A Comparison of the outcomes of two rehabilitation protocols after flexor tendon repair of the hand at Chris Hani Baragwanath Academic Hospital

Abstract

Flexor tendon repair of the hand and rehabilitation are frequently discussed between hand surgeons and therapists. This is mainly due to the poor outcomes commonly achieved after this type of surgery. There are many patients in public hospitals in South Africa who require flexor tendon repair surgery. They are regularly sent to therapists for rehabilitation, where the early passive motion protocol is commonly implemented. Although the early active motion protocol has yielded improved results globally, there is limited evidence on the comparison of the outcomes of these two protocols in the South African context. The aim of the study was to compare the outcomes of an early active motion protocol to the outcomes of an early passive motion protocol in patients with zone II to IV flexor tendon repairs of the hand, attending rehabilitation at Chris Hani Baragwanath Academic Hospital. The study was a quantitative single-blinded comparative controlled trial. Forty-six patients who sustained a zone II-IV flexor tendon injury were recruited for the study and equally distributed between the two groups (early active motion and early passive motion). Out of these participants, 11 did not return for the initial assessment at four weeks post-surgery and were therefore excluded. There were 19 participants in the early active motion group and 16 participants in the early passive motion group. Results were collected and classified at 4, 8 and 12 weeks post-surgery. Data collection took place from December 2014 to January 2016 in the Chris Hani Baragwanath Academic Hospital Hand Unit. At 12 weeks post-surgery, the total active motion, fingertip to table, and distal palmar crease measurements were similar between the two groups. Tendon rupture occurred in 8.57% (n=3, early active motion = 5.71%, early passive motion = 2.86%) of patients. This study found that there was no difference in outcomes between the two groups. Therefore, either protocol could be implemented in South African public hospitals. However, since the early active motion protocol takes less time to implement, this protocol is recommended. A study with a greater magnitude would be necessary to determine a significant comparison between the two groups; however, this is challenging due to poor patient compliance.