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Leong LX, Chai SC, Howell JW, Mohd Rasdi HF, Abdul Rahman NR. Relative motion splints versus metacarpophalangeal joint blocking splints in the management of trigger finger: Study protocol for a randomized comparative trial. PLoS One 2024; 19:e0307033. [PMID: 39137205 PMCID: PMC11321552 DOI: 10.1371/journal.pone.0307033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 05/15/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Evidence supports the use of hand-based metacarpophalangeal joint (MCPJ) blocking splints as an intervention for trigger finger (TF). In practice, finger-based relative motion (RM) splints are also implemented without evidence. PURPOSE This randomized comparative trial (RCT) aims to evaluate implementation of MCPJ blocking and RM splints for effectiveness, function, occupational performance and wearability after 6 weeks of TF management. METHODS AND ANALYSIS Priori analysis determined 36 individuals were needed for random assignment to the RM or MCPJ blocking splint groups. Individuals must be aged ≥21 years, and diagnosed with TF involving ≥1 finger. For blinding purposes, the primary author screens for eligibility, fabricates the splints and educates. Therapist A administers the primary outcome measures Week-1 and Week-6-stage of stenosing tenosynovitis and secondary outcome measures- number of triggering events in 10 active fists, visual analog scales (VAS) for pain, splint comfort and satisfaction, Disabilities of the Arm, Shoulder and Hand, and Canadian Occupational Performance Measure. Therapist B in Week-3 instructs participants in deep tissue massage and administers splint wearability VASs. The RM pencil test is used to determine the affected finger(s) MCPJ splint position i.e., more extension or flexion based on participant response. The MCPJ blocking splint holds the MCPJ in a neutral position. Analysis involves a mixed-effects ANOVA to compare Week-1 and Week-6 primary and secondary outcomes. RESULTS Recruitment and data collection are ongoing. DISCUSSION Biomechanically RM splints control tendon excursion and reduce passive tendon tension while allowing unencumbered finger motion and hand function. Hence clinicians use RM splints as an intervention for TF, despite the lack of implementation evidence. This RCT implements a function-focused as well as patient-centered approach with partial blinding of assessors and participants. CONCLUSION We anticipate that this study will provide evidence for the implementation of RM splints to manage adults with TF. TRIAL REGISTRATION Clinical trial registration This trial is registered with ClinicalTrials.gov (NCT05763017).
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Affiliation(s)
- Li Xian Leong
- Faculty of Health Sciences, Occupational Therapy Programme, Centre for Rehabilitation & Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Unit, Hospital Sultan Haji Ahmad Shah, Ministry of Health of Malaysia, Putrajaya, Malaysia
| | - Siaw Chui Chai
- Faculty of Health Sciences, Occupational Therapy Programme, Centre for Rehabilitation & Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Julianne W. Howell
- Self-Employed Hand and Upper Extremity Therapy Consultant, Saint Joseph, Michigan, United States of America
| | - Hanif Farhan Mohd Rasdi
- Faculty of Health Sciences, Occupational Therapy Programme, Centre for Rehabilitation & Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nur Rahimawati Abdul Rahman
- Orthopaedic Department, Hospital Sultan Haji Ahmad Shah, Ministry of Health of Malaysia, Putrajaya, Malaysia
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Kuwahara Y, Hara T, Kurahashi T, Takeshige H, Urata S, Oguchi T. Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap Using Nail Bed Graft for Fingertip Amputation with Replantation. Plast Reconstr Surg 2024; 153:1086-1092. [PMID: 37253041 DOI: 10.1097/prs.0000000000010760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF. METHODS Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa subzone II or III) at the authors' hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test, Fingertip Injuries Outcome Score, and Hand20 score. RESULTS Overall, in 74 analyzed cases (40 replantation, 34 DAF), the median operative time and the median length of hospital stay were longer with replantation than with DAF (188 versus 126 minutes; P < 0.01; 15 versus 4 days; P < 0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening with replantation was significantly lower than with DAF (42.5% versus 82.4%; P < 0.01). There were fewer nail deformities with replantation than with DAF (45.0% versus 67.6%; P = 0.06). The proportion of patients who achieved excellent or good Fingertip Injuries Outcome Score and median Hand20 score were not significantly different between the groups (89.5% versus 85.3%, P = 0.61; 8.0 versus 13.5, P = 0.42, respectively). Median postoperative Semmes-Weinstein monofilament test values were similar between the groups (3.61 versus 3.61; P = 0.23). CONCLUSION In this retrospective study, compared with replantation, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stays, but resulted in inferior cosmetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | | | | | - Shiro Urata
- From Orthopedic Surgery, Anjo Kosei Hospital
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Ling X, Jiang X, Guo H, Zhang T. Deep burn surgery of the whole dorsum of the hand: Composite skin grafting over acellular dermal matrix versus thick split-thickness skin grafting. Int Wound J 2024; 21:e14934. [PMID: 38783559 PMCID: PMC11116760 DOI: 10.1111/iwj.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/11/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split-thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen-Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites.
