Outcome measures will be gathered at baseline and weeks 3, 5 and 8 after the commencement of treatment (Table 1 ).
The primary outcome measure will be passive PIPJ extension. Passive PIPJ extension will be assessed in a standardised way as described by American Society of Hand Therapists (ASHT) [18 ]. Assessment of Passive Range of Motion (PROM) with a goniometer has been shown to be consistently reliable when standardised methods are implemented [18 ].
Secondary outcome measures for this study will include AROM and PROM of other joints, grip strength, oedema, pain level, function and treatment adherence will be captured.
AROM of all the joints of the injured digit including the Metacarpal Phalangeal Joint (MCPJ), PIPJ and DIPJ. This will be compared to the contralateral uninjured digit and will be undertaken using a single goniometer. In addition to AROM, Total Action Motion will be calculated and compared to the uninjured contralateral digit as per the ASHT guidelines [18 ].
PROM of all the joints of the injured digit will be compared to the contralateral uninjured digit and will be undertaken using a single goniometer. PROM can provide information about a joint’s capacity for motion [19 ] and ensure the home exercise program is tailored specifically to the patients’ impairments. In addition, Total Passive Motion will be calculated and compared to the uninjured contralateral digit [18 ].
Grip strength will be assessed using a standardised Jamar Dynamometer and adopting a standardised testing procedure as per the ASHT guidelines [19 ]. A single score of maximum effort will be recorded for the injured and uninjured side [20 (link)].
Oedema will be assessed using standardised testing procedure as described by ASHT guidelines. A standardised tape measure will be used to take a circumferential measurement of the PIPJ [21 ] and compared to the contralateral uninjured side.
Pain will be assessed using a Numerical Rating Scale. The patient will be asked to rate their pain between ‘0' and ‘10', with ‘0' describing ‘no pain’ and ‘10’ used to describe ‘worst pain imaginable’. Pain will also be assessed using the pain section of the Patient Rated Wrist and Hand Evaluation (PRWHE), which has been demonstrated to be a valid and reliable assessment of patient rated function and disability and complements the Numerical Rating Scale to assess pain in a holistic way [22 ].
Function will be assessed using the PRWHE, which has been shown to have good levels of evidence for validity, reliability [23 ] and responsiveness to trauma [24 (link)]. Return to work/everyday activities status will be determined by asking the patient if they have returned to their pre-injury roles, modified role or not at all. The adverse impact of hand injuries on return to work and everyday activities have been reported in the literature [25 (link)].
Adherence to treatment will be assessed via a questionnaire developed based on the work of SandfordBarlow [26 (link)]. The questionnaire asks the same key questions regarding adherence to treatment such as, if the splint has been removed, how often it may have been removed and why it may have removed but adapted slightly to reflect the different diagnostic group. This will be measured at the three-week assessment point, after this stage, patients will cease wearing the orthosis/buddy loop full time and commence a weaning process.
The primary outcome measure will be passive PIPJ extension. Passive PIPJ extension will be assessed in a standardised way as described by American Society of Hand Therapists (ASHT) [18 ]. Assessment of Passive Range of Motion (PROM) with a goniometer has been shown to be consistently reliable when standardised methods are implemented [18 ].
Secondary outcome measures for this study will include AROM and PROM of other joints, grip strength, oedema, pain level, function and treatment adherence will be captured.
AROM of all the joints of the injured digit including the Metacarpal Phalangeal Joint (MCPJ), PIPJ and DIPJ. This will be compared to the contralateral uninjured digit and will be undertaken using a single goniometer. In addition to AROM, Total Action Motion will be calculated and compared to the uninjured contralateral digit as per the ASHT guidelines [18 ].
PROM of all the joints of the injured digit will be compared to the contralateral uninjured digit and will be undertaken using a single goniometer. PROM can provide information about a joint’s capacity for motion [19 ] and ensure the home exercise program is tailored specifically to the patients’ impairments. In addition, Total Passive Motion will be calculated and compared to the uninjured contralateral digit [18 ].
Grip strength will be assessed using a standardised Jamar Dynamometer and adopting a standardised testing procedure as per the ASHT guidelines [19 ]. A single score of maximum effort will be recorded for the injured and uninjured side [20 (link)].
Oedema will be assessed using standardised testing procedure as described by ASHT guidelines. A standardised tape measure will be used to take a circumferential measurement of the PIPJ [21 ] and compared to the contralateral uninjured side.
Pain will be assessed using a Numerical Rating Scale. The patient will be asked to rate their pain between ‘0' and ‘10', with ‘0' describing ‘no pain’ and ‘10’ used to describe ‘worst pain imaginable’. Pain will also be assessed using the pain section of the Patient Rated Wrist and Hand Evaluation (PRWHE), which has been demonstrated to be a valid and reliable assessment of patient rated function and disability and complements the Numerical Rating Scale to assess pain in a holistic way [22 ].
Function will be assessed using the PRWHE, which has been shown to have good levels of evidence for validity, reliability [23 ] and responsiveness to trauma [24 (link)]. Return to work/everyday activities status will be determined by asking the patient if they have returned to their pre-injury roles, modified role or not at all. The adverse impact of hand injuries on return to work and everyday activities have been reported in the literature [25 (link)].
Adherence to treatment will be assessed via a questionnaire developed based on the work of SandfordBarlow [26 (link)]. The questionnaire asks the same key questions regarding adherence to treatment such as, if the splint has been removed, how often it may have been removed and why it may have removed but adapted slightly to reflect the different diagnostic group. This will be measured at the three-week assessment point, after this stage, patients will cease wearing the orthosis/buddy loop full time and commence a weaning process.
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