Scientific/Clinical Article| Volume 33, ISSUE 1, P13-24, January 2020

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

Published:March 21, 2019DOI:


      • 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.


      Study Design

      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.

      Purpose of the Study

      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.


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      JHT Read for Credit

      Quiz: # 651

      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 There is only one best answer for each question.
      • #1.
        The study design was
        • a.
          retrospective cohort
        • b.
        • c.
        • d.
          case series
      • #2.
        The critical outcome for comparison was
        • a.
          lesser extensor lag
        • b.
          greater PROM and AROM
        • c.
          grip strength
        • d.
          earlier recovery of hand function
      • #3.
        The two groups compared were
        • a.
          matched by age
        • b.
          an experimental group and a control group
        • c.
          CAM and RME treated patients
        • d.
          real patients vs. sham patients
      • #4.
        The primary outcome measure was the
        • a.
        • b.
        • c.
          Purdue Peg Board Test
        • d.
          Moberg Pick Up Test
      • #5.
        Patients managed with the orthotic program showed better results
        • a.
        • b.
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