Determinants of positive functional outcomes at 16 weeks after flexor tendon repair at a teritiary hospital in South Africa. A descriptive, analytical study

Master Thesis


Permanent link to this Item
Journal Title
Link to Journal
Journal ISSN
Volume Title
Title: Determinants of positive functional outcomes at 16 weeks after flexor tendon repair at a tertiary hospital in the Eastern Cape of South Africa: A descriptive, analytical study. Introduction: Flexor tendon injuries account for a substantial number of hand injuries presenting to health care facilities, yet rehabilitation following flexor tendon repair remains a challenge. There is limited research pertaining to flexor tendon rehabilitation in middle economic income countries like South Africa. Objectives: The aim was to identify determinants of positive functional outcomes sixteen weeks after flexor tendon repair at a tertiary hospital in South Africa. The objectives were: 1) to describe the functional outcomes at four, eight, twelve and sixteen weeks post flexor tendon repair using total active motion (TAM), muscle strength and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, 2) to ascertain the demographic profile for patients presenting to the hospital with a flexor tendon injury, 3) to describe the rate of recovery between the four assessment intervals, and 4) to cross-culturally translate the DASH questionnaire into isiXhosa. Method: Ethical approval was obtained through the University of Cape Town’s Human Research Ethics Committee. A quantitative, descriptive, analytical design was used. The DASH was translated as per the guidelines for cross-cultural translation by the Institute for Work and Health. All patients presenting to the target institution with a flexor tendon injury between February and August 2017 formed the sample. Twenty-two participants were recruited. Participants were assessed at four, eight, twelve and sixteen weeks post operatively using TAM, muscle strength and the DASH questionnaire. Demographic and treatment factors for each participant were compared to 16-week DASH scores using Mann-Whitney U and Kruskal-Wallis ANOVA tests. The rate of recovery was analysed using Spearman’s Rank Correlation Coefficient, Friedman’s ANOVA and Wilcoxon Matched Pairs for TAM, DASH score and muscle strength respectively. Results: Time to repair was the only factor to have statistical significance at 16-weeks post operatively (H(df=9)=15.3; p=0.05). Rate of recovery when compared to DASH (F(df=3)=12.98; p=0.005) and muscle strength (Z=3.076; p=0.002) scores showed statistical significance, though TAM did not (rs(df=2)=0.06; p=0.78). The epidemiological profile was similar to those documented elsewhere in South Africa and globally. Conclusion: The outcomes achieved in the present study were poorer than those described in the vast body of literature in the field, but similar to those described in a similar cohort elsewhere in the country. The demographic profile was similar to those previously documented in South Africa and across the globe, but with different environmental and institutional barriers. Rate of recovery appears greatest between four and eight weeks, as well as between weeks twelve and sixteen. Time to repair showed that it is not harmful to delay primary flexor tendon repair up to six days post injury. Recommendations for future policy, education, practice and research were made.