Highlights
- •No tendon ruptures recorded when using a RME only approach (no wrist orthosis)
- •Additional orthoses should be individually tailored rather than protocol-based
- •RME only approaches - RME orthosis with or without an overnight WHFO yielded clinically similar results
Abstract
Study design
Multi--center randomized controlled trial with two intervention parallel groups. An
equivalence trial.
Introduction
Relative motion extension (RME) orthoses are widely used in the postoperative management
of finger extensor tendon repairs in zones V-VI. Variability in orthotic additions
to the RME only (without a wrist orthosis) approach has not been verified in clinical studies.
Purpose of the study
To examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields
clinically similar outcomes.
Methods
Thirty-two adult (>18 years) participants (25 males, 7 females) were randomized to
one of two intervention groups receiving either 1) a relative motion extension orthosis
for day wear and an overnight wrist-hand-finger orthosis ('RME Day' group), or 2)
a relative motion extension orthosis to be worn continuously ('RME 24-Hr' group);
both groups for a period of four postoperative weeks.
Results
Using a series of linear mixed models we found no differences between the intervention
groups for the primary (ROM including TAM, TAM as a percentage of the contralateral
side [%TAM], and Millers Criteria) and secondary outcome measures of grip strength,
QuickDASH and PRWHE scores. The models did identify several covariates that are correlated
with outcome measures. The covariate ‘Age’ influenced TAM (P = .006) and %TAM (P = .007), with increasing age correlating with less TAM and recovery of TAM compared
to the contralateral digit. 'Sex' and 'Contralateral TAM' are also significant covariates
for some outcomes.
Discussion
With similar outcomes between both intervention groups, the decision to include an
additional night orthosis should be individually tailored for patients rather than
protocol-based. As the covariates of ‘Age’ and ‘Sex’ influenced outcomes, these should
be considered in clinical practice.
Conclusions
A relative motion extension only approach with or without an additional overnight wrist-hand-finger orthosis yielded
clinically similar results whilst allowing early functional hand use, without tendon
rupture.
Keywords
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Article info
Publication history
Published online: June 24, 2021
Accepted:
June 18,
2021
Received in revised form:
February 28,
2021
Received:
November 1,
2020
Publication stage
In Press Corrected ProofFootnotes
Conflict of interest: No Conflicts of Interest Declared.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
