Abstract
Objective
To investigate which orthosis results in (1) fewer complications; (2) the least extensor
lag; and (3) the highest rates of treatment success according to the Abouna and Brown
criteria for soft tissue mallet injury in adults.
Data Sources
Electronic databases AMED, CINAHL, Embase, MEDLINE, PubMed, OTseeker, and PEDro were
searched from the earliest available date until September 16, 2014.
Study Selection
Controlled trials evaluating orthosis type in the conservative management of mallet
injury were included. Database searching yielded 1024 potential studies, of which
7 met inclusion criteria with a total of 491 participants.
Data Extraction
Data were extracted using an author-designed extraction form by one reviewer, and
accuracy was assessed by a second reviewer. The PEDro scale was used to assess methodological
quality.
Data Synthesis
Results were pooled using a random-effects model with inverse variance methods. Dichotomous
outcomes are expressed as risk ratios (RRs) and 95% confidence intervals (CIs) and
continuous outcomes as standardized mean differences and 95% CIs. There is moderate
quality evidence that prefabricated orthoses had 3 times the risk of developing skin
complications as compared with all other orthoses (RR, 3.17; 95% CI, 1.19–8.43; I2=47%) and nearly 7 times the risk of developing skin complications as compared with
custom-made thermoplastic orthoses (RR, 6.72; 95% CI, 1.59–28.46; I2=0%). Treatment outcomes were found to be similar for treatment success when prefabricated
orthoses were compared with custom-made orthoses (RR, .99; 95% CI, 0.80–1.22; I2=39%; very low quality evidence), as well as for extensor lag when custom-made thermoplastic
orthoses were compared with other orthoses (standardized mean difference, .03; 95%
CI, −.29 to .36; I2=0%; moderate quality evidence).
Conclusions
Prefabricated orthoses were found to increase the risk of developing skin complications
as compared with custom-made orthoses, but there were no differences in treatment
success, failure, or extensor lag.
Keywords
List of abbreviations:
CI (confidence interval), DIP (distal interphalangeal), PIP (proximal interphalangeal), RCT (randomized controlled trial), RR (risk ratio), SMD (standardized mean difference), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 08, 2015
Footnotes
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
