Stroke Structured Abstract - S #15
Splinting may not reduce spasms in a paralyzed hand
CITATION: Langlois, S., Pederson, L., & MacKinnon, J. R. (1991). The effect of splinting on the spastic hemiplegic hand: Report of a feasibility study. Canadian Journal of Occupational Therapy, 58, 17-25.
LEVEL OF EVIDENCE: IC3c
What is the effect of different wearing schedules of a spasticity-inhibiting splint on spasticity of hemiplegic hands?
Randomized controlled trial (RCT)
Subjects were randomly assigned to one of three groups defined by wearing schedules of 22, 12, and 6 hours per day.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Subjects were recruited through the London chapter of the Ontario Stroke Recovery Association; The Department of Occupational Therapy of Parkwood Hospital; and Home Care Service, London, Ontario.
All subjects had a single diagnosis of stroke at least 12 months prior to admission to the study which resulted in hemiplegia. Additionally, they showed a medically stable condition and were free of any other medical problem that could influence the degree of spasticity. Further, all subjects were able to understand and cooperate with all test and treatment procedures. Lastly, subjects were not involved in any other therapy designed to reduce spasticity.
N = 9
Male = 3
Female = 6
Mean age = 64.2
LCVA = NR
RCVA = NR
Attrition = 31%
NR = Not Reported
(R = Reliability established; V = Validity established)
Level of spasticity by a torque motion analyzer - R
A finger spreader splint was given to participants, and they were instructed to wear it according to their group assignment:
Group 1: 6 hours/day
Group 2: 12 hours/day
Group 3: 22 hours/day
WHO DELIVERED INTERVENTION
OT (patient was responsible for daily splint wearing)
Home for treatment. Clinical laboratory for evaluation.
FREQUENCY & DURATION
The number of hours as designated by group assignment, daily for 4 weeks.
The greatest reduction in the level of spasticity was noted in Group 1 (6 hours).
pretest - posttest Group 1: t = 2.2184, p = .08, r = .84
pretest - posttest Group 2: t = 0.214, p = .43, r = .15
pretest - posttest Group 3: t = 0.33, p = .38, r = .27
The overall effect size r for all groups was .68 (confounded with maturation effect), indicating reductions in spasticity over the study period.
THREATS TO VALIDITY
Small sample size leads to Type II error - p level for Group 1 was not significant (.08), but the effect size was large, indicating a strong effect of less wearing time.
Compliance was an issue. Subjects in Group 1 were more compliant than in the other groups. Seven of the nine subjects reported that they adhered to the wearing schedule. The other two subjects (from Groups 2 & 3) reported only ~50% compliance. Poor compliance could contaminate the application of the independent variable (i.e., those who were supposed to wear the splint a longer time wore it for less time, thereby reassigning themselves to Group 1 or 2).
The researchers concluded that the longer the wearing time, the better the result.
Contrary to the researchers' conclusion, those who wore the splint for 22 hours reduced spasticity only .12 Nm rads (the resistive torque [measured in Newton meters] on the vertical axis versus displacement of the wrist [measured in radians] on the horizontal axis) from baseline value compared with those who wore it for 6 hours and reduced spasticity almost twice as much (.2384 Nm rads). Whether there is an error in reporting, a failure to consider the initial level of spasticity in the analysis, or an error in conclusion is not known. The reviewers concluded that the shorter the wearing time, the greater the effect.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.