The effect of mobilization on repaired extensor tendon injuries of the hand: a systematic review.

OBJECTIVE: To systematically review the available evidence comparing the effectiveness of different rehabilitation regimes in repaired extensor tendon injuries of the hand. DATA SOURCES: A systematic literature search of the Cochrane Library, MEDLINE (1950-January 2008), PEDro (up to January 2008), EMBASE (1980-January 2008) and CINAHL (1982-January 2008) databases was conducted, and reference lists were scanned for relevant studies. STUDY SELECTION: Studies on the rehabilitation of surgically repaired extensor tendon injuries of the hand in which patients received one of the following interventions: immobilization, early controlled mobilization, or early active mobilization. DATA EXTRACTION: The methodologic quality of the selected studies was assessed by 2 reviewers. All randomized controlled trials, high quality controlled clinical trials, and other design studies with sufficient quality were included in the best evidence synthesis. DATA SYNTHESIS: Four randomized controlled trials and 1 other design study were included. Short-term outcomes after immobilization were significantly inferior to outcomes after early controlled mobilization. Inconclusive findings suggested that early controlled mobilization might lead to better short-term effects (4 wk postoperatively) than early active mobilization. In time, differences in effects disappeared and 3 months postoperatively no significant differences were found between early controlled mobilization and early active mobilization. CONCLUSIONS: Although strong evidence was found for the short-term superiority of early controlled mobilization over immobilization for extensor tendons, no conclusive evidence was found regarding the long-term effectiveness of the different rehabilitation regimes. High quality prospective studies should be performed to further explore the outcomes of rehabilitation of extensor tendon injuries and to substantiate the available evidence.

The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review.

OBJECTIVE: To describe the effects of upper body training on the physical capacity of people with a spinal cord injury. DATA SOURCES: The databases of PubMed, CINAHL, Sport Discus and Cochrane were searched from 1970 to May 2006. REVIEW METHODS: The keywords 'spinal cord injury', 'paraplegia', 'tetraplegia' and 'quadriplegia' were used in combination with 'training'. The methodological quality of the included articles (both randomized controlled trials and controlled clinical trials) was assessed with the modified 'van Tulder et al.' checklist. Studies were described with respect to population, test design, training protocol and mode of training. The training effects on physical capacity, reflected by peak power output (PO(peak)) and oxygen uptake (VO(2peak)), were summarized. RESULTS: Twenty-five studies were included with a mean score of 8.8 out of 17 items on the quality checklist. The methodological quality was quite low, mostly because of the absence of randomized controlled trials. Therefore no meta-analysis was possible. In the 14 articles of acceptable quality the mean (SD) increase in VO( 2peak) and PO(peak,) following a period of training, was 17.6 (11.2)% and 26.1 (15.6)%, respectively. CONCLUSIONS: Due to the overall low quality of studies it is not possible to draw definitive conclusions on training effects for different lesion groups or training modes. The results of the relatively few studies with an acceptable quality seem to support the view that upper body exercise may increase the physical capacity of people with spinal cord injury. The magnitude of improvement in PO( peak) and VO(2peak), however, varies considerably among studies.