The use of the ICAM Splint Programme in Zone IV to VII Extensor Tendon Repairs: Patient outcomes and clinician experiences in a specialised hand unit in SA

Abstract

Background: The ICAM splint programme was developed in the 1980s and is known to produce favourable results in the 
management of extensor tendon repairs from zone IV to zone VII. It has only become popular in South Africa over the past 
several years and to the authors' knowledge its application in South Africa has not previously been reported.
Aim: The study sought to describe the use of the ICAM splint programme following an extensor tendon repair from zone IV to 
VII at a specialised hand unit in SA.
Methods: The study followed a concurrent mixed methods design. In phase one, a retrospective file audit was conducted with 
a sample of patients following the ICAM programme (n=75). Phase two involved individual therapist interviews (n=3), surgeon 
interviews (n=2) and a focus group with physiotherapists and occupational therapists (n=7) that had experience with the ICAM splint programme.
Microsoft excel was used to descriptively analyse phase one data and thematic analysis was used to analyse phase two data. 
Data were merged and represented in a joint display.
Results: The majority of patients (83%) were male with 40% in the age range of 26-35 years old. The injuries were mainly 
violence-related (69%) in comparison to accidental injuries (31%) with extensor tendon zone V (40%) and VI (47%) being the 
most commontly involved. Adherence was reportedly influenced by factors such as patients' financial status, education and language barriers.
Conclusions: The results suggest that the ICAM splint programme is beneficial in managing extensor tendon repairs from 
zone IV to VII. Therapists should consider factors that affect non-adherence when selecting patients for the ICAM programme 
to determine its suitability. Educating patients on the ICAM splint programme is essential to facilitate adherence. Novice 
therapists to the ICAM programme should receive formal training to improve confidence and skill.

Key words: ICAM splint programme, extensor tendon repair, zone IV to VII