Item-level reanalysis of DASH outcomes after flexor tendon repair using Svensson’s non-parametric method

To examine longitudinal item-level changes in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire after flexor tendon repair and to compare outcomes between passive mobilisation with place-and-hold exercises and true active mobilisation. Randomised controlled trial with follow-ups at 3, 6, and 12 months postoperatively. Sixty-four patients were randomised before rehabilitation; 54 completed follow-up. DASH responses were reanalysed using Svensson’s non-parametric rank-based method to evaluate systematic group-level changes and individual variability at the item level. Symptom items showed the greatest deterioration relative to baseline, with 37–69% of patients reporting persistent impairment at 12 months. Patients most often rated symptom items as ‘mild’ and ‘moderate’. All symptom items and three of four social functioning items demonstrated significant changes at each follow-up, whereas only 8 of 21 activity items were consistently significant. No statistically significant differences were observed between treatment groups. One year after flexor tendon repair, patients continued to report difficulties, particularly with symptoms (stiffness, weakness, pain) and social interaction, while activity limitations were less prominent. These challenges were consistent across the cohort and did not differ between mobilisation protocols. Item-level analysis provided insights beyond total DASH scores, highlighting the clinical value of this approach. The original randomized controlled trial was conducted in accordance with the CONSORT guidelines and was registered on ClinicalTrials.gov, PRS (Protocol Registration and Result System) (ClinicalTrials.gov Identifier NCT04385485 protocol ID 1001). The trial was retrospectively registered on 20,170,704. The present study represents a secondary analysis, specifically an itemlevel reanalysis, of data from this trial.