Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial.
Emma Bamford, Hannah Berntsson, Suzanne Beale et al.
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In 30 seconds
The FIRST pragmatic, multicentre randomised trial compared forearm-based long, Manchester short, and relative motion flexion mini splints for rehabilitation after primary zone 1 or 2 finger flexor tendon repair. It enrolled 430 participants aged 16 years or older at 26 UK hospitals; 403 were included in the intention-to-treat analysis. Mean post-randomisation PRWHE scores were 24.5, 23.5, and 22.4, respectively, with no statistically significant differences between any splint groups. Serious adverse event rates were also similar, at 10%, 11%, and 11%.
Key findings
- Mean PRWHE scores were 24.5 with the long, 23.5 with the short, and 22.4 with the mini splint; no between-group difference was statistically significant.
- Adherence for at least five weeks was 83% (118/143) with the long, 76% (106/140) with the short, and 78% (115/147) with the mini splint.
- Serious adverse events occurred in 10% (14/143), 11% (15/140), and 11% (16/147) of participants in the long, short, and mini splint groups, respectively.
Why it matters
Splint choice is part of rehabilitation after flexor tendon repair, and this trial found comparable patient-reported wrist and hand outcomes across three commonly used approaches. The findings provide comparative evidence for clinicians and rehabilitation teams when considering these options, while the absence of a statistically significant difference does not establish that every splint is equivalent in all settings or patients.
What to keep in mind
Participants could not be masked to splint assignment, and 403 of the 430 randomised participants were included in the intention-to-treat analysis.