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Affiliation(s)
- Xiang‐Wei Ling
- National Key Clinical Specialty(Wound Healing)The First Affiliated Hospital Of Wenzhou Medical UniversityWenzhouChina
| | | | - Hai‐Lei Guo
- National Key Clinical Specialty(Wound Healing)The First Affiliated Hospital Of Wenzhou Medical UniversityWenzhouChina
| | - Ting‐Ting Zhang
- National Key Clinical Specialty(Wound Healing)The First Affiliated Hospital Of Wenzhou Medical UniversityWenzhouChina
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Ayhan E, Arslan OB, Cevik K, Oksuz C. Relative Motion Extension Splint after Extensor Tendon Reconstruction. J Hand Microsurg 2024; 16:100020. [PMID: 38854382 PMCID: PMC11127533 DOI: 10.1055/s-0043-1761222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Recently, the wide-awake local anesthesia no tourniquet (WALANT) technique and relative motion extension (RME) splint changed practice in extensor tendon reconstruction and therapy. We wanted to share our approach for zones 5 to 8 extensor tendon management following the up-to-date developments. The impacts of surgery under WALANT and early active motion therapy with RME splinting were explained frankly and shown in several videos throughout the article.
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Affiliation(s)
- Egemen Ayhan
- Department of Orthopedics and Traumatology, Hand Surgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ozge Buket Arslan
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Kadir Cevik
- Department of Orthopedics and Traumatology, Hand Surgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cigdem Oksuz
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Hirth MJ, Hunt I, Briody K, Milner Z, Sleep K, Chu A, Donovan E, O'Brien L. Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: A randomized equivalence trial. J Hand Ther 2023; 36:347-362. [PMID: 34400031 DOI: 10.1016/j.jht.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/28/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia.
| | - Ian Hunt
- TIA, College of Sciences and Engineering, University of Tasmania, Tasmania, Australia
| | - Kelly Briody
- Occupational Therapy Department, Monash Health, Dandenong, Victoria, Australia
| | - Zoe Milner
- Occupational Therapy Department, Melbourne Health, Parkville, Victoria, Australia
| | - Kate Sleep
- Malvern Hand Therapy, Malvern, Victoria, Australia
| | - Angela Chu
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Emily Donovan
- Occupational Therapy Department, Western Health, Footscray, Victoria, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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Feehan LM, Ewald SG. Relative motion orthoses: A five-question decision making tool for thinking beyond thermoplastics. J Hand Ther 2023; 36:479-485. [PMID: 36470784 DOI: 10.1016/j.jht.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 12/11/2022]
Abstract
We introduce a five-question decision-making tool for using relative motion in practice. The tool considers the primary aim of the relative motion orthosis, the amount of relative motion required and the number of fingers that should be included. The tool also helps clincians consider the person-specific characteristics that will impact the use of the orthoses, as well as, a variety of materials that could be used to fabricate the relative motion orthosis. Clinical examples demonstrate the use of the decision tool and illustrate the varied use of relative motion orthoses.
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Affiliation(s)
- Lynne M Feehan
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia. Canada.
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Collocott S, Wang A, Hirth MJ. Systematic review: Zone IV extensor tendon early active mobilization programs. J Hand Ther 2023; 36:316-331. [PMID: 37032244 DOI: 10.1016/j.jht.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 04/11/2023]
Abstract
STUDY DESIGN Systematic review INTRODUCTION: Early active mobilization (EAM) of tendon repairs is preferred to immobilization or passive mobilization. Several EAM approaches are available to therapists; however, the most efficacious for use after zone IV extensor tendon repairs has not been established. PURPOSE OF THE STUDY To determine if an optimal EAM approach can be identified for use after zone IV extensor tendon repairs based on current available evidence. METHODS Database searching was undertaken on May 25, 2022 using MEDLINE, Embase, and Emcare with further citation searching of published systematic/scoping reviews and searching of the Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Studies involving adults with repaired finger zone IV extensor tendons, managed with an EAM program, were included. Critical appraisal using the Structured Effectiveness Quality Evaluation Scale was performed. RESULTS Eleven studies were included, two were of moderate methodological quality, and the remainder was low. Two studies reported results specific to zone IV repairs. Most studies utilized relative motion extension (RME) programs; two utilized a Norwich program, and two other programs were described. High proportions of "good" and "excellent" range of motion (ROM) outcomes were reported. There were no tendon ruptures in the RME or Norwich programs; small numbers of ruptures were reported in other programs. CONCLUSIONS The included studies reported minimal data on outcomes specific to zone IV extensor tendon repairs. Most studies reported on the outcomes for RME programs which appeared to provide good ROM outcomes with low levels of complications. The evidence obtained in this review was insufficient to determine the optimal EAM program after zone IV extensor tendon repair. It is recommended that future research focus specifically on outcomes of zone IV extensor tendon repairs. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Shirley Collocott
- Hand Therapy Department, Manukau SuperClinic, Counties Manukau, Te Whatu Ora, Manukau, Auckland, New Zealand.
