Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis

Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking. This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions. Systematic review. A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren’s release for improving total active extension (mean difference [MD] −2.8°, 95% confidence interval [CI]: −9.6° to 4.0°, p = 0.84), total active flexion (MD −5.8°, 95% CI: −12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: −2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: −0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD −16.7°, 95% CI: −20.1° to −13.3°, p