Article

Over the past decade, early
mobilization (initiated within a week) has become an increasing trend in
postoperative rehabilitation after tendon transfer surgery in the hand. However,
there are no published reviews summarizing the effectiveness of early
mobilization protocols in comparison with conventional immobilization in tendon
transfer rehabilitation. PURPOSE: To systematically review available evidence on
the effectiveness of early mobilization protocols to conventional immobilization
protocol after tendon transfers in the hand. METHODS: A literature search of the
Cochrane Library, PubMed, PEDro, EMBASE, and CINAHL databases was conducted (1980
to date). Randomized controlled trials (RCTs), case-control, and other study
designs were included. Six articles were eligible for inclusion in the analysis
(five RCTs and one retrospective study) and 260 articles that did not meet
inclusion criteria were excluded. Level of evidence (Center for Evidence-based
Medicine) and methodological quality (Structured Effectiveness Quality Evaluation
Scale [SEQES] score) of each study were assessed by two independent reviewers.
RESULTS: This review found three high quality trials (SEQES score: 35-43 of 48),
with level 1b and 2b evidence, supporting early mobilization of tendon transfers.
The literature reports reduced total cost, total rehabilitation time, and
demonstrates that early mobilization is a safe approach with no incidence of
tendon ruptures or insertion pull out. In the initial phase of rehabilitation,
outcomes like range of motion, grip strength, pinch strength, total active motion
of digits, deformity correction, and tendon transfer integration were
significantly superior with early mobilization compared with immobilization.
However, in the long term, these outcomes were similar in both the groups,
suggesting that early mobilization protocol improves hand function in the initial
phase of rehabilitation (four weeks) and the long-term results (two months to one
year) are equivalent to immobilization. CONCLUSIONS: Based on a limited number of
small studies, there is evidence of short-term benefit for early mobilization,
but inconclusive findings for longer-term outcomes. Until the body of evidence
increases, clinicians should consider the clinical context, their experience in
optimizing patient outcomes after surgery, and the patient's preferences when
selecting between early and late mobilization after tendon transfer. LEVEL OF EVIDENCE: 2a.
CI - Crown Copyright (c) 2013. Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS