The Effect of Early Active Range of Motion Following Tendon Transfers on Disability and Health Status: A Retrospective Cohort Study
Moaath Saggaf, MD1; Dimitri J Anastakis, MD2
1University of Toronto, Toronto, ON, Canada; 2Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
Purpose: The study aim was to compare the changes in patient-reported disability and health status between patients who underwent Early Active Range of Motion (EAROM) compared to patients who had delayed mobilization.
Methods: A retrospective cohort study design was used to evaluate adult patients treated with a tendon transfer from January 2004 to December 2019. Exclusion criteria were a prior tendon transfer, pediatric patients, upper motor neuron lesions, and a major psychiatric diagnosis. Cohorts were dichotomized based on the start of therapy within 21 days (EAROM) or after 21 days postoperatively. The primary outcome measures were the change in patient-reported disability, measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and health status, measured by Short-Form 36 (SF-36). Patients were assessed at baseline, six months, one year and two years following surgery. A Generalized Estimating Equation (GEE) model was used to estimate the effect at the population level after adjusting for age, sex and medical comorbidities.
Results: A total of 141 patients were reviewed for eligibility, and 49 patients completed both the DASH and SF-36 questionnaires. There were 37 (75.5%) participants in the EAROM cohort and 12 (24.5%) participants in the delayed mobilization cohort. The mean age of the participants was 40 years (SD= 16.6), and 18 patients (72%) were males. The majority of the study participants were employed (n=16, 64.0%). EAROM was found to be associated with a slight improvement in disability (beta= -4.5, 95% CI: -15.1 to 6.1, P=0.40). EAROM improved the bodily pain domain by 15.3 points, on average (95% CI: 2.1 to 28.6, P=0.02).
Conclusion: EAROM was associated with an overall improvement in patient-reported health status and the bodily pain domain of SF-36 compared to delayed mobilization following tendon transfers. Economic evaluation studies should compare the two rehabilitation strategies.
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