Implementing an internal audit to change practice: Current evidence and review of patient outcomes enabled transition to the relative motion extension approach in the postoperative management of zones IV-VI extensor tendon repairs.
Evidence supports use of the relative motion extension (RME) approach following extensor tendon repairs in zones V-VI yielding good or excellent outcomes. To demonstrate how a 3-year internal audit and regular review of emerging evidence guided our change in practice from our longstanding use of the...
| Publicado en: | Journal of Hand Therapy Vol. 36; no. 2; pp. 389 - 400 |
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| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Apr2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=170745079&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 170745079 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08941130 4C0 jtl: Journal of Hand Therapy issn: 08941130 maglogo: N pubinfo: dt: Apr2023 vid: 36 iid: 2 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 170745079 170745079 170745079 10.1016/j.jht.2023.05.015 170745079 ppf: 389 ppct: 11 formats: tig: atl: Implementing an internal audit to change practice: Current evidence and review of patient outcomes enabled transition to the relative motion extension approach in the postoperative management of zones IV-VI extensor tendon repairs. aug: au: Pilbeam Kirk, Chloë E. Howell, Julianne W. Hirth, Melissa J. Johnson, Nick affil: Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK sug: subj: Tendon Injuries, Finger Surgery Tenotomy Rehabilitation Extension Hand Therapy Methods Treatment Outcomes Evaluation Postoperative Care Implementation Science Human Surgical Patients Audit Prospective Studies Adult Range of Motion Postoperative Complications Hand Therapists Surgeons Confidence Adult: 19-44 years ab: Evidence supports use of the relative motion extension (RME) approach following extensor tendon repairs in zones V-VI yielding good or excellent outcomes. To demonstrate how a 3-year internal audit and regular review of emerging evidence guided our change in practice from our longstanding use of the Norwich Regimen to the RME approach using implementation research methods. We compared the outcomes of both approaches prior to the formal adoption of the RME approach. Prospective clinical audit. A prospective audit of all consecutive adult finger extensor tendon repairs in zones IV-VII rehabilitated in our tertiary public health hand centre was undertaken between November 2014 and December 2017. Each audit year, outcomes were reviewed regarding the Norwich regimen and the RME early active motion approaches. As new evidence emerged, adjustments were made to our audit protocol for the RME approach. Discharge measurements of the range of motion of the affected and contralateral fingers and complications were recorded. During the 3-year audit, data was available on 79 patients (56 RME group including 59 fingers with 71 tendon repairs; 23 Norwich group including 28 fingers with 34 tendon repairs) with simple (n = 68) and complex (n = 11) finger extensor tendon zones IV-VI repairs (no zone VII presented during this time). Over time, the practice pattern shifted from the Norwich Regimen approach to the RME approach (and with the use of the RME plus [ n = 33] and RME only [ n = 23] approaches utilized). All approaches yielded similar good to excellent outcomes per total active motion and Miller's classification, with no tendon ruptures or need for secondary surgery. An internal audit of practice provided the necessary information regarding implementation to support a shift in hand therapy practice and to gain therapist or surgeon confidence in adopting the RME approach as another option for the rehabilitation of zone IV-VI finger extensor tendon repairs. • Audit is valuable in changing hand therapy practice alongside emerging evidence. • We have adopted relative motion post finger extensor tendon repairs in zones IV-VI. • Relative motion and Norwich's early active motion approaches provide similar outcomes. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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