In 2013, a committee of surgeons from the British Society of Surgery to the Hand (BSSH) including representative hand therapists, set up a National Trauma Working Group to develop the first hand trauma standards of care. These standards were intended to inform commissioners, providers and patients to improve hand trauma services nationally.
As these standards would include postoperative rehabilitation, a separate committee of specialised hand therapists was also formed with the support of the British Association of Hand therapists (BAHT) to produce standards for therapists working in this field.
A group of eight hand therapists representing units from across the UK, with extensive experience in the rehabilitation of tendon injury convened in December 2014 with the aim of producing standards to compliment those of those set by the surgeons.
After careful discussion, taking into consideration differing practices and geographical and demographic variation across the UK, it was decided that evidence based standards should reflect this and facilitate audit, without specific details of individual treatment regimens.
These standards relate to the treatment of all flexor tendon injuries of the hand, wrist and forearm in all age groups.
- Following surgery all patients should be referred to a recognized hand therapist for assessment and formulation of a treatment plan. Access to accurate operative details is required.
- Following a robust repair the selected rehabilitation regimen should be initiated ideally between 3 – 5 days and before 7 days.
- The regimen of choice should include a protective splint and an active motion component to promote tendon glide.
- Patients should be offered Hand Therapy on a weekly basis for at least six weeks.
- The postoperative rehabilitation regimen should be supported by both written and verbal information.
- Range of motion should be measured at 6 and 12 weeks and outcome measures taken as a core data set including a patient recorded outcome measure (PROM) at the point of discharge.
Implementation of these standards should be used to guide and advise therapists in the field. However, it is recognised that they may be influenced by factors including access to hand therapy, injury and patient characteristics and surgical management. Professional judgement , based on clinical reasoning will strongly influence the management and outcome following flexor tendon injury.
Our standards will be presented to the surgeons group at BSSH in October 2015.
It is anticipated that on the completion of writing of the surgeons standards, that the two documents will work together to enhance and compliment each other.
- European Federation of Societies for Hand Therapy (EFSHT), Hand Therapist Profile, Education Committee May 2012
- Yi Cao, J.B. Tang. Resistance to motion of flexor tendons and digital oedema. An in vitro study in chicken model. J. Hand Surg (Am) 2006 31; 1645-51
- Starr HM, Snoddy M, Hammond KE, Seiler JG III. Flexor tendon repair rehabilitation protocols: A systematic review. J Hand Surg Am. 2013;38:1712-7
- Peck FH, Bucher CA, Watson JS, Roe AE. An Audit of Flexor tendon Injuries in zone II and its influence on management. J Hand Therapy, 1996 Oct-Dec;9(4);306-8
- NHS institute for Innovation and Improvement, 2006-13. Quality and Service Improvement Tools Patient Information
- Valdes K, MacDermid J, Algar L, Connors B, Cyr LM, Dickmann S, Lucado AM, Naughton N. (2014) Hand therapist use of patient report outcome (PRO) in practice: A survey study. Journal of Hand Therapy. 27 (4): 299–308.