Variation in patient information and rehabilitation regimens after flexor tendon repair in the United Kingdom

Abstract

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) short DBS; and (iii) relative motion flexion splint. Duration of full-time splint wear ranged from 4 to 6 weeks. There were variations in splint design and composition of home exercise programmes, particularly for the long DBS. Where reported, recommended return to driving ranged from 8 to 12 weeks, and return to light work activities ranged from 5 to 10 weeks. Discussion Treatment guidelines varied across UK hand therapy departments, suggesting that patients receive differing advice about how to protect, move and use their hand after zone I/II flexor tendon repair. The disparity in splint wear duration, home exercise frequency and prescribed functional restrictions raises potential financial and social implications for patients. Future research should explore rehabilitation burden in addition to clinical outcomes.

Relative motion flexion following zone I-III flexor tendon repair: Concepts, evidence and practice.

“…Conversely, too much flexion relative to the unaffected digits may prohibit active movement and tendon gliding. To date, only four small studies have published data on the use of RMF orthoses after flexor tendon repair, and MCP joint differential flexion ranged from 15-40° (8,10,14,20).…”

“…Finally, a cross-sectional evaluation of flexor tendon rehabilitation guidelines across UK hand therapy departments identified one RMF guideline, which advocated a minimum of 20° differential flexion (20).…”

“…This may also depend on the RMF orthosis design, for example whether the orthosis conforms with the transverse metacarpal arch or has a flatter arrangement (23). Interestingly, none of the identified RMF studies reported different differential flexion targets for individual fingers (8,10,14,20).…”

“…Henry and Howell describe positioning in wrist flexion for their first three patients, before switching to the extended position, which they now advocate (8). In the single RMF rehabilitation guideline identified in the UK, the advocated wrist position was 0-15° extension (20).…”

Relationship between pain, nerve injury and clinical outcomes after flexor tendon injuries in zones 1-2: a retrospective cohort study

“…3 The therapists' expertise during the different rehabilitation regimens is fundamental to safely guiding the patients through the recovery process, in conjunction with a continuous and standardized measurement of the treatment outcomes. [4][5][6] In this day and age, patient-reported outcome measures (PROMs), such as satisfaction with treatment results and pain should be documented in support of clinician-reported outcome measures (CROMs), such as grip and pinch strength or range of motion. 7 The patient's perceived level of pain is an important factor that guides the therapeutic process and may delay or even hinder the recovery of finger motion and resumption of daily activities.…”