151. Are the outcomes of relative motion extension orthoses non-inferior and cost-effective compared with dynamic extension orthoses for management of zones V-VI finger extensor tendon repairs: A randomized controlled trial.
- Author
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Bűhler, Miranda, Gwynne-Jones, David, Chin, Michael, Woodside, Joshua, Gough, Jamie, Wilson, Ross, and Abbott, J. Haxby
- Subjects
TENDON injuries ,GRIP strength ,WRIST joint ,CONFIDENCE intervals ,LABOR productivity ,HAND injury treatment ,PATIENT satisfaction ,REGRESSION analysis ,TREATMENT effectiveness ,RANDOMIZED controlled trials ,FUNCTIONAL assessment ,COST effectiveness ,DESCRIPTIVE statistics ,QUALITY of life ,QUESTIONNAIRES ,ORTHOPEDIC apparatus ,ALLIED health personnel - Abstract
• Noninferiority of relative motion extension (RME) plus to dynamic orthoses. • RME plus is an option to dynamic orthoses after zones V-VI tendon repair. • RME plus noninferior for range-of-motion and satisfaction at week-6 and -12. • The greatest costs were loss of wages and productivity due to time off work. There is no comparative evidence for relative motion extension (RME) orthosis with dynamic wrist-hand-finger-orthosis (WHFO) management of zones V-VI extensor tendon repairs. To determine if RME with wrist-hand-orthosis (RME plus) is noninferior to dynamic WHFO for these zones in clinical outcomes. Randomized controlled non-inferiority trial. Skilled hand therapists managed 37 participants (95% male; mean age 39 years, SD 18) with repaired zones V-VI extensor tendons randomized to RME plus (n = 19) or dynamic WHFO (n = 18). The primary outcome of percentage of total active motion (%TAM) and secondary outcomes of satisfaction, function, and quality of life were measured at week-6 and -12 postoperatively; percentage grip strength (%Grip), complication rates, and cost data at week-12. Following the intention-to-treat principle non-inferiority was assessed using linear regression analysis (5% significance) and adjusted for injury complexity factors with an analysis of costs performed. RME plus was noninferior for %TAM at week-6 (adjusted estimates 2.5; 95% CI -9.0 to 14.0), %TAM at week-12 (0.3; -6.8 to 7.5), therapy satisfaction at week-6 and -12, and orthosis satisfaction, QuickDASH, and %Grip at week-12. Per protocol analysis yielded 2 tendon ruptures in the RME plus orthoses and 1 in the dynamic WHFO. There were no differences in health system and societal cost, or quality-adjusted life years. RME plus orthosis wearers had greater injury complexity than those in dynamic WHFOs, with overall rupture rate for both groups comparatively more than reported by others; however, percentage %TAM was comparable. The number of participants needed was underestimated, so risk of chance findings should be considered. RME plus management of finger zones V-VI extensor tendon repairs is non-inferior to dynamic WHFO in %TAM, therapy and orthotic satisfaction, QuickDASH, and %Grip. Major costs associated with this injury are related to lost work time. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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