Can Relative Motion Extension Splinting (RMES) Provide an Earlier Return to Function Than a Controlled Active Motion (CAM) Protocol? A Randomised Clinical Trial
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Various active mobilisation protocols are used after repair of extensor tendons in zone V and VI. These include relative motion extension splinting (RMES) and controlled active motion (CAM) protocols. Similar outcomes are reported for most early active mobilisation protocols, however reports on RMES protocols suggest a possible earlier return to work and functional use of the affected hand. To date no published prospective trials have compared the RMES to other early active mobilisation protocols. This randomised clinical trial prospectively investigated whether patients with extensor tendon repairs in zone V and VI managed with an RMES protocol would return to functional use of the hand sooner than those managed with an extensor CAM protocol. Between January 2015 and February 2016, 42 participants who had undergone extensor tendon repair in zone V and/or VI were recruited to the study. They were randomised into two groups: one group was treated using a CAM protocol, the other an RMES protocol. Participants were reviewed at four and eight weeks post-operatively. The primary outcome was the Sollerman Hand Function Test (SHFT) score. Secondary outcomes included: days to return to work, total active motion (TAM), grip strength the QuickDASH (Disabilities of Arm, Shoulder and Hand) questionnaire and participant satisfaction. Complications were recorded. The RMES group demonstrated significantly better results than the CAM group at four weeks with regard to the SHFT mean score (p=0.0073), the QuickDASH score (p=0.77) and TAM (p=0.008). At eight weeks the RMES group continued to show better results than the CAM group for TAM (p=0.030), but there was no difference between groups for the SHFT and QuickDASH scores. Median days to return to work were similar between groups with RMES group 20 days (Interquartile range [IQR]: 12, 57) and CAM 18 days (IQR: 6, 55), (p=0.77). There was no significant difference between groups with regard to grip strength at eight weeks. RMES participants reported a significantly higher level of satisfaction with the splint than the CAM group (p<0.0001). No tendon ruptures occurred in either group. One RMES participant underwent tenolysis surgery and there was no significant difference in complication rates between groups. This is the first randomised clinical trial to prospectively compare an RMES protocol to a CAM protocol. Participants treated with an RMES protocol demonstrated better early return to functional use of the hand than those treated with a CAM protocol, and RMES participants continued to show better range of motion than CAM participants at eight weeks. RMES participants were also more satisfied with splinting than CAM participants. There was no difference in return to work timeframes, possibly due to factors outside the control of the study. No ruptures occurred in either group, complication rates were low and not significantly different between groups. This study has demonstrated that an RMES protocol provides an earlier return to hand function than a CAM protocol for patients who have undergone extensor tendon repair in zone V and VI.