title: Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial.
abstract: BACKGROUND
  Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal.
  
  
  METHODS
  A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77) or hand therapy with night-splinting (n = 77). Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat.
  
  
  RESULTS
  148 (96%) patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703), total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172) or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315) at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes.
  
  
  CONCLUSIONS
  No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to patients having to wear a device, the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur.
  
  
  BACKGROUND
  The trial was registered as an International Standard Randomised Controlled Trial ISRCTN57079614.
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK. c.jerosch-herold@uea.ac.uk
authors.forename: Christina
authors.initials: C
authors.lastname: Jerosch-Herold
authors.forename: Lee
authors.initials: L
authors.lastname: Shepstone
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Chojnowski
authors.forename: Debbie
authors.initials: D
authors.lastname: Larson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Barrett
authors.forename: Susan P
authors.initials: SP
authors.lastname: Vaughan
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D004387:Dupuytren Contracture / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D005205:Fascia / Q000473:pathology / Q000503:physiopathology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D013165:Splints / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome