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Title: 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.
Austin Authors: Hirth, Melissa J ;Hunt, Ian;Briody, Kelly;Milner, Zoe;Sleep, Kate;Chu, Angela;Donovan, Emily;O'Brien, Lisa
Affiliation: Occupational Therapy Department, Western Health, Footscray, Victoria, Australia
Occupational Therapy Department, Monash Health, Dandenong, Victoria, Australia
Occupational Therapy Department, Melbourne Health, Parkville, Victoria, Australia
Occupational Therapy
Malvern Hand Therapy, Malvern, Victoria, Australia
Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia
TIA, College of Sciences and Engineering, University of Tasmania, Tasmania, Australia
Issue Date: 13-Aug-2021
Date: 2021
Publication information: Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists 2021-08-13
Abstract: Multi--center randomized controlled trial with two intervention parallel groups. An equivalence trial. 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. To examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields clinically similar outcomes. 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. 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. 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. 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.
DOI: 10.1016/j.jht.2021.06.006
Journal: Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists
PubMed URL: 34400031
Type: Journal Article
Subjects: Occupational Therapy
Orthotic Devices
Physical Therapy Specialty
Tendon Injuries
Appears in Collections:Journal articles

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