ICF components of corresponding outcome measures in flexor tendon rehabilitation – a systematic review (original) (raw)
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Hand Therapy, 2012
Introduction. Gliding without adhesion is imperative to regain full range of motion after flexor tendon repair. The purpose of this study was to find assessment tools that represent these outcomes and to explore their relationship with hand function. Methods. Ninety-six flexor tendon injuries in 24 patients were assessed at 12 weeks after flexor tendon repair. Total active motion (TAM) and total passive motion (TPM) were recorded with a goniometer. For patientreported upper extremity function, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used. Results. A moderate negative correlation was found between total active motion and DASH score (r ¼ 20.3809 to 20.5815, P , 0.0001). While TAM and TPM improved over the 12-week period, mean values did not reach those of the uninjured hand. Mean DASH scores improved from 46.05 points at four weeks to 23.5 points at 12 weeks. Conclusion. Despite early flexor tendon rehabilitation in this sample, after 12 weeks, some degree of dysfunction and loss of active ability for finger flexion still persisted. The DASH appears to be an appropriate outcome tool after flexor tendon repair. The combination of patient-reported questionnaire and measures of impairment such as TAM and TMP give a more comprehensive picture of functional outcome.
Flexor tendon rehabilitation in the 21st century: A systematic review
Study Design: Systematic review. Introduction: The rehabilitation of patients following flexor tendon injury has progressed from immo-bilization to true active flexion with the addition of wrist motion over the last 75 years. Purpose of the Study: This review specifically intended to determine whether there is evidence to support one type of exercise regimen, early passive, place and hold, or true active, as superior for producing safe and maximal range of motion following flexor tendon repair. Methods: The preferred reporting items for systematic review and meta-analysis (PRISMA-P 2015) checklist was utilized to format the review. Both reviewers collaborated on all aspects of the research, including identifying inclusion/exclusion factors, search terms, reading and scoring articles, and authoring the paper. Articles were independently scored by each reviewer using the Structured Effectiveness Quality Evaluation Scale (SEQES). Results: A total of nine intervention studies that included a rehabilitative comparison group were systematically reviewed: one pediatric, four comparing passive flexion protocols to place and hold flexion, and four comparing true active flexion to passive and/or place and hold flexion. Discussion: This review provides moderate to strong evidence that place and hold exercises provide better outcomes than passive flexion protocols for patients with two to six-strand repairs. The studies included in this review suffered from methodological limitations including short timeframes for follow-up, unequal group distribution, and limited attention to repair site strength. Conclusions: Based on a lack of superior benefits following true active motion regimens, there is not sufficient evidence to support true active motion as an effective or preferable choice for flexor tendon rehabilitation at this time. Ó 2018 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. Introduction The rehabilitation of patients after flexor tendon repair has been the source of intensive study and heated debate for more than 75 years. Early work by Mason and Allen 1 in the 1940s demanded immobilization during the exudative phase of wound healing, and the underlying concept of extrinsic processes as vital for tendon healing was supported for more than 35 years. 2,3 New frontiers in flexor tendon rehabilitation were pursued in the 1970s, resulting in the Duran 4 and Kleinert 5 regimens, which afforded early passive flexion and early active extension of the affected digits. The science of flexor tendon healing advanced soon after, with multiple bench studies supporting the intrinsic healing capacity of flexor tendons and the benefits of early passive motion for increasing repair site strength and tendon excursion. 6-14 It was during this time that the subspecialty of hand therapy was formalized, and the collaboration between hand therapists and surgeons greatly informed the advancement of flexor tendon rehabilitation during the next 40 years. The next major shift in flexor tendon research focused on the biomechanical benefits of wrist motion related to flexor tendon excursion and force modulation. 15-22 Synergistic motion, defined as the combination of wrist extension with digit flexion, was found to decrease passive tension of the antagonistic extensor musculature, thereby decreasing active tension of the digital flexors. 15-18 In addition, combining wrist and digit motion was reported to yield greater tendon excursion. 19-21 These concepts served as the basis for Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Hand Therapy
Introduction There is clinical uncertainty regarding the optimal method of rehabilitation following flexor tendon repair. Many splint designs and rehabilitation regimens are reported in the literature; however, there is insufficient evidence to support the use of any one regimen. The aim of this study was to describe rehabilitation guidelines used in the United Kingdom (UK) following zone I/II flexor tendon repair. Methods Using a cross-sectional design, hand units in the UK were invited to complete a short survey and to upload their flexor tendon rehabilitation guidelines and patient information material. Approval was granted by the British Association of Hand Therapists. Data were extracted in duplicate, using a pre-piloted form, and analysed using descriptive statistics. Results Thirty-five hand units responded (21%), providing 52 treatment guidelines. Three splinting regimens were described, and all involved early active mobilisation: (i) long dorsal-blocking splint (DBS); (ii) ...
