The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review

Alison L. Wong, Madeline Wilson, Sakina Girnary, Matthew Nojoomi, Soumyadipta Acharya, Scott M. Paul

Research output: Contribution to journalArticle

Abstract

Study Design Systematic review Introduction There exist numerous combinations of orthoses and motion protocols for the treatment of proximal extensor tendon injuries. Purpose The purpose of this study was to determine the optimal combination of motion protocol and orthotic treatment for the rehabilitation of proximal extensor tendon injuries (zones IV-VIII). Methods A systematic review of English language randomized clinical trials and cohort studies investigating extensor tendon rehabilitation from 1960 to 2016 was conducted in MEDLINE, Embase, Cochrane, CINAHL, PEDro, and OTseeker. Outcomes of total active motion, grip strength, return to work, patient attrition, and patient-reported outcomes were compared. Results Eleven studies of predominantly average quality (1, low; 8, average; and 2, high) were included in the final review. Results were difficult to compare due to differences in reporting. Early total active motion and final grip strength were greater with dynamic extension orthoses (191°-214° 35-38 kg/89% contralateral side) and relative motion orthoses (205°-236° 85%-95% contralateral side) compared to static orthoses (79°-202° 23-34 kg/59% contralateral side). Four studies excluded patients who did not follow up, and loss to follow-up was 12%-33% in the other studies. Patient-reported outcomes were not comparable, as they were only included in 3 studies, and each used a different assessment tool. Conclusion Average quality evidence supports the use of early active motion (EAM) as the superior motion protocol, but optimal orthosis to deliver EAM could not be determined. Prospective research should focus on patient-reported outcomes and the design of orthoses that facilitate the use of the EAM. Level of Evidence 2a

Original languageEnglish (US)
Pages (from-to)447-456
Number of pages10
JournalJournal of Hand Therapy
Volume30
Issue number4
DOIs
StatePublished - Oct 1 2017

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Tendon Injuries
Orthotic Devices
Splints
Hand Strength
Clinical Protocols
Rehabilitation
Return to Work
MEDLINE
Tendons
Cohort Studies
Language
Randomized Controlled Trials

Keywords

  • Extensor tendon
  • Motion protocol
  • Orthosis
  • Orthotic device
  • Rehabilitation
  • Systematic review

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII : A systematic review. / Wong, Alison L.; Wilson, Madeline; Girnary, Sakina; Nojoomi, Matthew; Acharya, Soumyadipta; Paul, Scott M.

In: Journal of Hand Therapy, Vol. 30, No. 4, 01.10.2017, p. 447-456.

Research output: Contribution to journalArticle

Wong, Alison L. ; Wilson, Madeline ; Girnary, Sakina ; Nojoomi, Matthew ; Acharya, Soumyadipta ; Paul, Scott M. / The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII : A systematic review. In: Journal of Hand Therapy. 2017 ; Vol. 30, No. 4. pp. 447-456.
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abstract = "Study Design Systematic review Introduction There exist numerous combinations of orthoses and motion protocols for the treatment of proximal extensor tendon injuries. Purpose The purpose of this study was to determine the optimal combination of motion protocol and orthotic treatment for the rehabilitation of proximal extensor tendon injuries (zones IV-VIII). Methods A systematic review of English language randomized clinical trials and cohort studies investigating extensor tendon rehabilitation from 1960 to 2016 was conducted in MEDLINE, Embase, Cochrane, CINAHL, PEDro, and OTseeker. Outcomes of total active motion, grip strength, return to work, patient attrition, and patient-reported outcomes were compared. Results Eleven studies of predominantly average quality (1, low; 8, average; and 2, high) were included in the final review. Results were difficult to compare due to differences in reporting. Early total active motion and final grip strength were greater with dynamic extension orthoses (191°-214° 35-38 kg/89{\%} contralateral side) and relative motion orthoses (205°-236° 85{\%}-95{\%} contralateral side) compared to static orthoses (79°-202° 23-34 kg/59{\%} contralateral side). Four studies excluded patients who did not follow up, and loss to follow-up was 12{\%}-33{\%} in the other studies. Patient-reported outcomes were not comparable, as they were only included in 3 studies, and each used a different assessment tool. Conclusion Average quality evidence supports the use of early active motion (EAM) as the superior motion protocol, but optimal orthosis to deliver EAM could not be determined. Prospective research should focus on patient-reported outcomes and the design of orthoses that facilitate the use of the EAM. Level of Evidence 2a",
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