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Collocott S.1, Ellis R.2, Kelly E.2, Foster M.3, Zang I.4
1Counties Manukau District Health Board, Hand Therapy, Auckland, New Zealand, 2Auckland University of Technology, Physiotherapy, Auckland, New Zealand, 3Counties Manukau District Health Board, Orthopaedics, Auckland, New Zealand, 4Counties Manukau District Health Board, Biostatistics, Auckland, New Zealand
Background: Various active mobilisation protocols are used after repair of extensor tendons in zone V and VI. These include relative motion extension splinting (RMES) and controlled active motion (CAM) protocols. Similar outcomes are reported for most early active mobilisation protocols, however reports on RMES protocols suggest a possible earlier return to work and functional use of the affected hand. To date no published prospective trials have compared a RMES protocol to other early active mobilisation protocols.
Purpose: This randomised clinical trial prospectively investigated whether patients with extensor tendon repairs in zone V and VI managed with an RMES protocol would return to functional use of the hand sooner than those managed with a CAM protocol.
Methods: 42 participants who had undergone extensor tendon repair in zone V and/or VI were recruited to the study. They were randomised into two separate groups: one group was treated using a CAM protocol, the other a RMES protocol. Participants were reviewed at four and eight weeks post-operatively. The primary outcome was the Sollerman Hand Function Test score. Secondary outcomes were days to return to work, joint range of motion, grip strength and the QuickDASH and satisfaction questionnaires. Incidence of tendon rupture and post-operative complications were also recorded.
Results: Participants following the RMES protocol demonstrated significantly better results (p 0.05), compared to participants following the CAM protocol for the following outcome measures: Sollerman Hand Function Test score (four weeks), the QuickDASH score (four weeks) and joint range of motion (four and eight weeks). There was no significant difference between groups with regard to grip strength or number of days to return to work at eight weeks. Participants following the RMES protocol demonstrated a significantly (p 0.05) greater satisfaction (76%) with the splint compared to participants following the CAM protocol (43%). No tendon ruptures occurred in either group and there was no significant difference in complication rates between groups.
Conclusion(s): This is the first randomised clinical trial to prospectively compare a RMES protocol to a CAM protocol. Participants treated with a RMES protocol demonstrated better early return to functional use of the hand and improved joint range of motion compared to those treated with a CAM protocol. Furthermore, at eight weeks post-operative, the RMES participants continued to show better range of motion compared to the CAM participants. RMES participants were also more satisfied with splinting than CAM participants. There was no difference in return to work timeframes between the two groups. No ruptures occurred in either group, complication rates were low and not significantly different between groups.
Implications: This study has demonstrated that a RMES protocol provides an earlier return to hand function compared to a CAM protocol for patients who have undergone extensor tendon repair in zones V and VI. This finding has resulted in a change towards the use of a RMES protocol at a large New Zealand hand surgery and rehabilitation clinic.
Funding acknowledgements: This research was funded by the Ko Awatea Tupu Research Fund and the New Zealand Association of Occupational Therapists
Topic: Musculoskeletal: peripheral
Ethics approval: This research was approved by the Auckland University of Technology Ethics Committee (AUTEC).
All authors, affiliations and abstracts have been published as submitted.
