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. If conservative treatment fails, an operative release –excision and release of the scarred hypertrophic elbow capsule– of the posttraumatic stiff elbow is often performed. After surgical treatment, several rehab protocols are available, but based on evidence, there is no rehabilitation protocol superior over any of the post-operative treatment options that patients will be assigned to in this study. The following rehab protocols will be compared: 3-day in-hospital regime of CPM with PT versus 3-day in-hospital 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. 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

No difference in range of motion at 12 months follow-up

Clinical assessment will be performed preoperatively (baseline), during surgery, at day three, at day ten, eight weeks, five months and one year after surgery.

Patients that are assigned to the ‘CPM’ group will receive in-hospital CPM in combination with supervised physical therapy the first three days after surgery and supervised physical therapy from day three till day 14 postoperative. Patients that are assigned to the ‘PT’ group will receive in-hospital supervised physical therapy the first three days after surgery and supervised physical therapy from day three till day 14 postoperative. Patients that are assigned to the ‘DPT’ group will receive outpatient physical therapy from postoperative day 7 till 14 and will be discharged from the hospital immediately after surgery. Physical therapy includes both active and passive exercises; moreover patients will be invited to practice at home as well.