Outcome measurement in adult flexor tendon injury: A systematic review

Shaw, AbigailV; Holmes, D.E.; Rodrigues, JeremyN; Lane, JenniferCE; Gardiner, MatthewD; Wormald, Justin C.R.

doi:10.1016/j.bjps.2021.08.033

Cited by 5 publications

(3 citation statements)

References 49 publications

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“…Clinical uncertainty surrounds many aspects of care including patient information, surgical repair method, splinting, rehabilitation and outcome measurement. [3][4][5][6][7] Restoration of movement and function after flexor tendon repair remains a challenge, particularly for zone II injuries. 8,9 Rehabilitation must find the balance of protecting the repair site from attenuation or rupture, while also enabling sufficient movement and tendon glide to prevent scar adhesions and joint contractures.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Hence, the need arises to standardize the outcome measures that has been raised by several authors. 14 30 35 36 Our review illustrates that these differences still exist and that Noaman's criteria which is developed solely for zone V has not been extensively explored. As a solution to this variability, Peters et al (2021) suggested the use of goniometric measurement for affected digits that is individual joint flexion/extension measurements and TAM as it is easier to compare and interpret the clinical significance across groups within a study and across studies comparing the same interventions.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Outcome Measures of Zone V Flexor Tendon Injury: A Systematic Review

Cardoz Lobo,

Manek,

Bhosale

et al. 2023

Indian J Plast Surg

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Background Flexor tendon injury zone V is a multicomponent soft tissue injury involving tendons, nerves, and vessels. Outcome assessment of repair thus requires evaluation of the hand as a whole rather than solely evaluating tendon function. The purpose of this Preferred Reporting Items for Systematic Reviews and Meta-Analyses -compliant systematic review was to identify and assess the components of outcome measures used in flexor zone V. Methods A total of 3,761 studies were retrieved from four databases (PubMed, ProQuest, Cochrane Central, and Google Scholar). These studies were then screened for inclusion using a validated screening form. Fifteen articles fulfilling the eligibility criteria were included in the review. Subsequently, the included studies were assessed for methodological quality using the Joanna Brigg Institute tool. Results Out of the 15 studies, 11 were case series, 3 were cross-sectional studies, and 1 was a randomized controlled trial. Out of 15 included studies, 13 were of low risk, whereas 2 studies suggested moderate risk when assessed for methodological quality using the Joanna Brigg Institute tool. Eight outcome measures were identified, out of which the most frequently used were Total Active Motion by the American Society for Surgery of Hand (TAM-ASSH) and Noaman's criteria. Our study found that Noaman's criteria assessed sensory-motor function and finger deformity in addition to the range of motion (ROM), which was found to be assessed by all the other outcome measures. Conclusion We concluded that although Buck-Gramcko criteria is well suited for the ROM evaluation, Noaman's criteria, a recently developed outcome measure used exclusively for combined injuries in zone V, took into consideration the implications of nerve injury along with tendon function. Although being specifically designed for combined injuries of tendons, nerves, and vessels in zone V, there is a lack of usage of Noaman's in the literature. There still exists a lack of a consistent and appropriate choice of outcome measure.

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“…Most studies measure the range of motion (ROM) in degrees of the injured finger (Libberecht et al., 2006), which is then converted to one of typically four words of quality (Excellent, Good, Fair and Poor) using a predetermined set of criteria (Karjalainen et al., 2019). The criteria most used are those of Strickland's original method (Strickland and Glogovac, 1980); however other methods, such as that of Buck-Gramcko or the total active motion as proposed by the American Society for Surgery of the Hand (ASSH) are also used occasionally (Shaw et al., 2022; Tang, 2005). The classification into four groups (Excellent, Good, Fair and Poor) is an interpretation that has not been thoroughly validated in terms of how it relates to patient-reported outcome measures (PROMs) (Karjalainen et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Patient-reported outcome measures and their association to the original Strickland classification after flexor tendon repair

Renberg

Svingen

Arner

et al. 2023

J Hand Surg Eur Vol

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The aim of this study was to examine the relationship between patient-reported outcome measures (PROMs) and the original Strickland classification after flexor tendon injuries in Zones 1 and 2. Data were collected from the Swedish national health care registry for hand surgery (HAKIR). The studied PROMs were the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) and the patient questionnaire from the HAKIR (HQ-8). Complete data of both range of motion (ROM) and PROMs were available for 215 patients at 3 months after surgery, and for 150 patients at 12 months after surgery. We found that QuickDASH values were low and similar between all groups as classified by the Strickland system at 12 months. A statistically significant difference between PROM values (for stiffness and satisfaction) was found only between the Strickland groups Fair and Good, but not between Poor and Fair or Good and Excellent. This suggests that further categorization according to the Strickland classification is less important to the patients as long as they regain 70% of their ROM. Level of evidence: III

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Outcome measurement in adult flexor tendon injury: A systematic review

Cited by 5 publications

References 49 publications

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

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

Evaluation of Outcome Measures of Zone V Flexor Tendon Injury: A Systematic Review

Patient-reported outcome measures and their association to the original Strickland classification after flexor tendon repair

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