Controversy exists as to which rehabilitation protocol provides the best outcomes for patients after surgical repair of the extensor tendons of the hand.
Purpose of the Study
To determine which rehabilitation protocol yields the best outcomes with respect to range of motion and grip strength in extensor zones V–VIII of the hand.
A comprehensive literature review and assessment was undertaken by two independent reviewers. Methodological quality of randomized controlled trials and cohort studies was assessed using the Scottish Intercollegiate Guidelines Network scale.
Seventeen articles were included in the final analysis (κ=0.9). From this total, seven evaluated static splinting, 12 evaluated dynamic splinting, and four evaluated early active splinting. Static splinting yielded “excellent/good” results ranging from 63% (minimum) to 100% (maximum) on the total active motion (TAM) classification scheme and TAM ranging from 185° (minimum) to 258° (maximum) across zones V–VIII. Dynamic splinting studies demonstrated a percentage of “excellent/good” results ranging from 81% (minimum) and 100% (maximum) and TAM ranging from 214° (minimum) and 261° (maximum). Early active splinting studies showed “excellent/good” results ranging from 81% (minimum) and 100% (maximum). Only one study evaluated TAM in zones V–VIII, which ranged from 160° (minimum) and 165° (maximum) when using two different early active modalities.
The available level 3 evidence suggests better outcomes when using dynamic splinting over static splinting. Additional studies comparing dynamic and early active motion protocols are required before a conclusive recommendation can be made.
Level of Evidence
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JHT Read for Credit
Quiz: Article #207
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.Methodological quality of papers under review was assessed using the
- b.SIGN50 scale
- #2.The primary outcome measure in assessing effectiveness of intervention was most often
- a.patient satisfaction
- #3.The results support the use of
- a.cast immobilization for 4 weeks
- b.early AROM over both dynamic and static splints
- c.dynamic splints over static splints
- d.static splints over dynamic splints
- #4.An important limitation of the study was the
- a.research was not carried out by a CHT
- b.small sample size
- c.research was conducted outside the US
- d.technique of measuring outcomes was not reliable
- #5.This study revealed a clear difference in outcomes comparing early active motion and dynamic splinting protocols
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: September 02, 2011
Competing interests: none.
© 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.