Yates Sally E, Glinsky Joanne V, Hirth Melissa J, Fuller Joel T
Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Healthia Limited, Brisbane, Queensland, Australia.
Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
J Hand Ther. 2024 Oct-Dec;37(4):495-506. doi: 10.1016/j.jht.2023.12.018. Epub 2024 Jan 26.
Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking.
This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions.
Systematic review.
A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation.
Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren's release for improving total active extension (mean difference [MD] -2.8°, 95% confidence interval [CI]: -9.6° to 4.0°, p = 0.84), total active flexion (MD -5.8°, 95% CI: -12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: -2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: -0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD -16.7°, 95% CI: -20.1° to -13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion.
The addition of an extension orthosis following procedures to manage Dupuytren's contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion.
近端指间关节（PIPJ）活动受限会给手部受伤和患病的人带来严重的功能障碍。已经对手部矫形器干预改善PIPJ活动的作用进行了研究；然而，高质量的系统评价和荟萃分析尚缺乏。
本研究旨在确定矫形器干预对手部受伤或患病后恢复PIPJ伸展/屈曲的有效性。
系统评价。
在MEDLINE、CINAHL、Embase、Cochrane Central和PEDro中进行了全面的文献检索，使用了与矫形器、手指PIPJ活动范围和随机对照试验设计相关的术语。采用PEDro评分评估方法学质量，尽可能使用随机效应荟萃分析汇总研究结果，并使用推荐分级评估、制定和评价方法评估证据的确定性。
纳入12项试验（PEDro评分：4 - 7/10）。在Dupuytren挛缩松解术后，增加矫形器干预在改善总主动伸展（平均差[MD] -2.8°，95%置信区间[CI]：-9.6°至4.0°，p = 0.84）、总主动屈曲（MD -5.8°，95% CI：-12.7°至1.2°，p = 0.70）、手臂、肩部和手部残疾评分（MD 0.4，95% CI：-2.7至3.6，p = 0.79）或患者满意度（标准化MD 0.20，95% CI：-0.49至0.09，p = 0.17）方面并不比单纯手部治疗更有效。对于创伤性手指损伤或手术后的固定屈曲畸形，矫形器干预在改善PIPJ伸展方面比单纯手部治疗更有效（MD -16.7°，95% CI：-20.1°至-13.3°，p < 0.001）。没有研究评估矫形器干预改善PIPJ屈曲的效果。
在处理Dupuytren挛缩的手术之后增加伸展矫形器在改善PIPJ伸展方面并不比单纯手部治疗更好。相比之下，对于存在创伤性PIPJ固定屈曲畸形时增加PIPJ伸展矫形器在改善PIPJ伸展方面比单纯手部治疗更有效。未来需要研究评估矫形器干预在改善PIPJ屈曲方面的作用。
