Our research challenges the routine use of night splints after surgery for Dupuytren’ s contracture. Early adoption of our findings has influenced practice guidelines worldwide and saved NHS resources.
Duypuytren’s disease is a common hand disorder which causes the fingers to contract, in many cases causing considerable functional disability. It is most common in people of North European ancestry and results in over 16,000 operations in England each year to restore finger extension. Post-surgery care provided by hand therapists often involves patients wearing a night splint for up to six months. Splints are thought to maintain the finger extension and prevent recurrence of contractures but there has been some question over how effective they are and their use varies, with some surgeons routinely advocating splints for all patients.
Our research, funded by Action Medical Research, was the first definitive, multicentre, pragmatic randomised trial (SCoRD trial) which studied the effect of night splinting on patient-reported function, active range of movement and patient satisfaction. In the trial, 154 patients from five centres randomly received either only hand therapy or hand therapy with a night splint worn for six months. All patients were followed for 12 months after surgery.
The study showed that routine night-time splints were no more effective than providing splints only when a contracture recurs, which was in less than 20% of patients. It did not find any differences between groups regarding range of movement, patient satisfaction or the number of therapy sessions they required. These findings challenge traditionally held beliefs that splints are effective and necessary following surgery for Dupuytren’s contracture.
Several health care providers in the UK (BUPA), USA (Aetna) and New Zealand (Counties Manukau District Health Board of New Zealand) adopted our findings and no longer advocate routine addition of night-time splints to the post-operative care for patients with Dupuytren’s contracture.
The result of the SCORD trial had an impact on patient information leaflets at NHS trusts, public and patient information websites such as NHS Choices and clinical guidelines worldwide. One NHS Trust in England reported significant efficiency savings, with fewer patient attendances as a result of a change in policy to only provide splints if contractures recur.
Only splinting when a contracture recurs spares patients the inconvenience of wearing a splint at night, saves therapists’ time and reduces healthcare costs.