Inpatient occupational therapists hand-splinting practice for clients with stroke: A cross-sectional survey from Ireland

Abstract

Introduction: Hand splinting after stroke is a common practice despite inadequate evidence. This warrants a better understanding of the therapists' splinting practice, to develop clinically meaningful treatment options.

Aims: The study examined the nature and prevalence of the factors associated with therapists' hand splinting practice and their perceived splinting efficacy.

Settings and design: A cross-sectional national survey of hand-splinting practice among inpatient occupational therapists (OTs) in Ireland.

Materials and methods: Sixty-two therapists participated in this national survey.

Statistical analysis used: A number of factors were analyzed to explore their relationship with therapists' perception of splint efficacy using Spearman's rank order correlation.

Results: 53(85.5%) out of 62 survey respondents prescribed splints to their clients at the time of taking the survey. To reduce spasticity, to correct contractures and thus increase range of motion (ROM) were the commonly used splinting goals. These were the goals that were significantly associated with the therapists' splinting efficacy too.

Conclusions: Hand-splint prescription following stroke was found to be a common practice among OTs who perceive splints to be quite effective. A custom-made, volar forearm-based wrist-hand splint is the preferred splint among therapists to achieve a number of clinical aims such as improving ROM, stretching soft tissue contractures and reducing spasticity in the upper extremity. A wide variety of splinting regimens is currently practiced, reflecting the lack of a universally accepted and comprehensive practice guideline to regulate therapy. Methodologically valid clinical trials evaluating the efficacy of therapist-preferred splints in achieving their favored outcomes are needed. Development of common, universally accepted therapeutic guidelines based on comprehensive scientific review of such studies is thus needed.

Keywords: Hand splint; occupational therapy; rehabilitation; stroke; survey.

Figure 1

Custom-made volar forearm-based wrist-hand splint

Figure 2

Custom-made dorsal forearm-based wrist splint

Figure 3

Occupational therapists’ perceived splint efficacy among post-stroke clients