A meta-analysis comparing active and passive rehabilitation protocols following flexor tendon surgery
Nader Paskima1, Michael Walsh2, Frank Lovecchio3, Anand Panchal4
1Department of Orthopedic Surgery, The New York University Hospital for Joint Diseases
2Department of Division of Outcomes Studies, The New York University Hospital for Joint Diseases
3Department of Emergency Medicine, Maricopa Medical Center
4Department of Orthopedic Surgery, Grandview Hospital Medical Center
Keywords: Data collection; exercise therapy/methods; finger injuries/surgery/rehabilitation; meta-analysis; tendon injuries/ surgery/rehabilitation.
Objectives: The purpose of this meta-analysis was to determine which type of rehabilitation protocol (active versus passive) was superior following surgical repair of zone 2 flexor tendon lacerations.
Patients and methods: We searched Medline, the Cochrane Library, bibliographies of published texts, reviews, reports, and interviewed experts in the field. Three reviewers examined all sources of potential articles independently and compiled a list of potential articles. The reports were categorized into three groups: randomized controlled trials (RCT), clinical trials (CT) and case series (CS). Data were analyzed on Stata Intercool 7 using a random-effects model for meta-analysis.
Results: Following various steps of the exclusion process, three CTs and 25 CSs remained. Meta-analysis of three CTs showed a relative risk ratio of 1.2 (95% CI 0.78, 1.85) when comparing the active versus passive groups in terms of “good-excellent” outcomes. The pooled risk ratio for rupture rate in the clinical trials of active versus passive groups was 2.58 (95% CI 0.985, 6.759). Secondary to a scarcity of extractable information from CTs, case series using the active or passive protocol were also meta-analyzed individually. Using meta-regression, the differences in proportions of “good-excellent” outcomes and rupture rates between passive and active case series were found as -0.01 (95% CI -0.17, 0.15) and 0.029 (95% CI -0.033, -0.025), respectively.
Conclusion: Based on the review of three comparative series and the pooled estimates of the case series, there is a lack of robust evidence favoring active versus passive mobilization protocols with regard to outcomes and rupture rates.