Continuous Passive Motion and Physical Therapy (CPM) versus Physical Therapy (PT) versus Delayed Physical Therapy (DPT) after Surgical Release for Elbow Contractures; A Prospective Randomized Controlled Trial

The elbow is prone to stiffness after trauma. To regain functional elbow motion
several conservative- and surgical treatment options are available.
Conservative treatment includes physical therapy, intra-articular injections
with corticosteroids, and a static progressive or dynamic splinting program.
If conservative treatment fails, an operative release -excision and release of
the scarred hypertrophic elbow capsule- of the posttraumatic stiff elbow is
often performed.
The best Evidence-Based rehabilitation protocol for patients after an operative
release is unknown, and therefore differs per surgeon, hospital and country to
date. Options include early- or delayed motion supervised by a physical
therapist, immediate continuous passive motion (CPM), (night) splinting, and a
static progressive or dynamic splinting program.

Objective of current study is to compare continuous passive motion in
combination with physical therapy (CPM) versus early motion supervised physical
therapy (PT) versus outpatient delayed supervised physical therapy (DPT) after
surgery for posttraumatic elbow contractures in a prospective randomized
controlled trial (RCT).

A multi-centre randomized controlled trial and 12 months follow-up.

The following rehab protocols are compared: regime of CPM with PT versus regime
of early motion PT supervised by an upper extremity specialized physical
therapist versus outpatient delayed PT supervised by an upper extremity
specialized physical therapist from postoperative day 7 as rehabilitation
protocol.

Based on Evidence, there is no rehabilitation protocol superior over any of the
other respective post-operative treatment options that patients will be
assigned to in this study. The different treatment options are commonly applied
rehabilitation protocols for operative release for posttraumatic elbow
stiffness. Main risk is residual stiffness for all treatment options,
irrespective of rehab strategy. However, this exposure is part of routine
clinical care for posttraumatic elbow stiffness and represents no increased
risk.
By conducting this study, we hope to make a statement on the efficacy of costly
in-hospital CPM in the treatment of post-operative rehabilitation for patients
undergoing surgery for their posttraumatic stiff elbow. Hereby, unnecessary
treatment burden for our patients (prolonged hospital stay, and lengthy CPM
sessions) as well as redundant costs for society can be avoided, a more
universal Evidence-Based method of treatment can be established and the quality
of the care can be improved.