| | - Amy Wang
- Hand Therapy Department, Manukau SuperClinic, Counties Manukau, Te Whatu Ora, Manukau, Auckland, New Zealand
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia
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Yates SE, Glinsky JV, Hirth MJ, Fuller JT. The use of exercise relative motion orthoses to improve proximal interphalangeal joint motion: A survey of Australian hand therapy practice. J Hand Ther 2023; 36:414-424. [PMID: 37031058 DOI: 10.1016/j.jht.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 04/10/2023]
Abstract
STUDY DESIGN Cross-sectional online survey. INTRODUCTION Exercise relative motion (RM) orthoses are prescribed by hand therapists to improve finger motion but there is limited scientific evidence to guide practice. PURPOSE OF THE STUDY To describe Australian hand therapists' use of exercise RM orthoses to improve PIPJ motion, including trends in orthosis design, prescription, clinical conditions, and their opinions on orthosis benefits and limitations. METHODS 870 Australian Hand Therapy Association members were sent an electronic survey that included multiple choice, Likert scale and open-ended questions under four subgroups: demographics, design trends, prescription, and therapist opinions. Data analysis consisted of predominantly descriptive statistics and verbatim transcription. RESULTS 108 Australian therapists completed the survey, over a third with ≥ 20 years of clinical experience. Exercise RM orthoses were prescribed weekly to monthly (82%) for between 2-6 weeks duration (81%) and used during exercise and function (87%). The most common differential MCPJ position was 11-30° extension (98%) or flexion (92%). Four-finger designs were most common for border digits (OR ≥3.4). Exercise RM orthoses were more commonly used for active and extension deficits compared to passive (OR ≥3.7) and flexion deficits (OR ≥1.4), respectively. Clinicians agreed that the orthosis allowed functional hand use (94%), increased non-intentional exercise (98%), and was challenging to use with fluctuating oedema (60%). DISCUSSION This survey highlights notable clinical trends despite only reaching a small sample of Australian hand therapists. Exercise RM orthoses were frequently being used for active PIPJ extension and flexion deficits. A common MCPJ differential angle was reported, while the number of fingers incorporated into the design depended on the digit involved. Therapists' preferences mostly agreed with the limited available evidence. CONCLUSION(S) This limited survey identified common exercise RM orthosis fabrication and prescription trends amongst Australian therapists. These insights may inform future biomechanical and clinical research on this underexplored topic.
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Affiliation(s)
- Sally E Yates
- Department of Health Sciences, Health and Human Sciences, Macquarie University, Australia.
| | - Joanne V Glinsky
- Department of Health Sciences, Health and Human Sciences, Macquarie University, Australia
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Australia; Malvern Hand Therapy, Melbourne, Malvern, Australia
| | - Joel T Fuller
- Department of Health Sciences, Health and Human Sciences, Macquarie University, Australia
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Bűhler M, Gwynne-Jones D, Chin M, Woodside J, Gough J, Wilson R, Abbott JH. Are the outcomes of relative motion extension orthoses non-inferior and cost-effective compared with dynamic extension orthoses for management of zones V-VI finger extensor tendon repairs: A randomized controlled trial. J Hand Ther 2023; 36:363-377. [PMID: 37045642 DOI: 10.1016/j.jht.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION There is no comparative evidence for relative motion extension (RME) orthosis with dynamic wrist-hand-finger-orthosis (WHFO) management of zones V-VI extensor tendon repairs. PURPOSE OF THE STUDY To determine if RME with wrist-hand-orthosis (RME plus) is noninferior to dynamic WHFO for these zones in clinical outcomes. STUDY DESIGN Randomized controlled non-inferiority trial. METHODS Skilled hand therapists managed 37 participants (95% male; mean age 39 years, SD 18) with repaired zones V-VI extensor tendons randomized to RME plus (n = 19) or dynamic WHFO (n = 18). The primary outcome of percentage of total active motion (%TAM) and secondary outcomes of satisfaction, function, and quality of life were measured at week-6 and -12 postoperatively; percentage grip strength (%Grip), complication rates, and cost data at week-12. Following the intention-to-treat principle non-inferiority was assessed using linear regression analysis (5% significance) and adjusted for injury complexity factors with an analysis of costs performed. RESULTS RME plus was noninferior for %TAM at week-6 (adjusted estimates 2.5; 95% CI -9.0 to 14.0), %TAM at week-12 (0.3; -6.8 to 7.5), therapy satisfaction at week-6 and -12, and orthosis satisfaction, QuickDASH, and %Grip at week-12. Per protocol analysis yielded 2 tendon ruptures in the RME plus orthoses and 1 in the dynamic WHFO. There were no differences in health system and societal cost, or quality-adjusted life years. DISCUSSION RME plus orthosis wearers had greater injury complexity than those in dynamic WHFOs, with overall rupture rate for both groups comparatively more than reported by others; however, percentage %TAM was comparable. The number of participants needed was underestimated, so risk of chance findings should be considered. CONCLUSIONS RME plus management of finger zones V-VI extensor tendon repairs is non-inferior to dynamic WHFO in %TAM, therapy and orthotic satisfaction, QuickDASH, and %Grip. Major costs associated with this injury are related to lost work time.
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Affiliation(s)
- Miranda Bűhler
- Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand.
| | - David Gwynne-Jones
- Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand; Dunedin School of Medicine, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Michael Chin
- Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand; Dunedin School of Medicine, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Joshua Woodside
- Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Jamie Gough
- Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Ross Wilson
- Dunedin School of Medicine, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Dunedin School of Medicine, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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Pilbeam Kirk CE, Howell JW, Hirth MJ, Johnson N. Implementing an internal audit to change practice: Current evidence and review of patient outcomes enabled transition to the relative motion extension approach in the postoperative management of zones IV-VI extensor tendon repairs. J Hand Ther 2023; 36:389-399. [PMID: 37385903 DOI: 10.1016/j.jht.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Evidence supports use of the relative motion extension (RME) approach following extensor tendon repairs in zones V-VI yielding good or excellent outcomes. PURPOSE To demonstrate how a 3-year internal audit and regular review of emerging evidence guided our change in practice from our longstanding use of the Norwich Regimen to the RME approach using implementation research methods. We compared the outcomes of both approaches prior to the formal adoption of the RME approach. STUDY DESIGN Prospective clinical audit. METHODS A prospective audit of all consecutive adult finger extensor tendon repairs in zones IV-VII rehabilitated in our tertiary public health hand centre was undertaken between November 2014 and December 2017. Each audit year, outcomes were reviewed regarding the Norwich regimen and the RME early active motion approaches. As new evidence emerged, adjustments were made to our audit protocol for the RME approach. Discharge measurements of the range of motion of the affected and contralateral fingers and complications were recorded. RESULTS During the 3-year audit, data was available on 79 patients (56 RME group including 59 fingers with 71 tendon repairs; 23 Norwich group including 28 fingers with 34 tendon repairs) with simple (n = 68) and complex (n = 11) finger extensor tendon zones IV-VI repairs (no zone VII presented during this time). Over time, the practice pattern shifted from the Norwich Regimen approach to the RME approach (and with the use of the RME plus [n = 33] and RME only [n = 23] approaches utilized). All approaches yielded similar good to excellent outcomes per total active motion and Miller's classification, with no tendon ruptures or need for secondary surgery. CONCLUSIONS An internal audit of practice provided the necessary information regarding implementation to support a shift in hand therapy practice and to gain therapist or surgeon confidence in adopting the RME approach as another option for the rehabilitation of zone IV-VI finger extensor tendon repairs.
