Comparison of Early Passive and Active Mobilization Protocols in Flexor Tendon Repair Rehabilitation of the Hand
Condition: Tendon Injuries
MeSH terms: Tendon Injuries
Study type: Interventional

Summary: 
      Many active and passive rehabilitation programs are applied in the rehabilitation processes
      after flexor tendon repair. There is no clear rehabilitation program accepted by the whole
      world. An accurate understanding of these injuries at the histological and biomechanical
      level is necessary to improve rehabilitation outcomes. Mechanical properties of tendons, such
      as their viscoelasticity, are affected by the increase in stiffness caused by the rupture,
      repair, and healing process. Previous studies have shown that the mechanical properties of a
      repaired tendon, such as stiffness, material properties and functionality of tendon tissue
      Shear-wave elastography can detect pathological changes in tendinopathy before they are
      visible on conventional Ultrasonography imaging. In addition, shear wave elastography allows
      the evaluation of quantitative measurements and is considered more objective because it
      provides reproducible results. Our aim in this study is to evaluate the changes in the
      mechanical properties of the hand flexor tendons repaired using shear wave elastography (SWE)
      during the rehabilitation process and natural process and their effect on functionality.
    

Detailed description: 
      Patients' affected tendons will be evaluated by shear wave elastography within 3 - 5 days
      after surgery. The tendons of the healthy hands of the patients will also be evaluated as the
      control group.

      Afterwards, patients will be randomized into two groups by computer-assisted randomization.

      Group 1: early passive mobilization Within 3 to 5 days following surgery, patients will begin
      using a dorsal forearm-based orthosis with 30* flexion of the wrist, 70* flexion of the
      metacarpophalangeal (MCP) joints, full extension of the interphalangeal (IF) joints. Home
      exercises will be performed as passive flexion and active extension exercises with rubber
      band 10 times per hour on the postoperative 3rd day for 3 weeks. Passive flexion and
      extension exercises will be performed ten times a day, four times a day, on the MCP +
      Proximal Interphalangeal (PIP) + IF joints. The bands will be removed at night and the
      fingers will be kept in full extension. In 3 weeks, the orthosis will be modified so that the
      wrist is in a neutral position and the MCP joints are extended a little more. Approximately 3
      weeks after the repair, the dorsal orthosis will be removed during the exercises, and
      non-resistance active movement and tenodesis exercises will be started in the presence of a
      physiotherapist. From the 6th week, the dorsal orthosis will be worn only at night, tendon
      gliding exercises and blocking exercises will be started.

      Group 2: early active mobilization Patients will begin to use a dorsal forearm-based orthosis
      that positions the wrist in a neutral position, metacarpophalangeal (MCP) joints 50* -70*
      flexion, IF joints in full extension within 3 to 5 days after surgery. After the flexion
      active extension exercises, full passive flexion of the fingers with the other intact hand
      and then gently keeping the fingers in the flexion position for 3-5 seconds when the
      contralateral hand is raised will be performed for 3 weeks, no force will be applied on the
      fingers. Passive flexion and extension exercises will be performed ten times a day, four
      times a day, on the MCP + PIP + IF joints. These exercises will be organized as a home
      exercise program. The patients will be evaluated by the physiotherapist and clinician once a
      week in the first two weeks of the exercises, and 3 days a week in the third week, in terms
      of monitoring the exercises, and the exercises will be shown again. The bands will be removed
      at night and the fingers will be kept in full extension. Approximately 3 weeks after the
      repair, the dorsal orthosis will be removed during the exercises, and the patients will be
      started with non-resistance active movement and tenodesis exercises in the form of a home
      exercise program 3 days a week with a physiotherapist on the remaining days. From the 6th
      week, the dorsal orthosis will be worn only at night, tendon gliding exercises and blocking
      exercises will be started.

      Patients will be evaluated by an investigator blinded to the treatment groups at week 8 and
      week 12 using the following methods.

        1. Tendon elasticity will be evaluated with shear wave elastography

        2. Measurements of hand grip strength and pinch strength (only at 12 weeks) will be
           evaluated with a dynamometer device.

        3. Duruoz Hand Index will be filled.

        4. Total active movements of the fingers will be calculated.
    

Intervention name(s): early active mobilization; early passive mobilization
Intervention type(s): Procedure; Procedure
Intervention description(s): In the active rehabilitation group, active extension and passive flexion of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints were performed with kleinert splint at angles suitable for active mobilization group.Then, the patients were asked to passively flex the injured side with their healthy hand and hold it in the flexion position for 3-5 seconds.; In the passive rehabilitation group, active extension and passive flexion of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints were performed with kleinert splint at angles suitable for passive mobilization group.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients were divided into two groups as early active and passive mobilization groups. The angles of the dorsal orthoses of the active and passive groups were different. In the home exercise program in the active group, in addition to the exercises in the passive group, flexion was continued for 3-5 seconds at the end of passive flexion. The rehabilitation program was similar apart from these distinctions.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment