Evaluation of the effect of virtual reality based task specific exercises on functional level and disease related quality of life in patients with hand flexor tendon injury

Introduction and Aim: Flexor tendon injuries have an important place in hand injuries and can lead to serious disabilities. In hand rehabilitation, especially in the last decade, the use of virtual reality applications in addition to conventional treatments has been widely accepted in the clinical environment. In our study, we aimed to investigate the effects of virtual reality-based task-specific exercises applied in addition to conventional rehabilitation program on functional level and disease-related quality of life in patients who underwent surgical repair due to flexor tendon damage due to traumatic hand injury. Patients and Methods: Within the scope of our study, which was planned as a randomised controlled prospective study, 52 patients who applied to Ankara City Hospital - Physical Medicine and Rehabilitation Hospital, Traumatic Hand Rehabilitation Outpatient Clinic with operated hand flexor tendon injury between 01/06/2021-31/01/2022 and met the study criteria were included. Group 1 (study group) consisted of patients who received a virtual reality-based task-specific exercise programme in addition to the early passive mobilisation programme and Group 2 (control group) consisted of patients who received the early passive mobilisation programme. Our patients were evaluated at the beginning of the study (postop 6th week- T1) after the four-week virtual reality programme and at the end of the study (postop 10th week- T2). Range of motion was measured with a goniometer and fine grip strength of the hand was measured with a pinchmeter. The functional level of dexterity and coordination was assessed by Nine-Hole Peg Test (NHPT), dexterity-related activity limitations in activities of daily living were assessed by Duruöz hand index (DEI) and Quick DASH (Quick Disability of Arm, Shoulder and Hand), and quality of life was assessed by Short Form 36 (SF-36). Results: In both study and control groups, statistically significant improvements were observed in goniometric measurements, fine grip strength measurement, DEI, Quick DASH scores and NHPT completion times after treatment compared to the pretreatment period (p<0.05). However, when the changes in these parameters after treatment compared to pretreatment were compared between the groups, the results were similar (p>0.05). When SF-36 scores were analysed, statistically significant improvements were found in the other subgroups except for mental health and general health subgroups in both groups before and after treatment (p<0.05). When the change amounts of SF-36 subgroups were analysed; there was no significant difference between the groups in the post-treatment period compared to the pretreatment period in all subgroups (p>0.05). When total passive motion (TPM) and total active motion (TAM) classifications were analysed before treatment, the majority of the patients were in the middle class. After the treatment, it was observed that most of the patients in both groups were in the good class. When the classification distributions were compared between the groups, there was no statistically significant difference both before and after treatment (p>0.05). Conclusion: In our study, we did not find any superiority of virtual reality-based task-specific exercises applied in addition to conventional rehabilitation programme on functional level and disease-related quality of life of patients with operative traumatic flexor tendon injury compared to conventional methods. On the other hand, the significant improvement in functional level and quality of life in both groups compared to the beginning of treatment proves the effectiveness of the conventional rehabilitation programme once again. Since there are few studies in the literature examining the effects of virtual reality-based exercise applications in hand flexor tendon rehabilitation, there is no agreed upon treatment protocol. In addition to the limited number of studies in this field, our study may contribute to the literature in providing data and pioneering new research. In order to evaluate the effectiveness of virtual reality applications in the rehabilitation of flexor tendon injuries and to determine appropriate design and standard protocols, studies with larger sample groups, more number and duration of sessions and post-treatment follow-up evaluations are needed. Keywords: flexor tendon rehabilitation, virtual reality, task specific exercise