The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review.
Alison L Wong, Madeline Wilson, Sakina Girnary and 3 others
PMID 28400179WHAT IT FOUND
Early active motion after proximal extensor tendon repair gave better early finger motion and grip strength than static immobilization.
Immediate relative motion protocols returned patients to light duties around 3 weeks versus 9.4 weeks with static orthoses.
Key findings
01Early active motion protocols gave better total active motion than static protocols. At 4–6 weeks, dynamic extension orthoses produced 191–214° and relative motion orthoses 205–236°, compared with 79–202° for static orthoses.
02Grip strength improved more with early active motion than static treatment: dynamic extension 35–38 kg or 89% of the opposite side, relative motion 85–95%, and static 23–34 kg or 59%.
03Return to light duties was around 3 weeks (3.2–3.9) with immediate relative motion protocols, compared with 9.4 weeks for static orthoses.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 11 studies were included, and only two were considered high quality. The studies used different orthoses, motion protocols and outcome measures. Direct comparison was difficult. Blinding was not possible because the treatment involved an orthosis and a motion protocol. Loss to follow-up was 12–33% in eight studies, and dropout may reflect poor adherence rather than protocol effects. Patient adherence was rarely measured, and only three studies used different patient-reported outcome tools. Effect sizes could not be calculated because many studies did not report enough statistical outcomes. Three studies found no difference in long-term follow-up, so early gains may not persist.
Declared interests
The paper reports that Dr. Scott Paul is an employee of the NIH. No other funding or conflict-of-interest details are given.
The easy way to misread this
Do not conclude that one orthosis is proven superior to the others. The included studies used different orthoses and motion protocols. Direct comparison was difficult.