Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.
Saint Joseph (Self-employed), MI, USA.
J Hand Ther. 2021 Jan-Mar;34(1):58-75. doi: 10.1016/j.jht.2019.12.019. Epub 2020 Mar 9.
Electronic Web-based survey.
Evidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide.
The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries.
Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their "most used" approach in the previous year.
There were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%).
In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis.
The RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.
基于电子网络的调查。
有证据支持术后伸肌腱修复管理中早期运动而非固定。目前使用了各种早期运动方案和矫形器，但没有一种方法被认为是优越的。目前尚不清楚全世界的手部治疗师是否以及如何使用早期运动。
本研究旨在确定是否存在首选方法，并确定国际手治疗学会正式会员国家的构成要素的实践模式。
参与这项英语调查的要求是，在过去一年中至少管理过一次伸肌腱修复术后的患者。调查的方法包括固定、早期被动（EPM）和早期主动（EAM）运动，通过休息手、动态、掌指关节（IPJ）自由或相对运动延伸（RME）矫形器来实现。调查流程取决于受访者对前一年“最常用”方法的回答。
来自 28 个国际手治疗学会成员国的 992 名个人做出了回应，其中包括 887 名符合条件的回应，完成率为 81%。最常用的方案顺序为 EAM（83%）、EPM（8%）和固定（7%）。用于实施 EAM 的两种最常用的矫形器是 RME（43%）和掌侧/IPJ 自由（25%）。RME 矫形器更有利于手部功能和运动的早期恢复。治疗师希望使用 RME/EAM 方法的障碍与对手术医生（70%）和诊所（24%）的偏好有关。
在实践中，许多治疗师会从多种方法中选择来管理 V 区和 VI 区伸肌腱修复。治疗师认为，使用 RME/EAM 方法达到的 TAM 优于其他方法。与文献相反，在实践中，许多治疗师修改基于前臂的掌侧/IPJ 自由矫形器以排除手腕来治疗这种诊断。
RME/EAM 方法被认为是首选方法。实践模式和证据并不总是一致的。