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Affiliation(s)
- Chloë E Pilbeam Kirk
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK; Rheumatology Department, Florence Nightingale Community Hospital, Derby, UK.
| | - Julianne W Howell
- Self-employed hand and upper extremity consultant, Saint Joseph, MI, USA.
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia.
| | - Nick Johnson
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK.
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Arslan ÖB, Şahin Y, Sığırtmaç İC, Yildiz B, Ayhan E, Öksüz Ç. Use of relative motion orthoses from the perspective of hand-injured patients: A qualitative study. J Hand Ther 2023; 36:425-432. [PMID: 37037730 DOI: 10.1016/j.jht.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Relative motion (RM) orthoses have gained popularity with therapists as their versatility lends to "protective," "exercise," and "adaptive" uses. PURPOSE OF THE STUDY To ask for comments from patients wearing RM orthoses for protective or exercise reasons. STUDY DESIGN Interpretive descriptive qualitative study. METHODS Semi-structured face-to-face interviews comprised of nine open-ended questions were conducted with 20 hand injured patients who were advised to wear a protective or exercise RM orthosis for at least 4 weeks. RESULTS Twenty patients participated in the interviews. Thirteen patients wore the protective RM orthoses had a mean age of 28 years (range,16-54) and the mean age was 34 years (range, 20-51) for 7 patients using exercise RM orthoses. Interviews generated 4 major themes: physical characteristics of the orthoses, challenges in daily living activities, emotional response to orthotic wear, and impact of social environment. DISCUSSION Comments from both groups of patients suggested the small size of the orthosis contributed to wearing the orthosis as advised. Most found the orthosis comfortable, when not, comments were related to rubbing of the orthosis causing pain and rigidity of the orthosis resulting in finger swelling. A few were impacted by the orthosis drawing attention to their injured hand. Those wearing the exercise RM orthosis often removed it instead of using it for nonintentional exercise. CONCLUSIONS Comments obtained from the limited structured interview of 20 patients wearing protective or exercise RM orthosis may offer therapists with some understanding from the patient's perspective. Additional study is worthwhile.
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Affiliation(s)
- Özge Buket Arslan
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Yeşim Şahin
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - İlkem Ceren Sığırtmaç
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Büşra Yildiz
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Egemen Ayhan
- Hand Surgeon-Orthopaedics and Traumatology, University of Health Sciences, Diskapi Y. B. Training and Research Hospital, Ankara, Turkey
| | - Çiğdem Öksüz
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Cole T, Jamwal R, Hirth MJ. Photovoice to explore the patient experience of a relative motion orthosis following a hand injury. J Hand Ther 2023; 36:433-447. [PMID: 37059599 DOI: 10.1016/j.jht.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Little is known about the patient experience of relative motion (RM) orthoses, or how they impact hand use and participation in occupational roles. PURPOSE To explore the use of Photovoice methodology in hand-injured patients and the patient experience of wearing a RM orthosis. STUDY DESIGN Photovoice methodology, Qualitative Participatory research, feasibility study METHODS: Purposive sampling was used to identify adult patients prescribed a RM orthosis as part of their therapy intervention for an acute hand injury. Over a 2-week period and using their personal camera device participants captured their experience of wearing a RM orthosis and its impact on their daily life. Participants shared 15-20 photos with the researchers. At a face-to-face semi-structured interview, 5 key photographs were selected by the participants with context and meaning explored. Interview data was transcribed, captions and context of images confirmed by member checking, and thematic analysis completed. RESULTS Protocol fidelity was observed using our planned Photovoice methodology. Three participants (aged 22-46 years) shared 42 photos and completed individual interviews. All participants reported their involvement as a positive experience. Six themes were identified: adherence, orthosis factors, expectations and comparisons, impact on daily activities, emotions, and relationships. RM orthoses allowed freedom of movement enabling participation in a range of occupations. Challenges included water-based activities, computer use and kitchen tasks. Participants expectation of orthotic wear and recovery appeared to contribute to their overall experience, with RM orthoses viewed favourably when compared to other orthoses and immobilization methods. CONCLUSIONS Photovoice methodology was a positive process for participant reflection and a larger study is recommended. Wearing a RM orthosis enabled functional hand use as well as providing challenges completing everyday activities. Participants had different demands, experiences, expectations, and emotions associated with wearing a RM orthosis, reinforcing the need for clinicians to take a client-centred approach.
