Is hand splinting effective for adults following stroke? A systematic review and methodological critique of published research

Background: Upper limb hemiplegia after stroke is common and disabling. Hand splints are widely used to prevent contracture and reduce spasticity. Objective: To assess the effectiveness of hand splinting on the hemiplegic upper extremity following stroke. Search strategy: A search was conducted of the Cochrane Central Register of Controlled Trials; the electronic databases MEDLINE, EMBASE, CINAHL, PEDro, SCI, SSCI; websites of professional associations; reference lists in trial reports and other relevant articles. Selection criteria: Studies of the effect of upper extremity splinting on motor control, functional abilities, contracture, spasticity, or pain in the hand or wrist. Data collection and analysis: Validity of studies was assessed systematically and a content analysis was conducted of the methodologies used. Methodological quality of randomized trials was rated by two independent assessors using the PEDro scale. Results: Nineteen studies were appraised for content. Of these, most (63%) were reports of case series. Four studies (21%) were randomized controlled trials. Methodological scores of trials ranged from 2 to 8 (maximum possible score 10). One trial of nominally ‘medium’ quality reported that in‘atable arm splinting makes no difference to hand function (mean difference on Fugl-Meyer Assessment –0.12, 95% confidence interval (CI) –9.8 to 9.6). The remaining trials investigated effects of thermoplastic splints; one trial of ‘high quality’ reported no difference in contracture formation in the wrist and finger ‘exor muscles after wearing a hand splint which positioned the wrist in the traditional functional position for 12 hours each night for four weeks (mean difference in range of movement after four weeks was 1°, 95% CI –3.7° to 6.1°; power >80%). All remaining trials were of poor methodological quality. Limited research and lack of a no-splint control group in all trials to date limit the usefulness of these results. Reviewer's conclusion: There is insufficient evidence to either support or refute the effectiveness of hand splinting for adults following stroke.

[1]  R. Boyd,et al.  Current evidence for the use of botulinum toxin type A in the management of children with cerebral palsy: a systematic review , 2001, European journal of neurology.

[2]  J. Mackinnon,et al.  The Effects of Splinting on the Spastic Hemiplegic is Hand: Report of a Feasibility Study , 1991 .

[3]  M. Donohue,et al.  A survey of rationales for and against hand splinting in hemiplegia. , 1981, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[4]  Hui-ing Ma,et al.  A synthesis of the effects of occupational therapy for persons with stroke, Part II: Remediation of impairments. , 2002, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[5]  Proposal for splinting the adult hemiplegic hand to promote function. , 1988, Occupational therapy in health care.

[6]  V. Mathiowetz,et al.  Immediate effects of positioning devices on the normal and spastic hand measured by electromyography. , 1983, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[7]  Jack Crosbie,et al.  Does stretching induce lasting increases in joint ROM? A systematic review. , 2002, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[8]  L. Bouter,et al.  Occupational Therapy for Stroke Patients: A Systematic Review , 2003, Stroke.

[9]  P. Flett.  Rehabilitation of spasticity and related problems in childhood cerebral palsy , 2003, Journal of paediatrics and child health.

[10]  S. Sahrmann,et al.  Review of length-associated changes in muscle. Experimental evidence and clinical implications. , 1982, Physical therapy.

[11]  Susan Edwards,et al.  Neurological Physiotherapy: A Problem-Solving Approach , 2002 .

[12]  Effect of splinting on reflex inhibition and sensorimotor stimulation in treatment of spasticity. , 1962, Archives of physical medicine and rehabilitation.

[13]  M. Radomski,et al.  Occupational therapy for physical dysfunction , 1977 .

[14]  G. Stoms,et al.  Psychological impact of abortion: methodological and outcomes summary of empirical research between 1966 and 1988. , 1989, Health care for women international.

[15]  A comparison of volar and dorsal splinting of the hemiplegic hand. , 1968, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[16]  Colleen G. Canning,et al.  Key Issues in Neurological Physiotherapy , 1991 .

[17]  Brennan Jb.  Response to stretch of hypertonic muscle groups in hemiplegia. , 1959 .

[18]  Catherine Sherrington,et al.  Reliability of the PEDro scale for rating quality of randomized controlled trials. , 2003, Physical therapy.

[19]  Lorraine Williams Pedretti,et al.  Occupational Therapy: Practice Skills for Physical Dysfunction , 1985 .

[20]  J. Poole,et al.  The Effectiveness of Inflatable Pressure Splints on Motor Function in Stroke Patients , 1990 .

[21]  Lauren E. Milton,et al.  Annual Meeting—President's Address , 1945 .

[22]  J. Wilton,et al.  Hand splinting : principles of design and fabrication , 1997 .

[23]  G. Gillen.  Stroke Rehabilitation: A Function-Based Approach , 1998 .

[24]  Hui-ing Ma,et al.  A synthesis of the effects of occupational therapy for persons with stroke, Part I: Restoration of roles, tasks, and activities. , 2002, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[25]  Robert Herbert,et al.  Splinting the hand in the functional position after brain impairment: a randomized, controlled trial. , 2003, Archives of physical medicine and rehabilitation.

[26]  R. Young,et al.  Spasticity, disordered motor control , 1980 .

[27]  S. Pocock,et al.  Clinical Trials: A Practical Approach , 1984 .

[28]  A comparison of dorsal and volar resting hand splints in the reduction of hypertonus. , 1982, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[29]  J. J. McPherson,et al.  Dynamic splint to reduce the passive component of hypertonicity. , 1985, Archives of physical medicine and rehabilitation.

[30]  K. Terayama,et al.  Application of a shape memory alloy to hand splinting , 1992, Prosthetics and orthotics international.

[31]  E. Scherling,et al.  A tone-reducing wrist--hand orthosis. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.