Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial
BMJ · 27 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Flexor tendon repairs in zones 1 and 2 are common hand injuries, and this is the first large randomised comparison of the splints therapists choose between after surgery.
The evidence
This UK trial randomised 430 adults after zone 1 or 2 finger flexor tendon repair to one of three custom splints: a long forearm-based splint, the Manchester short splint, or a small finger-based relative motion flexion (mini) splint. Across 52 weeks, patient-rated pain and disability (PRWHE, 0 to 100, lower is better) was similar in all groups; for example the long versus mini adjusted difference was 2.3 points (98.3% CI -1.9 to 6.5), well under the 6-point target difference. Rupture and serious adverse event rates were also broadly similar, though the trial was not powered for safety.
Mean postrandomisation PRWHE score over 52 weeks (long versus short splint): Mean difference 0.3 (95% CI -4 to 4.6; PRWHE). The interval includes no difference. This does not establish equivalence or rule out an important effect.
Why this rigour score?
Multicentre RCTDesign starting point: 63.4
Raised the score
- Blinded outcome assessment+6.8
- Adequately powered+6
Lowered the score
- 6% loss to follow-up−0.1
- 12-month follow-up−0
Score capped at 55. The conclusion asserts a benefit the primary outcome did not show.
Methods at a glance
Recorded assessment- Outcome assessors blindedMet
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisMet
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 63.4
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Compared against current standard of care
- +3.4
- Blinded outcome assessment
- +6.8
- Intention-to-treat analysis
- +3.4
- 12-month follow-up
- −0
- 6% loss to follow-up
- −0.1
- Adequately powered
- +6
- Prospectively registered
- +5.1
- Methodological cap
- −40.5
- Final rigour score rounded
- 55 / 100
Study design sets the starting point and a ceiling of 100. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If the long, short, and mini splints give similar patient-reported outcomes, how should a hand surgeon and therapist decide which splint a manual worker versus an office worker receives?
2.Given that rupture rates of 5% to 10% were seen in all groups, how would you counsel a patient about protecting the repair and the warning signs of rupture during the first six weeks?
Original publication title
Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial