12 research outputs found
Hand therapy or not following collagenase treatment for Dupuytren's contracture? Protocol for a randomised controlled trial
Background: Dupuytren’s contracture (DC) is a fibrotic hand condition in which one or more fingers develop
progressive flexion deformities. Quality of life is diminished due to disabling limitations in performing everyday
activities. For DC patients treated with collagenase, referral for subsequent hand therapy is inconsistent. It is
unknown whether subsequent hand therapy is beneficial compared to no therapy. The purpose of this study is to
determine whether hand therapy improves DC patients’ performance of and satisfaction with performing everyday
activities one year after collagenase treatment.
Methods: We will conduct a randomised controlled trial with two treatment groups (hand therapy vs. control) of
DC patients who have received collagenase treatment. DC patients with contracted metacarpophalangeal joint(s)
(MCPJ) (hand therapy, n = 40; control, n = 40) and those with proximal interphalangeal joint(s) (PIPJ) involvement
(hand therapy, n = 40; control, n = 40) comprise two subgroups, and we will study if the treatment effect will be
different between both groups (n = 160). Patients with a previous injury or treatment for DC in the treatment finger
are excluded. Hand therapy includes oedema and scar management, splinting, movement exercises, and practice of
everyday activities. The main outcome variable is patients’ performance of and satisfaction with performing
everyday activities, as assessed with the Canadian Occupational Performance Measure. Secondary outcomes are DCspecific activity problems, as assessed with the Unité Rhumatologique des Affections de la Main scale, and active/
passive flexion/extension of treated joints and grip force using standard measuring tools, and self-reported pain
level. Demographic and clinical variables, degree of scarring, cold hypersensitivity, number of occupational sickleave days are collected. Self-reported global impression of change will be used to assess patient satisfaction with
change in hand function. Assessments are done pre-injection and 6 weeks, 4 months, and 1 year later. Standard
univariate and multivariate statistical analyses will be used to evaluate group differences.
Discussion: This study aims to assess whether hand therapy is beneficial for activity-related, biomechanical, and
clinical outcomes in DC patients after collagenase treatment. The results will provide an objective basis for
determining whether hand therapy should be conducted after collagenase treatment