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Scientific/Clinical Article| Volume 24, ISSUE 4, P365-373, October 2011

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A Systematic Review of Rehabilitation Protocols after Surgical Repair of the Extensor Tendons in Zones V–VIII of the Hand

  • Author Footnotes
    1 First author.
    Mojib Sameem
    Footnotes
    1 First author.
    Affiliations
    Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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  • Author Footnotes
    1 First author.
    Thomas Wood
    Footnotes
    1 First author.
    Affiliations
    Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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  • Teegan Ignacy
    Affiliations
    Surgical Outcomes Research Centre, McMaster University, Hamilton, Ontario, Canada
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  • Achilleas Thoma
    Affiliations
    Division of Plastic and Reconstructive Surgery, McMaster University, Hamilton, Ontario, Canada
    Department of Surgery, McMaster University, Hamilton, Ontario, Canada
    Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    Surgical Outcomes Research Centre, McMaster University, Hamilton, Ontario, Canada
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  • Nick Strumas
    Correspondence
    Correspondence and reprint requests to Nick Strumas, MD, Division of Plastic and Reconstructive Surgery, McMaster Medical Centre 4E9, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5.
    Affiliations
    Division of Plastic and Reconstructive Surgery, McMaster University, Hamilton, Ontario, Canada
    Department of Surgery, McMaster University, Hamilton, Ontario, Canada
    Plastic and Reconstructive Surgery, McMaster University, Hamilton, Ontario, Canada
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  • Author Footnotes
    1 First author.
Published:September 02, 2011DOI:https://doi.org/10.1016/j.jht.2011.06.005

      Abstract

      Study Design

      Systematic review.

      Introduction

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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

      2.
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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
        • a.
          DASH
        • b.
          SIGN50 scale
        • c.
          ANOVA
        • d.
          ICC
      • #2.
        The primary outcome measure in assessing effectiveness of intervention was most often
        • a.
          patient satisfaction
        • b.
          PROM
        • c.
          AROM
        • d.
          TAM
      • #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
        • a.
          false
        • b.
          true
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.