The Long-term Relationship between Duration of Treatment and Contracture Resolution Using Dynamic Orthotic Devices for the Stiff Proximal Interphalangeal Joint: A Prospective Cohort Study
STUDY DESIGN: Descriptive design with a prospective cohort. INTRODUCTION: Little is known about the long-term relationship between the duration of treatment using dynamic orthoses (splints), and contracture resolution in the stiff proximal interphalangeal (PIP) joint. PURPOSE OF THE STUDY: To examine the long-term relationship between weeks of treatment using dynamic orthoses and contracture resolution, in both flexion and extension deficits of the PIP joint. METHODS: Forty-one participants were treated with a dynamic orthotic device (splint) for either a flexion or extension deficit of the PIP joint (n=48 joints). The relationship between contracture resolution and weeks of treatment was examined controlling for baseline range of motion (ROM), weekly total end range time, pretreatment joint stiffness, time since injury, and diagnosis. Outcome was measured via change in torque and active ROM. RESULTS: Outcome with orthotic use was significantly associated with the weeks of treatment (p<0.001). ROM increased in a linear fashion although faster progress was observed when treatment was aimed at improving flexion rather than extension. Flexion deficits appeared to maximize gains with orthotic treatment after 12 weeks. However, extension deficits continued to demonstrate slow and continuous improvement beyond the 17 weeks of recorded data. Less treatment duration (in weeks) was needed to restore flexion than extension. CONCLUSIONS: The duration of orthotic use (weeks of treatment) is significantly associated with the extent of contracture resolution. Slower recovery of ROM and a longer duration of orthotic use may be expected when the treatment goal is to improve extension rather than flexion. LEVEL OF EVIDENCE: 2b.