Efficacy of mirror therapy in improving hand function post flexor tendon repair
Abstract
The aim of this study was to determine the efficacy of mirror therapy (MT) in improving the total active range of motion (AROM) of the affected finger, hand grip strength, and hand function in patients with flexor tendon repair (FTR) in zone II. The study was an open-label, parallel-group, randomized controlled trial. Thirty patients with zone II FTR, aged 20-45 years, were recruited and randomized into two equal groups: the MT group and the sham MT group. The intervention began in the fourth week post-operation, consisting of thirty minutes of MT or sham MT, three sessions per week for four weeks, in addition to the traditional physical therapy (PT) program. The total AROM of the interphalangeal (IP) joints of the affected fingers, hand grip strength, and hand function were assessed. After four weeks of intervention, the percentage change in total AROM was 25.7% in the MT group and 19.93% in the sham MT group. Additionally, hand grip strength and Michigan Hand Outcomes Questionnaire (MHQ) scores showed greater improvement in the MT group compared to the sham MT group (p < 0.05). Adding MT to the traditional PT program may be more effective than the traditional PT program alone in improving the AROM of the interphalangeal (IP) joints of the operated fingers, grip strength, and MHQ scores.
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References
Arya, K. N. (2016). Underlying neural mechanisms of mirror therapy: Implications for motor rehabilitation in stroke. Neurology India, 64(1), 38-44. https://doi.org/10.4103/0028-3886.173622
Ayhan, E., Tuna, Z., & Oksuz, C. (2021). Getting better results in flexor tendon surgery and therapy. Plastic and Reconstructive Surgery- Global Open, 9(2), 1-6.
Bain, G. I., Polites, N., Higgs, B. G., Heptinstall, R. J. & McGrath. A. M. (2014). The functional range of motion of the finger joints. Journal of Hand Surgery, 40(4), 406-411.
Dy, C. J., Hernandez-Soria, A., Ma, Y., Roberts, T. R., & Daluiski, A. (2012). Complications after flexor tendon repair: a systematic review and meta-analysis. Journal of Hand Surgery, 37(3), 543–551. https://doi.org/10.1016/j.jhsa.2011.11.006
Henry, S. L., & Howell, J. W. (2020). Use of a relative motion flexion orthosis for postoperative management of zone I/II flexor digitorum profundus repair: A retrospective consecutive case series. Journal of Hand Therapy, 33(3), 296–304. https://doi.org/10.1016/j.jht.2019.05.002
Kang, Y. J., Ku, J., Kim, H. J., & Park, H. K. (2011). Facilitation of corticospinal excitability according to motor imagery and mirror therapy in healthy subjects and stroke patients. Annals of Rehabilitation Medicine, 35(6), 747–758. https://doi.org/10.5535/arm.2011.35.6.747
Karnati, V. P., Maddirala, R., & Mohammed, A. M. A. (2015). Effectiveness of mirror therapy on hand functions in subacute stroke patients. International Journal of Physiotherapy, 2(4), 646-651.
Khaja, A., Alroudhan, M., Hanna, S., Boshahri, M., AlAwad, M. & Alsamhan, A. (2020). Cross-cultural adaptation, validation and reliability of the Michigan hand outcomes questionnaire: The Arabic-version. BMC Musculoskeletal Disorders, 4(1), 1-6.
Klifto, C. S., Capo, J. T., Sapienza, A., Yang, S. S., & Paksima, N. (2018). Flexor Tendon Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 26(2), 26–35. https://doi.org/10.5435/JAAOS-D-16-00316
Lilly, S. I., & Messer, T. M. (2006). Complications after treatment of flexor tendon injuries. The Journal of the American Academy of Orthopaedic Surgeons, 14(7), 387–396. https://doi.org/10.5435/00124635-200607000-00001
Matthys, K., Smits, M., Geest, J. N., Van der Lugt, A., Seurinck, R., Stam H. J. & Selles, R. W. (2009). Mirror induced visual illusion of hand movements: A functional magnetic resonance imaging study. Archives of Physical Medicine and Rehabilitation, 90(4), 675-681.