Influence of patient and injury-related factors in the outcomes of primary flexor tendon repair
European Journal of Plastic Surgery, 2014
Background Flexor tendon injuries are a group of lesions with a high socioeconomic impact and whose results are often uncertain. Knowing the factors associated with a poor outcome after tendon repair could help us find prognostic indicators. The aim of this study was to determine factors associated with the results of primary flexor tendon repair to identify the group of patients who will require exhaustive monitoring and rehabilitation. Methods We studied 95 injuries in which the flexor tendons were completely severed from January 2010 to March 2012. We used Student's t test and one-way analysis of variance (ANOVA) statistics to study the effects of age, sex, zone, finger, injured tendons, presence of nerve injury, and lesional mechanism on the total active movement achieved. The interactions between variables were evaluated using multivariate analysis. Results A statistically significant relationship was observed between total active movement and age, lesion mechanism, and the affected tendon zone. No statistically significant interaction was observed among these three factors. Sharp injuries in zones III and V in younger patients were associated with better results. Conclusions Our data show that age, finger topography, and injury mechanism are factors that are independently associated with the final prognosis of these lesions. This information enables us to anticipate the range of finger mobility to be expected and to inform patients in advance of their possible post-operation prognosis.
Journal of Physical Therapy Science, 2016
Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group.
Evaluation and functional assessment of flexor tendon repair in the hand
Acta chirurgica Belgica
Seventeen patients with 28 flexor tendon injuries were examined after tendon repair. The current most frequently used evaluation systems, including grip and pinch strength, were compared with functional outcome as assessed by a questionnaire, evaluating Disabilities of Arm, Shoulder and Hand (DASH). Good correlation was found between Total Active Motion (TAM) and the Original Strickland test (kappa = 0.85), however with reduced categories. Only limited correlation was found between the DASH-score and TAM (r = -0.33) as well as between the DASH-score and pinch strength (r = -0.35). We suggest reporting the average Range of Motion (ROM) of the complete finger as a percentage of the contralateral finger, instead of reporting the classified result, and to include assessment of pinch strength. It would be very useful to have an accurate functional outcome assessment, but DASH proves to be insufficiently sensitive.
Functional outcomes after flexor tendon repair of the hand
Turkish journal of physical medicine and rehabilitation, 2019
Objectives This study aims to evaluate the hand function after flexor tendon repair (FTR) and to investigate factors associated with functional outcomes. Patients and methods Between January 2013 and September 2015, a total of 126 patients (84 males, 42 females; mean age 31 years; range, 15 to 62 years) who underwent FTR due to flexor tendon injuries (FTIs) were included. The hand function was assessed using the Jebsen Hand Function Test (JHFT) and Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) at three and six months following FTR. Results Of the patients, 94 (75%) and 72 (56%) completed the three-month and six-month assessment visits, respectively. A total of 65 patients (51.1%) had both three and six-month follow-up data. The patients regained a fair amount of power grip strength and more than half of their pinch grip strength compared to the unaffected hand. The results of assessment of hand function at activity and participation levels (JHFT and Quick DASH) showe...
Improving Results of Flexor Tendon Repair and Rehabilitation
Plastic and Reconstructive Surgery, 2014
he management of flexor tendon injuries remains one of the most published topics in hand surgery, with the numbers of publications on this subject seeing a year-onyear increase (Fig. 1). The perfect repair and outcome continue to evade us, 1 despite the flexor tendon repair being one of the earliest skills acquired as a hand surgeon in either plastic or orthopedic surgery training. 2 New tendon repairs and hand therapy regimens are reported regularly. Occasionally, there is an announcement of a new treatment modality that promises hope for this clinical conundrum, but this rarely becomes part of standard practice. Over the past 50 years, there have been many innovations, but overall outcomes have not changed dramatically. For example, the best series published in the 1970s showed that a two-strand repair with simple circumferential suture and a Kleinert type rehabilitation regimen had a 5 percent rupture rate, with 75 percent of patients achieving good to excellent functional outcomes in 28 zone II injuries. 3 This compares favorably with more recent studies showing that a four-strand repair and early active mobilization regimen had a 5 percent rupture rate, with 71 percent achieving good to excellent outcomes in 73 cases. 4 Real paradigm shifts in this area require us to rethink the whole process of flexor tendon biology Disclosure: Neither author has a financial interest in any of the products or devices mentioned in this article.