Hand therapy or not following collagenase treatment for Dupuytren's disease? A randomized controlled trial

Collagenase treatment can improve finger extension and hand function in patients with Dupuytren's disease. The role of hand therapy in enhancing or prolonging these effects remains unclear.

The primary aim was to examine whether hand therapy, compared to no hand therapy, improves self-perceived occupational performance after collagenase treatment for Dupuytren's disease. The second aim was to investigate the effect of hand therapy on finger extension, grip strength, pain and overall patient impression. A third aim was to investigate whether outcomes differed between patients with metacarpophalangeal joint involvement only and those with combined metacarpophalangeal joint and proximal interphalangeal joint involvement.

Longitudinal randomized controlled trial with two parallel groups and four subgroups, registered at ClinicalTrials.gov.

Seventy-two patients with collagenase treated Dupuytren's disease were randomized to receive either hand therapy (Therapy group) or no hand therapy (Control group). Each group was stratified by joint involvement. The Canadian Occupational Performance Measure (COPM) was the primary outcome. Secondary outcomes were Unité Rhumatologique des Affections de la Main scale, finger joint goniometer, Jamar dynamometer, Visual Analog Scale for pain, and Patient Global Impression of Change and of Satisfaction.

At 1-year follow-up, no differences (mean difference (CI), p-value) were found between Therapy and Control groups in COPM scores: Metacarpophalangeal joint groups: COPM-P -0.2 (-1.9-1.4), p=0.519; COPM-S -0.6 (-2.3,1.2), p=0.450. Proximal interphalangeal joint groups: COPM-P -0.2 (-1.9,1.5), p=0.972; COPM-S -0.5 (-2.4,1.4), p=0.579. No significant differences were noted in secondary outcomes, except for pain and grip force CONCLUSIONS: Hand therapy did not improve COPM outcomes 1 year after collagenase treatment. Referral to hand therapy may be most beneficial for patients experiencing pain or requiring strong grip force. Whether more hand therapy improves residual proximal interphalangeal joint contractures remains unanswered.