Long-Term Use of a Static Hand-Wrist Orthosis in Chronic Stroke Patients: A Pilot Study

Hindawi Publishing Corporation Stroke Research and Treatment Volume 2013, Article ID 546093, 5 pages http://dx.doi.org/10.1155/2013/546093 Research Article Long-Term Use of a Static Hand-Wrist Orthosis in Chronic Stroke Patients: A Pilot Study Aukje Andringa, Ingrid van de Port, and Jan-Willem Meijer Revant Rehabilitation Centre Breda, Brabantlaan 1, 4817 JW Breda, The Netherlands Correspondence should be addressed to Aukje Andringa; Received 11 December 2012; Revised 31 January 2013; Accepted 31 January 2013 Academic Editor: Valery Feigin Copyright © 2013 Aukje Andringa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Long-term splinting, using static orthoses to prevent contractures, is widely accepted in stroke patients with paresis of the upper limb. A number of stroke patients complain about increased pain and spasticity, which leads to the nonuse of the orthosis and a risk of developing a clenched fist. Objectives. Evaluating long-term use of static hand-wrist orthoses and experienced comfort in chronic stroke patients. Methods. Eleven stroke patients who were advised to use a static orthosis for at least one year ago were included. Semistructured telephone interviews were conducted to explore the long-term use and experienced comfort with the orthosis. Data were analyzed using descriptive statistics. Results. After at least one year, seven patients still wore the orthosis for the prescribed hours per day. Two patients were unable to wear the orthosis 8 hours per day, due to poor comfort. Two patients stopped using the orthosis because of an increase in spasticity or pain. Conclusions. These pilot data suggest that a number of stroke patients cannot tolerate a static orthosis over a long-term period because of discomfort. Without appropriate treatment opportunities, these patients will remain at risk of developing a clenched fist and will experience problems with daily activities and hygiene maintenance. 1. Introduction Of all stroke survivors, more than half experience impairments of the upper limb in the chronic phase, including loss of strength and dexterity, spasticity, muscle contracture, pain, and edema [1–3]. Patients with a more severe paresis have a higher risk of developing spasticity [4] and muscle contractures of the wrist and finger flexor muscles [5– 7]. Without appropriate spasticity treatment or contracture prevention, patients are at risk of developing a clenched fist, a hand which is deformed into a fist by shortening of flexor muscles of the fingers and soft tissue [8]. The abnormal position of the hemiplegic hand and wrist due to spasticity and muscle contractures may interfere with daily activities and hygiene maintenance, both negatively influencing the quality of life [9–11]. Different approaches are used to inhibit spasticity, prevent contractures, reduce pain and edema, or improve hygiene maintenance of the hand in stroke patients with a nonfunctional spastic upper limb. However, there is no consensus about the most effective treatment [12]. A commonly used and widely accepted intervention is prolonged splinting using static orthoses [12–17]. Two reviews on the effect of upper limb splinting after stroke have been published [18, 19]. Both reviews showed no effect of static orthoses on upper limb function, range of motion, and pain after an intervention period less than 13 weeks. However, conclusions should be interpreted with caution because of the lack of high quality randomised controlled trials. There is a considerable heterogeneity of included study designs, clinical aims, and orthosis wearing protocols, materials, and regimes. In addition, all published studies focused on the short-term effect of splinting with splinting periods no longer than 13 weeks. Despite controversies concerning splinting of the hemiplegic upper limb, static orthoses continue to be advised in clinical practice. When used in clinical practice, a considerable amount of stroke patients complain about increased pain and spasticity since the use of the static orthosis [20, 21]. Due to discomfort, the orthosis cannot be worn for the advised 8 hours per day which leads to nonuse in chronic stroke patients and with that increases the risk of developing clenched fists with which patients may experience problems with daily activities and hygiene maintenance. 2 Stroke Research and Treatment orthosis by comparing the data of complaints before and since the use of the static orthosis using a Wilcoxon’s signed rank test. Statistical analysis was performed using SPSS 18.0. Statistical significance was set at the 5% level. 3. Results Figure 1: Example of a prefabricated static hand-wrist orthosis. Given our experiences in clinical practice, the purpose of this pilot study is to describe the long-term use of static hand-wrist orthoses and the experienced comfort of wearing the orthosis in chronic stroke patients in order to acquire preliminary data to further study the treatment of this specific patient population. We hypothesize that, in a number of the chronic stroke patients with upper limb impairments, discomfort—increased pain, and spasticity— is the reason for not wearing a static hand-wrist orthosis for the advised 8 hours per day. The secondary aim is to describe the self-reported complaints before and since the use of the static orthosis to evaluate the effect of the use of the orthosis in chronic stroke patients. Additionally, the use of cointerventions for the impaired upper limb is investigated. 2. Methods In this pilot study, semistructured interviews were used to explore the long-term use (i.e., more than one year) of the static orthosis in chronic stroke patients, and the experienced comfort with the static orthosis in chronic stroke patients (Figure 1). A selection of stroke patients, who received a static orthosis from the Orthopaedic Centre OIM Brabant Breda, The Netherlands, was taken from the database. All stroke patients who were advised to use a static orthosis at least one year ago and were independently living in the community were included. Patients were excluded when correct contact details were missing or when patients died in the study period. If patients were unable to communicate by telephone, information was obtained from the primary caregiver. Informed consent was obtained prior to each interview. Patients were asked about current use, comfort of the orthosis, reasons for wearing the orthosis, self-reported complaints in the hemiplegic upper limb, including spasticity, hygiene maintenance, pain, and edema, and applied cointerventions. Answers to all twelve questions were scored categorically except the complaints scores. Complaints scores were graded from 0 (no complaints) to 10 (major complaints). The telephone interviews were carried out by a physica (...truncated)