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Affiliation(s)
- Tanya Cole
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia.
| | - Rebecca Jamwal
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia.
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia.
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Howell JW, Ewald SG, Schwartz DA. Exercise relative motion orthoses: Use of the pencil test and variations of its use for assessing and managing different finger conditions. J Hand Ther 2023; 36:473-478. [PMID: 36914489 DOI: 10.1016/j.jht.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/09/2022] [Indexed: 03/16/2023]
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Howell JW, Hirth MJ. The ongoing evolution of a clinical innovation: Relative motion concept and orthoses. J Hand Ther 2023; 36:248-250. [PMID: 37648340 DOI: 10.1016/j.jht.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Julianne W Howell
- Self-employed Hand and Upper Extremity Consultant, Saint Joseph, MI, USA
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia
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Howell JW, Hirth MJ. "Around the global hand table": Hand surgeon and therapist perspectives on overcoming barriers to relative motion orthotic intervention in the management of zones V-VI finger extensor tendon repairs. J Hand Ther 2023; 36:400-413. [PMID: 37037729 DOI: 10.1016/j.jht.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION An international survey of therapists cited 2 barriers (physician preference and departmental policy) to the implementation of a relative motion extension (RME) orthosis/early active motion (EAM) approach. STUDY DESIGN e-survey PURPOSE: To glean insight from hand surgeons and hand therapists regarding their awareness and experiences in implementing or not implementing an RME orthosis/EAM approach for management of finger zones V-VI extensor tendon repairs. METHODS Two e-surveys, one to hand surgeons and the other to hand therapists were distributed. Participants were asked 8-open ended questions with the opportunity for additional comment. RESULTS Nine of 11 surgeons and 10 of 11 therapists (clinicians/educators/administrators) who were surveyed, participated. All respondents from 7 countries were aware of the RME/EAM approach, with only 1 surgeon and 2 therapists not implementing. Surgeons once aware, quickly implement; therapists in this survey implemented about 2.5 years after learning of the approach. Surgeon use was influenced more by their peers than the evidence while therapist knowledge came from professional meetings. Therapists teaching at university-level and continuing education integrate the approach. DISCUSSION Although the RME orthosis/EAM approach has been around for 4 decades, awareness for the hand surgeons and therapists surveyed has only been over the past 20 years. Surveyed surgeons like to visualize how the RME concept works and therapists depend more on the evidence. To overcome barriers to RME/EAM implementation, several strategies are outlined. CONCLUSION Although a small survey, valuable comments provide insight for addressing the previously cited barriers. Strategies for increasing awareness and fostering implementation of an RME orthosis/EAM approach are offered by international hand surgeons and therapists surveyed regarding the commonly cited barriers of surgeon preference and department procedures.
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Affiliation(s)
- Julianne W Howell
- Self-employed hand and upper extremity therapy consultant, Saint Joseph, MI, USA.
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia
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Newington L, Bamford E, Henry SL. Relative motion flexion following zone I-III flexor tendon repair: Concepts, evidence and practice. J Hand Ther 2023; 36:294-301. [PMID: 37029053 DOI: 10.1016/j.jht.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 04/09/2023]
Abstract
STUDY DESIGN Narrative review and case series. INTRODUCTION The relative motion approach has been applied to rehabilitation following flexor tendon repair. Positioning the affected finger(s) in relatively more metacarpophalangeal joint flexion is hypothesized to reduce the tension through the repaired flexor digitorum profundus by the quadriga effect. It is also hypothesized that altered patterns of co-contraction and co-inhibition may further reduce flexor digitorum profundus tension, and confer protection to flexor digitorum superficialis. METHODS We reviewed the existing literature to explore the rationale for using relative motion flexion orthoses as an early active mobilization strategy for patients after zone I-III flexor tendon repairs. We used this approach within our own clinic for the rehabilitation of a series of patients presenting with zone I-II flexor tendon repair. We collected routine clinical and patient reported outcome data. RESULTS We report published outcomes of the clinical use of relative motion flexion orthoses with early active motion, implemented as the primary rehabilitation approach after zone I-III flexor digitorum repairs. We also report novel outcome data from 18 patients. DISCUSSION We discuss our own experience of using relative motion flexion as a rehabilitation strategy following flexor tendon repair. We explore orthosis fabrication, rehabilitation exercises and functional hand use. CONCLUSIONS There is currently limited evidence informing use of relative motion flexion orthoses following flexor tendon repair. We highlight key areas for future research and describe a current pragmatic randomized controlled trial.
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Affiliation(s)
- Lisa Newington
- Hand Therapy, Guy's and St Thomas' NHS Foundation Trust, London, UK; MSk Lab, Department of Surgery and Cancer, Imperial College London, Sir Michael Uren Hub, London, UK.
