The effect of mobilization on repaired extensor tendon injuries of the hand: a systematic review

OBJECTIVE: To systematically review the available evidence comparing the effectiveness of different rehabilitation regimes in repaired extensor tendon injuries of the hand. DATA SOURCES: A systematic literature search of the Cochrane Library, MEDLINE (1950-January 2008), PEDro (up to January 2008), EMBASE (1980-January 2008) and CINAHL (1982-January 2008) databases was conducted, and reference lists were scanned for relevant studies. STUDY SELECTION: Studies on the rehabilitation of surgically repaired extensor tendon injuries of the hand in which patients received one of the following interventions: immobilization, early controlled mobilization, or early active mobilization. DATA EXTRACTION: The methodologic quality of the selected studies was assessed by 2 reviewers. All randomized controlled trials, high quality controlled clinical trials, and other design studies with sufficient quality were included in the best evidence synthesis. DATA SYNTHESIS: Four randomized controlled trials and 1 other design study were included. Short-term outcomes after immobilization were significantly inferior to outcomes after early controlled mobilization. Inconclusive findings suggested that early controlled mobilization might lead to better short-term effects (4 wk postoperatively) than early active mobilization. In time, differences in effects disappeared and 3 months postoperatively no significant differences were found between early controlled mobilization and early active mobilization. CONCLUSIONS: Although strong evidence was found for the short-term superiority of early controlled mobilization over immobilization for extensor tendons, no conclusive evidence was found regarding the long-term effectiveness of the different rehabilitation regimes. High quality prospective studies should be performed to further explore the outcomes of rehabilitation of extensor tendon injuries and to substantiate the available evidence