Dupuytren’s disease – do splints help people with this disabling hand condition?
This research was completed on 30 April 2010
Published on 31 January 2007
Around 2 million people in the UK have Dupuytren’s disease – their hands become disfigured, making many everyday tasks frustratingly difficult.(1) Surgery helps, but no-one knows whether splints, which some surgeons recommend, really aid subsequent rehabilitation. Researchers are conducting a clinical trial to find out once and for all.
What's the problem and who does it affect?
Dupuytren’s disease is an abnormal thickening of the tissues below the skin in the fingers and palm of the hand. Cords and nodules form, causing discomfort. The cords gradually contract, meaning the fingers – often the little finger and ring finger –bend into the palm. Sufferers have difficulty stretching out affected fingers, which causes problems with simple tasks like reaching into pockets, shaking hands and putting on gloves. Many sufferers worry that the disease will threaten their independence, and some find the appearance of their hands embarrassing. Surgery is the only available treatment. It can restore mobility in the fingers, helping sufferers regain more use of their hands. But it is not a cure. Unfortunately, the disease can recur and, in severe cases, people may even have fingers amputated. No-one knows whether splints help The success of surgery depends on the rehabilitative care provided after the operation. Some surgeons advocate using a static splint at night, which keeps the fingers in a straightened position, while others do not. The evidence as to whether splints are beneficial is weak and contradictory.
What is the project trying to achieve?
Do splints help people regain control of their hands?
The aim of surgery for Dupuytren’s, and of subsequent rehabilitative therapy, is to make people’s fingers fully mobile and supple, so they can use their hands normally. The purpose of this project is to find out whether night splints are beneficial after surgery. Researchers are recruiting about 130 people who are undergoing surgery for Dupuytren’s to take part in a clinical trial. Patients are being split randomly into two groups. People in one group will wear customised splints at night for 6 months after surgery, people in the other group will not. The splints are designed to keep the fingers stretched out as much as possible without putting tension on the surgical wound. Researchers will compare the recovery of patients in the two groups to find out whether or not splints affect the speed of recovery, improvements in use of the hands, and recurrence of the disease.
What are the researchers' credentials?
|Project Leader||Dr C Jerosch-Herold PhD|
|Location||School of Allied health Professions and Institute of Health, University of East Anglia and Department of Orthopaedics, Norfolk and Norwich University NHS Trust, Norwich|
|Grant awarded||31 October 2006|
|Start date||1 April 2007|
|End date||30 April 2010|
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The project team is multidisciplinary, comprising researchers and clinicians with national and international reputations in the fields of hand surgery, hand therapy, clinical trial design, medical statistics and project management. The project leader, Christina Jerosch-Herold, is an occupational therapist and researcher with an international reputation in the field of assessing the benefits of therapy and surgery to the hands. Dr Lee Shepstone is an expert in medical statistics and the design of clinical trials. Mr Adrian Chojnowski is an orthopaedic surgeon dedicated to hand surgery and Debbie Larson is a specialist hand therapist. Patients are being recruited from four teaching hospitals in East Anglia. The depth and breadth of expertise that the researchers bring to this multidisciplinary team mean they’re ideally placed to succeed in this project.
Who stands to benefit from this research and how?
Helping improve the outcome of surgery
Researchers hope this trial will reveal whether wearing a night splint after surgery for Dupuytren’s is beneficial, whether it makes no difference or, indeed, whether it does more harm than good. Surgeons and therapists will finally have the sound evidence they need to ensure they’re giving their patients the best possible care. Everyone who undergoes surgery for Dupuytren’s will eventually benefit from this research. If splints are found to be ineffective, then patients will be spared the inconvenience of wearing them. This will also save money, as custom-made splints are expensive – their construction takes up a lot of therapists’ time. In contrast, if splints are found to be beneficial, patients undergoing post-operative therapy in the future will probably be more motivated and willing to adhere to their treatment – they will know that the benefits of splints have been rigorously researched. The ultimate aim is to find out how to provide the most effective treatment for people with Dupuytren’s disease, so reducing their level of disability and speeding their return to everyday activities, work and hobbies.
1. Townley WA, Baker R, Sheppard N, Gobbelaar AO (2006) Clinical review: Dupuytren’s contracture unfolded. British Medical Journal 332:397-400