| | - Emma Bamford
- Pulvertaft Hand Unit, King's Treatment Centre, Royal Derby Hospital, Derby, England
| | - Steven L Henry
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Ascension Plastic and Hand Surgery, Austin, TX, USA
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Leong L, Chai SC, Howell JW, Hirth MJ. Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review. J Hand Ther 2023; 36:302-315. [PMID: 37391318 DOI: 10.1016/j.jht.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The design and efficacy of orthotic intervention to non-surgically manage adult and pediatric trigger finger vary widely. PURPOSE To identify types of orthoses (including relative motion), effectiveness, and outcome measurements used to non-surgically manage adult and pediatric trigger finger. STUDY DESIGN Systematic review. METHODS The study was undertaken according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement and registered with the International Prospective Register of Systematic Reviews Registry, number CRD42022322515. Two independent authors electronically and manually searched, and screened 4 databases; selected articles following pre-set eligibility criteria; assessed the quality of the evidence using the Structured Effectiveness for Quality Evaluation of Study; and extracted the data. RESULTS Of the 11 articles included, 2 involved pediatric trigger finger and 9 adult trigger finger. Orthoses for pediatric trigger finger positioned finger(s), hand, and/or wrist of children in neutral extension. In adults, a single joint was immobilized by the orthosis, blocking either the metacarpophalangeal joint or the proximal or distal interphalangeal joint. All studies reported positive results with statistically significant improvements and medium to large effect size to almost every outcome measure, including the Number of Triggering Events in Ten Active Fist 1.37, Frequency of Triggering from 2.07 to 2.54, Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure from 0.46 to 1.88, Visual Analogue Pain Scale from 0.92 to 2.00, and Numeric Rating Pain Scale from 0.49 to 1.31. Severity tools and patient-rated outcome measures were used with the validity and reliability of some unknown. CONCLUSIONS Orthoses are effective for non-surgical management of pediatric and adult trigger finger using various orthotic options. Although used in practice, evidence for the use of relative motion orthosis is absent. High-quality studies based on sound research questions and design using reliable and valid outcome measures are needed.
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Affiliation(s)
- Lixian Leong
- Occupational Therapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Occupational Therapy Unit, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia
| | - Siaw Chui Chai
- Occupational Therapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Julianne W Howell
- Self-employed Hand Therapy Consultant, Saint Joseph, MI, United States
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia
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Shaw AV, Verma Y, Tucker S, Jain A, Furniss D. Relative motion orthoses for early active motion after finger extensor and flexor tendon repairs: A systematic review. J Hand Ther 2023; 36:332-346. [PMID: 37037728 DOI: 10.1016/j.jht.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The relative motion (RM) orthosis was introduced over 40 years ago for extensor tendon rehabilitation and more recently applied to flexor tendon repairs. PURPOSE We systematically reviewed the evidence for RM orthoses following surgical repair of finger extensor and flexor tendon injuries including indications for use, configuration and schedule of orthosis wear, and clinical outcomes. STUDY DESIGN Systematic review. METHODS A PRISMA-compliant systematic review searched eight databases and five trial registries, from database inception to January 7, 2022. The protocol was registered prospectively (CRD42020211579). We identified studies describing patients undergoing rehabilitation using RM orthoses after surgical repair of acute tendon injuries of the finger and hand. RESULTS For extensor tendon repairs, ten studies, one trial registry and five conference abstracts met inclusion criteria, reporting outcomes of 521 patients with injuries in zones IV-VII. Miller's criteria were predominantly used to report range of motion; with 89.6% and 86.9% reporting good or excellent outcomes for extension lag and flexion deficit, respectively. For flexor tendon repairs, one retrospective case series was included reporting outcomes in eight patients following zones I-II repairs. Mean total active motion was 86%. No tendon ruptures were reported due to the orthosis not protecting the repair for either the RME or RMF approaches. DISCUSSION Variation was seen in use of RME plus or only, use of night orthoses and orthotic wear schedules, which may be the result of evolution of the RM approach. Since Hirth et al's 2016 scoping review, there are five additional studies, including two RCTs reporting the use of the RM orthosis in extensor tendon rehabilitation. CONCLUSIONS There is now good evidence that the RM approach is safe in zones V-VI extensor tendon repairs. Limited evidence currently exists for zones IV and VII extensor and for flexor tendon repairs. Further high-quality clinical studies are needed to demonstrate its safety and efficacy.
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Affiliation(s)
- Abigail V Shaw
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Yash Verma
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Tucker
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Imperial College London NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Dominic Furniss
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Wajon S, Howell JW. Prescription of exercise relative motion orthoses to improve limited proximal interphalangeal joint movement: A prospective, multi-center, consecutive case series. J Hand Ther 2023; 36:378-388. [PMID: 35039211 DOI: 10.1016/j.jht.2021.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective, multicenter, consecutive case series INTRODUCTION: There are 3 categories of relative motion orthoses; protective, exercise and adaptive, with only 2 unpublished studies that prescribed for exercise. These orthoses are of 2 types: relative motion extension (RME) orthoses and relative motion flexion (RMF) orthoses. PURPOSE OF STUDY To describe prescription of relative motion (RME and RMF) exercise orthoses when used to assist recovery of proximal interphalangeal joint (PIPJ) movement after injury or surgery. METHODS Therapists enrolled patients who had limited PIPJ movement after injury or surgery and demonstrated greater passive than active isolated PIPJ movement. Relative motion exercise orthoses and usual hand therapy treatments were implemented for 6 weeks. Measures of PIPJ motion, pain, and patient-report of orthotic wear time and perceived benefit were recorded at the time of orthotic intervention, at 3 weeks and at 6 weeks. RESULTS Eight therapists from 4 private hand therapy clinics implemented RM exercise orthoses in 14 patients with limited PIPJ flexion (RME orthoses) and 6 patients with limited PIPJ extension (RMF orthoses). One participant prescribed a RMF orthosis failed to complete the study. Isolated PIPJ active flexion improved for those prescribed RME orthoses (n = 14/14) and isolated PIPJ active extension improved for those prescribe a RMF orthosis (n = 2/5). Most patient-reports were positive about the relative motion experience. DISCUSSION Although diagnoses and prescription times differed, the outcomes of this patient series prescribed relative motion exercise orthoses agree with those of 2 unpublished case series; all in support relative motion exercise orthoses to improve limited PIPJ movement. CONCLUSION Future studies implementing relative motion exercise orthoses to recover limited PIPJ movement after injury or surgery may be worthwhile.
