Comparison Between Early Active and Passive Motion Protocols on Hand Function and Satisfaction After Flexor Tendon Repair in Zones 1 and 2: A Pilot Randomized Controlled Trial

Abstract

Background: One of the key challenges in hand surgery and rehabilitation is the restoration of finger function after flexor tendon injury. Objectives: The present study aimed to evaluate the effects of the Strickland/Cannon (early active) and Modified Duran (passive) motion protocols on hand function and satisfaction in patients recovering from flexor tendon injuries in zones 1 and 2. Methods: Thirty patients with sharp flexor tendon injury in zones 1 and 2, who had undergone surgery using a four-strand suture technique, participated in this double-blind (patients and assessor) pilot randomized controlled trial. The sample size was determined according to the standards for pilot RCT studies, and randomization was carried out using the random numbers table method. The Modified Duran protocol was implemented in the early passive motion group (n = 15), and the Strickland/Cannon protocol was implemented in the early active motion group (n = 15), with thrice-weekly interventions over eight weeks, followed by a follow-up at 14 weeks. The primary outcome measures were the Canadian occupational performance measure (COPM) and the Michigan Hand Outcomes Questionnaire (MHQ). The disabilities of the arm, shoulder, and hand outcome (DASH), total active motion (TAM), Purdue Pegboard test (PPT), box and block test (BBT), Visual Analog Scale (VAS), and power grip/pinch evaluation were used to assess the secondary outcomes. A mixed repeated measures analysis of variance was used as the statistical method. Results: There was no patient attrition in the current study. The active motion group, similar to the passive motion group, exhibited improvements in occupational performance, satisfaction, and hand function. However, the differences between the groups were not statistically significant in any of the primary outcomes (P > 0.05). No significant differences were also observed in power and pinch grip, DASH scores, and dexterity tests, except for the two-handed PPT (P = 0.03) and TAM (P < 0.001). Conclusions: Both protocols clinically improved occupational performance, satisfaction, and hand function in patients with flexor tendon injuries in zones 1 and 2. The generalizability of the results should be considered due to the pilot nature of the study.