motion extension finger orthosis.•A relative motion extension program did not result in earlier return to work.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Active control / Adult / Arm / Clinical trials / Comparative studies / Controlled active motion / Disabilities / Disability / Early active motion / Ethics / Exercise Therapy - methods / Extensor tendon rehabilitation / Female / Function / Grip strength / Hand / Hand Injuries - physiopathology / Hand Injuries - rehabilitation / Hand Injuries - surgery / Hand Strength / Humans / Male / Middle Aged / Orthoses / Orthosis / Orthotic Devices / Patient Satisfaction / Questionnaires / Range of Motion, Articular - physiology / Recovery of Function / Relative motion extension / Satisfaction / Tendon Injuries - physiopathology / Tendon Injuries - rehabilitation / Tendon Injuries - surgery / Tendons / Therapy / Time Factors / Treatment Outcome / Wrist / Young Adult