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Affiliation(s)
- Sally Wajon
- Macquarie Hand Therapy: Suite 403/2 Technology Place, Macquarie University Hospital, Clinic Building Macquarie University, NSW, Australia
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Howell JW, Hirth MJ, Chai SC, Brown T, O’Brien L. Postoperative management of zones V-VI extensor tendon repairs: A survey of practice in Malaysia and comparison to IFSHT member countries. HAND THERAPY 2021; 26:134-145. [PMID: 37904834 PMCID: PMC10584052 DOI: 10.1177/17589983211031259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/21/2021] [Indexed: 11/01/2023]
Abstract
Introduction A survey of International Federation of Societies for Hand Therapy (IFSHT) member countries identified relative motion extension as the preferred approach to management of zones V-VI extensor tendon repairs. The aims of this survey were to identify and compare hand therapy practice patterns in Malaysia (a non-IFSHT member country) with findings of the IFSHT survey including an IFSHT subset of Asia-Pacific therapists and to investigate if membership status of the Malaysian Society for Hand Therapists (MSHT) influenced therapy practice patterns. Methods An online English-language survey was distributed to 90 occupational therapists and physiotherapists including MSHT members and non-members. Participation required management of at least one extensor tendon repair in the preceding year. Five approaches were surveyed: immobilisation, early passive motion (EPM) with dynamic splinting, and early active motion (EAM) delivered by resting hand (RH), palmar resting interphalangeal joints free (PR), and relative motion extension (RME) splints. Results Thirty-seven of the 53 therapists (68%) who commenced the survey completed it. The most used approach was dynamic/EPM (28%), followed by RH/immobilisation (22%) and RH/EAM (22%). A preference for RME/EAM was identified with implementation barriers being surgeon preference and hand therapist confidence. Discussion Approach selection for Malaysian therapists differed from the combined IFSHT and Asia-Pacific respondents, with the former using dynamic/EPM and RH/immobilisation compared to IFSHT respondents who predominately used RME/EAM and PR/EAM. This survey provides valuable insights into Malaysian hand therapists' practices. If implementation barriers and therapist confidence are addressed, Malaysian practice patterns may change to better align with current evidence.
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Affiliation(s)
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia
- Malvern Hand Therapy, Malvern, Victoria, Australia
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Siaw Chui Chai
- Occupational Therapy Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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The Unknown Prevalence of Postrandomization Bias in 15 Physical Therapy Journals: A Methods Review. J Orthop Sports Phys Ther 2021; 51:542-550. [PMID: 34546817 DOI: 10.2519/jospt.2021.10491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the prevalence of prospective clinical trial registration and postrandomization bias in published musculoskeletal physical therapy randomized clinical trials (RCTs). DESIGN A methods review. LITERATURE SEARCH Articles indexed in MEDLINE and published between January 2016 and July 2020 were included. STUDY SELECTION CRITERIA Two independent blinded reviewers identified the RCTs using Covidence. We included RCTs related to musculoskeletal interventions that were published in International Society of Physiotherapy Journal Editors member journals. DATA SYNTHESIS Data were extracted independently for the variables of interest from the identified RCTs by 2 blinded reviewers. The data were presented descriptively or in frequency tables. RESULTS One hundred thirty-eight RCTs were identified. One third of RCTs were consistent with their prospectively registered intent (49/138); consistency with prospectively registered intent could not be determined for two thirds (89/138) of the RCTs. Four RCTs (8%)reported inconsistent results with the primary aims and 7 (14%) with the outcomes from the prospective clinical trial registry, despite high methodological quality (Physiotherapy Evidence Database [PEDro] scale score). Differences between prospectively registered and non-prospectively registered RCTs for PEDro scale scores had a medium effect size (r = 0.30). Two of 15 journals followed their clinical trial registration policy 100% of the time; in 1 journal, the published RCTs were consistent with the clinical trial registration. CONCLUSION Postrandomization bias in musculoskeletal physical therapy RCTs could not be ruled out, due to the lack of prospective clinical trial registration and detailed data analysis plans. J Orthop Sports Phys Ther 2021;51(11):542-550. Epub 21 Sep 2021. doi:10.2519/jospt.2021.10491.
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Hirth MJ, Howell JW, Feehan LM, Brown T, O'Brien L. Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice. J Hand Ther 2021; 34:58-75. [PMID: 32165052 DOI: 10.1016/j.jht.2019.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Electronic Web-based survey. INTRODUCTION Evidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide. PURPOSE OF THE STUDY The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries. METHODS Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their "most used" approach in the previous year. RESULTS There were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%). DISCUSSION In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis. CONCLUSIONS The RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.
