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20/28 Repair and rehabilitation of hand flexor tendon injury



We understand that many people will be prioritising NHS work and supporting COVID 19 research during the current pandemic. It is NIHR policy that these should always be the priority as reinforced by our April Programme Director’s message. It is also NIHR policy to keep the future research pipeline healthy and to support the research community. Please also note that these first stage applications do not need to contain a large amount of detail and that we only ask for estimates of costs at this stage.


The aim of the HTA Programme is to ensure that high quality research information on the effectiveness, costs and broader impact of health technology is produced in the most efficient way for those who use, manage, provide care in or develop policy for the NHS. Topics for research are identified and prioritised to meet the needs of the NHS. Health technology assessment forms a substantial portfolio of work within the National Institute for Health Research and each year about fifty new studies are commissioned to help answer questions of direct importance to the NHS. The studies include both primary research and evidence synthesis.

The HTA Programme is interested in proposals for definitive primary research to evaluate interventions used in the repair and/or rehabilitation of hand flexor tendon injuries. Applicants should clearly define and justify their choice of intervention(s), patient group, study design and outcome measures, and explain how the research will fit into the remit of the HTA programme.


Injury to the flexor tendons, which allow the fingers and thumb to bend, are a common occurrence. Such injuries are typically caused by cuts or crushing injuries and often result in a loss of movement, restricting the ability to carry out everyday activities or to work.

Flexor tendon injuries often require surgical intervention under general or regional anaesthetic to repair the tendon and restore function to the affected digit(s). The damaged tendon can be repaired by a number of different techniques which aim to produce a strong, low friction repair that can withstand early mobilisation. Rehabilitation is prescribed after surgical repair to promote healing and restore function. Types of rehabilitation vary and progress over time and may include elements such as patient education, prescription of an orthosis to protect the repair, and an exercise regimen.

Variations in repair technique or rehabilitation protocol can impact on the strength of the repair, the ability of the tendon to glide within the tendon sheath and the likelihood of adverse outcomes such as tendon rupture, formation of adhesions and poor functional recovery. Outcomes may also vary depending on which anatomical zone of the hand is affected and the time between injury and repair. There is currently a lack of high quality research to guide practice/inform guidelines for both repair and rehabilitation. It remains unclear which interventions are clinically and cost-effective and whether this differs for different types of injury.

The James Lind Alliance Priority Setting Partnership on Common Conditions Affecting the Hand and Wrist, a process that involved patients and clinicians, identified a research uncertainty around the best methods for repair and rehabilitation of tendon injuries. In response, the HTA Programme wishes to commission definitive primary research to evaluate interventions used in the repair and/or rehabilitation of hand flexor tendon injuries taking into account published and ongoing research in the field. Examples of topics of interest could include, but are not limited to, the clinical and cost-effectiveness of different repair techniques for adult flexor tendon injuries, the effectiveness and acceptability of splints with or without wrist immobilisation, interventions to increase patient compliance with rehabilitation, and the effectiveness of repair and/or rehabilitation interventions for children with flexor tendon injuries. Interventions should be defined and justified by applicants and are NOT limited to the aforementioned examples. Efficient study designs would be welcomed.

Making an application

If you wish to submit a Stage 1 application for this call, the online application form can be found on the Funding opportunities page.  To select this call, use the filters on the right of the screen or search using the call name and/or number.

Your application must be submitted on-line no later than 1pm on the 6 January 2021. Applications will be considered by the HTA Funding Committee at its meeting in March 2021.

Guidance notes and supporting information for HTA Programme applications are available by clicking the links.

IMPORTANT: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in July 2021.

Applications received electronically after 1300 hours on the due date will not be considered.

Should you have any queries please contact us:


Telephone: Commissioning Funding Committee 02380 595510