Comparison of excursion-based approach with force-based approach in rehabilitation of repaired flexor tenons in zone ii and iii
Date
2017
Authors
Coates, Michelle Suzanne
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Abstract
This study explores the implementation of two different synergistic wrist motion
approaches in the treatment of flexor tendon injuries, the excursion-based
approach and the force-based approach. A prospective, quantitative, comparative
intervention research design was used to compare the two approaches and
determine their effectiveness in a public hospital in South Africa.
The five participants’ range of motion, independence in activities of daily living and
satisfaction levels were measured throughout the 12 week treatment programme.
The excursion-based group showed significant improvement in passive Strickland
and Glogovac scores over the rehabilitation period. The excursion-based group
also achieved better final place-and-hold and active Strickland and Glogovac
scores than the force-based group which showed a decline in these scores over
the 12 weeks. Both groups had a poor result for active movement at the final
session due to the development of adhesions, but were found to have an
improvement in their upper limb function measured on the Disabilities of the Hand,
Shoulder and Arm questionnaire in all activities except for those related to work.
These results were not statistically significant.
The poor results may be attributed to the unique challenges experienced by
patients with flexor tendon injuries, living in under-resourced South African
communities. The small sample and the fact that the excursion-based group
received isolated flexor digitorum profundus tendon repairs while the force-based
group received combined flexor digitorum profundus and flexor digitorum
superficialis repairs may also have had an impact on the results. The outcomes of
this study indicate that despite yielding successful results in research studies
performed in developed countries, it is unlikely that either of these approaches will
be suitable in the rehabilitation of patients with flexor tendon repairs in a public
hospital in South Africa.
Description
A dissertation submitted to the Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg
in fulfillment of the requirements for the degree of Master
of Science in Occupational Therapy
Johannesburg, June 2017