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Affiliation(s)
- Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.
| | | | - Lynne M Feehan
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
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Hirth MJ, Howell JW, Brown T, O'Brien L. Relative motion extension management of zones V and VI extensor tendon repairs: Does international practice align with the current evidence? J Hand Ther 2021; 34:76-89. [PMID: 32165056 DOI: 10.1016/j.jht.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/03/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Electronic Web-based survey. INTRODUCTION Therapists participating in an international survey selected relative motion extension (RME) as the "most used" approach for the postoperative management of zones V and VI extensor tendon repairs. A subgroup of respondents identified RME as their preferred approach and were asked about their routine RME practices. PURPOSE OF THE STUDY The purpose of this study was to capture data from routine RME users about their practices and compare this with the RME evidence. METHODS An English-language survey was distributed to 36 International Federation of Societies for Hand Therapy full-member countries. Participation required therapists to have postsurgically managed at least one extensor tendon repair within the previous year. Those who selected RME as their "most used" approach were asked to identify which variation of the RME approach they favored: RME plus (with wrist orthosis), RME only, or "both" RME plus and RME only, and then were directed to additional questions related to their choice. RESULTS Respondents from 28 International Federation of Societies for Hand Therapy full-member countries completed the survey. RME users (N = 368; 41.5% of sample) contributed to this secondary data. Respondents favored the RME variation "RME plus" (47%), followed by "both" (44%), then "RME only" (9%) with most managing single digit/simple injuries (n = 287, 81%) versus multiple digit/complex injuries (n = 96, 27%), and partial repairs (n = 278, 79%). DISCUSSION Practices not aligning with limited level II-IV evidence includes half of RME only users not adding/substituting an overnight orthosis; use of RME plus versus RME only for both repairs of independent extensor tendons and repairs proximal to the juncturae tendinum; fabrication of three not four-finger orthotic design; and restricting use to only repairs of one or two fingers. CONCLUSIONS RME plus and RME only are used interchangeably depending on surgeon preferences and patient/tendon factors. Compared with RME plus, from this survey, it appears that the RME only approach yields similar uncomplicated, early return of motion and hand function.
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Affiliation(s)
- Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Australia; Malvern Hand Therapy, Malvern, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Australia.
| | | | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Australia
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Newington L, Ross R, Howell JW. Relative motion flexion splinting for the rehabilitation of flexor tendon repairs: A systematic review. HAND THERAPY 2021; 26:102-112. [PMID: 37904882 PMCID: PMC10584049 DOI: 10.1177/17589983211017584] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/22/2021] [Indexed: 11/01/2023]
Abstract
Introduction Relative motion splinting has been used successfully in the treatment of extensor tendon repairs and has recently been applied in flexor tendon rehabilitation. The purpose of this systematic review was to identify articles reporting use of relative motion flexion (RMF) splinting following flexor tendon repair and to examine indications for use and clinical outcomes. Methods Seven medical databases, four trials registries and three grey literature sources were systematically searched and screened against pre-specified eligibility criteria. Screening, data extraction and quality appraisal were independently performed by two reviewers. Results A total of 12 studies were identified, of which three met the review eligibility criteria: one retrospective case series; one cadaveric proof of concept study; and one ongoing prospective case series. The type of splint (including metacarpophalangeal joint position and available movement), exercise programme, and zone of tendon injury varied between studies. Both case series presented acceptable range of movement and grip strength outcomes. The prospective series reported one tendon rupture and two tenolysis procedures; the retrospective series reported no tendon ruptures or secondary surgeries. Discussion We found limited evidence supporting the use of RMF splinting in the rehabilitation of zones I-III flexor tendon repairs. Further prospective research with larger patient cohorts is required to assess the clinical outcomes, patient reported outcomes and safety of RMF splinting in comparison to other regimes. Application of the relative motion principles to flexor tendon splinting varied across the included studies, and we suggest an operational definition of relative motion in this context.
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Affiliation(s)
- Lisa Newington
- Hand Therapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Rachel Ross
- Hand Therapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Fiona Stanley Hospital, Perth, Australia
| | - Julianne W Howell
- Independent Hand and Upper Extremity Consultant, Saint Joseph, MI, USA
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25
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Abstract
Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.
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Affiliation(s)
- Sandeep C. Patel
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Karen Smith
- Department of Plastic, Reconstructive and Hand Surgery, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Khalid D. Mohammed
- University of Otago, Dunedin, New Zealand
- Department of Orthopaedic Surgery, Christchurch and Burwood Hospitals, Christchurch, New Zealand
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26
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Cesim ÖB, Ayhan E, Baş CE, Öksüz Ç. Use of relative motion splint in extensor mechanism repairs: a retrospective case series. HAND SURGERY & REHABILITATION 2020; 40:81-86. [PMID: 33157270 DOI: 10.1016/j.hansur.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
This case series determines the clinical outcomes of relative motion extensor splints (RMES) in extensor mechanism repairs. Nine patients who underwent extensor tendon repair, juncturae tendinum or sagittal band repair were included. A forearm-based volar blocking wrist splint was applied after surgery. The RMES was configured at the initial hand therapy appointment. Total active motion (TAM) at 4 and 8 weeks after surgery and return to work were assessed. There were 7 males and 2 females with a mean age of 28 (16-53 years). The mean TAM of the uninjured digits was 270° (245°-290°). The mean TAM of the injured digits was 209° (125°-275°) at week 4 and 245° (185°-290°) at week 8. The mean return to work time was 25 days. None of the patients had tendon ruptures and required secondary procedures. In our study, active movement with RMES was allowed immediately after surgery. The RMES program supported safer and earlier recovery of motion. All patients were able to perform activities of daily living while wearing the splint.
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Affiliation(s)
- Ö B Cesim
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Sıhhiye, 06100 Ankara, Turkey.
| | - E Ayhan
- Department of Orthopaedics and Traumatology-Hand Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No:1, 06110 Altındağ/Ankara, Turkey
| | - C E Baş
- Department of Orthopaedics and Traumatology-Hand Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No:1, 06110 Altındağ/Ankara, Turkey
| | - Ç Öksüz
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Sıhhiye, 06100 Ankara, Turkey
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