A Hand Based Dorsal Blocking Orthosis for Zone II Flexor Tendon Repairs: A Prospective Randomized Controlled Pilot Study
Materi Miranda, OTD, CHT1; Cynthia Ivy, OTD, OTR/L, M.Ed., CHT2; Lucas Richer, OTS2; Melissa Frazier, OTD, OTR/L3; Maggie Miller, OTS2
1Northern Arizona University, Gilbert, AZ, 2Northern Arizona University, Phoenix, AZ, 3Hand Therapy Parnters, Mesa, AZ
Introduction: The purpose of this study is to determine if a hand based dorsal blocking orthosis compared to forearm based dorsal blocking orthosis will improve functional outcomes while preserving flexor tendon repairs. The pilot study compares outcomes of a traditional forearm based orthosis with a hand based orthosis following a zone II flexor tendon repair. Materials & Methods: This prospective pilot study randomly assigned patients to either the hand based dorsal blocking orthosis (2) or the forearm based dorsal blocking orthosis (4). Patients in both groups followed an early active range of motion flexor tendon rehabilitation protocol. Outcome measures including total active range of motion (TAM), total passive range of motion (TPM), and the QuickDASH were taken at initial evaluation, 4 weeks, 8 weeks, 12 weeks, and 6 months; strength was assessed at 8 weeks, 12 weeks and 6 months.
Due to the small sample size (6) of the feasibility study, exploratory data analysis (EDA) was performed to illustrate the effectiveness of hand based dorsal orthosis with that of a traditional forearm based dorsal blocking orthosis. Results: he results yield preliminary and useful insights to the efficacy of the two therapeutic approaches. Post-surgery, the results were almost identical after the first month for both the hand based and forearm based groups. Subsequent measurement periods at months 2, 3 and 6, the hand based group had higher scores than the forearm based group, which suggest that the hand based treatment protocol yielded better therapeutic outcomes when compared with the forearm group. The hand based group had higher QuickDash scores for months 1 and 2 but it subsequently had better scores for months 3 and 6. The QuickDash results also suggested that the hand based treatment protocol yielded better outcome especially in the later periods. At month 3, the hand based group had higher grip score than the forearm based group. At month 6, scores of the two groups converged.
Conclusion: Due to the small sample size, EDA was performed to illustrate the differences in outcome measures for the hand based and forearm based groups. Across different measures, the results triangulated and corroborated that the hand based treatment protocol had better outcomes, which provide justification for future study involving larger sample size for both groups. With sufficient sample size, inferential statistics such as mixed ANOVA could be performed to account for between and within-subject differences.
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