A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial

OBJECTIVE: Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon. DESIGN: Prospective multi-centre randomised controlled trial. SETTING: Four hand surgery departments in Sweden. SUBJECTS: A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52). INTERVENTION: A smartphone application to facilitate rehabilitation. MAIN OUTCOME MEASURES: Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks. RESULTS: Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8–13.3), 11.8 (CI 11.0–12.8) for the intervention group, and 13.3 (CI 12.6–14.0), 12.8 (CI 12.0–13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9–99.5) compared to the controls 82.9 (CI 76.9–88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction. CONCLUSION: The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed. LEVEL OF EVIDENCE: I. Randomised controlled trial