Neiduski, R. L., & Powell, R. K. (2019). Flexor tendon rehabilitation in the 21st century: A systematic review. Journal of Hand Therapy, 32(2), 165-174.
Neumann, D. A. (2013). Kinesiology of the kinesiology of the musculoskeletal system: Foundations for rehabilitation. Elsevier Health Sciences.
Newington, L., Ross, R., & Howell, J. W. (2021). Relative motion flexion splinting for the rehabilitation of flexor tendon repairs: A systematic review. Hand Therapy, 26(3), 102–112. https://doi.org/10.1177/17589983211017584
Rizzolatti, G., & Craighero, L. (2004). The mirror-neuron system. Annual Review of Neuroscience, 27, 169–192. https://doi.org/10.1146/annurev.neuro.27.070203.144230
Rrecaj, S., Martinaj, M., Murtezani, A., Ibrahimi-Kaçuri, D., Haxhiu, B., & Zatriqi, V. (2014). Physical therapy and splinting after flexor tendon repair in zone II. Medical Archives (Sarajevo, Bosnia and Herzegovina), 68(2), 128–131. https://doi.org/10.5455/medarh.2014.68.128-131
Sanmartín-Fernández, M., Fernández-Bran, B., & Couceiro-Otero, J. (2017). Home-based rehabilitation in the postoperative treatment of flexor tendon repair. Rehabilitación domiciliaria en el tratamiento postoperatorio de la reparación de los tendones flexores. Revista Espanola de Cirugia Ortopedica y Traumatologia, 61(4), 224–232. https://doi.org/10.1016/j.recot.2017.02.006
Savage, R., Pritchard, M. G., Thomas, M., & Newcombe, R. G. (2005). Differential splintage for flexor tendon rehabilitation: an experimental study of its effect on finger flexion strength. Journal of Hand Surgery, 30(2), 168–174. https://doi.org/10.1016/j.jhsb.2004.10.014
Shaker, H., Fahmy, E., Anwar, E., Honin, N. & Shaheen, S. (2020). Effect of mirror therapy on hand functions in Egyptian chronic stroke patients. The Egyptian Journal of Neurology Psychiatry and Neurosurgery, 56(1), 1-6.
Tang, J. B., Lalonde, D., Harhaus, L., Sadek, A. F., Moriya, K., & Pan, Z. J. (2022). Flexor tendon repair: recent changes and current methods. The Journal of Hand Surgery, 47(1), 31–39. https://doi.org/10.1177/17531934211053757
Thieme, H., Morkisch, N., Rietz, C., Dohle, C., & Borgetto, B. (2016). The Efficacy of Movement Representation Techniques for Treatment of Limb Pain--A Systematic Review and Meta-Analysis. The Journal of Pain, 17(2), 167–180. https://doi.org/10.1016/j.jpain.2015.10.015
Thill, S., Caligiore, D., Borghi, A. M., Ziemke, T., & Baldassarre, G. (2013). Theories and computational models of affordance and mirror systems: an integrative review. Neuroscience and Biobehavioral Reviews, 37(3), 491–521. https://doi.org/10.1016/j.neubiorev.2013.01.012
Trosclair, D. Bellar, D., Judge, L. W., Smith, J., Mazerat, N. & Brignac, A. (2011). Hand-grip strength as a predictor of muscular strength and endurance. Journal of Strength and Conditioning Research, 25, 89-99.
Yavuzer, M., Selles, R., Sezer, N., Tomruk S. S., Bussmann, J., Köseoğlu, F., Atay, M. & Stam, H. (2008). Mirror therapy improves hand function in subacute stroke: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89(3), 393-398.
Zarraa, A., Ahmed, E., Khalil, A. & Abd El Baky, A. (2022). Relative motion protocol versus place and hold protocol after hand zone ii flexor tendon repair: A Prospective randomized controlled trial. The Egyptian Journal of Hospital Medicine, 89(2), 6617-6621.
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