Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.

OBJECTIVE To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits. DESIGN Randomized trial. SETTING Rehabilitation center. PARTICIPANTS Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program. INTERVENTION The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily. MAIN OUTCOME MEASURES Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups. RESULTS At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups. CONCLUSIONS Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.

[1]  R. Harden,et al.  Proposed new diagnostic criteria for complex regional pain syndrome. , 2007, Pain medicine.

[2]  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.

[3]  S C Gandevia,et al.  Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients. , 2000, Archives of physical medicine and rehabilitation.

[4]  A. Leibovitz,et al.  Edema of the paretic hand in elderly post-stroke nursing patients. , 2007, Archives of gerontology and geriatrics.

[5]  A. Algra,et al.  Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke. , 2007, Journal of rehabilitation medicine.

[6]  A. Pizzi,et al.  Application of a volar static splint in poststroke spasticity of the upper limb. , 2005, Archives of physical medicine and rehabilitation.

[7]  K.,et al.  Reliability of measurements of muscle tone and muscle power in stroke patients. , 2000, Age and ageing.

[8]  C. Roy,et al.  Shoulder pain in acutely admitted hemiplegics , 1994 .

[9]  J. Arruda,et al.  Measurement of mood states in stroke patients: validation of the visual analog mood scales. , 1999, Archives of physical medicine and rehabilitation.

[10]  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.

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

[12]  Annie McCluskey,et al.  Effects of Splinting on Wrist Contracture After Stroke: A Randomized Controlled Trial , 2007, Stroke.

[13]  S. Braver,et al.  The measurement of clinical pain intensity: a comparison of six methods , 1986, Pain.

[14]  L. Bouter,et al.  Effect of Triamcinolone Acetonide Injections on Hemiplegic Shoulder Pain: A Randomized Clinical Trial , 2000, Stroke.

[15]  A. Prevo,et al.  Poststroke hand swelling and oedema: prevalence and relationship with impairment and disability , 2005, Clinical rehabilitation.

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

[17]  E. Glaser.  The randomized clinical trial. , 1972, The New England journal of medicine.

[18]  L. Bouter,et al.  Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews , 2005, Clinical rehabilitation.

[19]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.

[20]  Claude Desnuelle,et al.  Use of the Faces Pain Scale by left and right hemispheric stroke patients , 2007, Pain.

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

[22]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.

[23]  M. Garcia‐Elias.  The treatment of wrist instability , 1997 .

[24]  D. Price,et al.  The validation of visual analogue scales as ratio scale measures for chronic and experimental pain , 1983, Pain.

[25]  E. Ohnhaus,et al.  Methodological problems in the measurement of pain: A comparison between the verbal rating scale and the visual analogue scale , 1975, PAIN.

[26]  E. Mackin,et al.  Examination of the hand and wrist , 1998 .

[27]  L. Arendt-Nielsen,et al.  Sensory abnormalities in consecutive, unselected patients with central post-stroke pain , 1995, Pain.

[28]  C. Chauvière.  La spasticité : Mécanismes et traitements masso-kinésithérapiques , 2002 .

[29]  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.

[30]  P. Stratford,et al.  Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. , 1993, Physical therapy.

[31]  Joanne M Wagner,et al.  Sensorimotor Impairments and Reaching Performance in Subjects With Poststroke Hemiparesis During the First Few Months of Recovery , 2007, Physical Therapy.

[32]  H Rodgers,et al.  Biomechanical examination of a commonly used measure of spasticity. , 2001, Clinical biomechanics.

[33]  R. Kakigi,et al.  Recording of corticospinal evoked potential for optimum placement of motor cortex stimulation electrodes in the treatment of post-stroke pain. , 2007, Neurologia medico-chirurgica.

[34]  H Rodgers,et al.  Can stroke patients use visual analogue scales? , 1999, Stroke.

[35]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[36]  R D Herbert,et al.  Is hand splinting effective for adults following stroke? A systematic review and methodological critique of published research , 2003, Clinical rehabilitation.

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

[38]  Akio Tsubahara,et al.  Therapeutic Orthosis and Electrical Stimulation for Upper Extremity Hemiplegia After Stroke: A Review of Effectiveness Based on Evidence , 2004, Topics in stroke rehabilitation.

[39]  Réadaptation fonctionnelle de la main hémiparétique d'après le concept Bobath actuel , 1999 .

[40]  J. Espadaler,et al.  Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial. , 2007, Journal of rehabilitation medicine.