W.H.O., What, Where, When, & Why? Practitioners’ Practice Patterns, Experiences, & Perceptions in the Use of Wrist Hand Orthotics After Stroke

Wrist hand orthotics (WHO) are commonly used in practice poststroke for spasticity and contracture management despite inconclusive evidence of effectiveness1 and limits in survivor tolerance2. This study explored current practice patterns in the use of WHO poststroke and practitioners’ perceptions, experiences, and clinical reasoning to include use of evidence and practice guidelines. Using a mixed method design, quantitative data via survey (n=45) and qualitative data via semi-structured interviews (n=5) was simultaneously collected. Participants were recruited through use of professional social media platforms, discussion forums, and contacts. Data was descriptively and thematically analyzed, respectively. Mostly inpatient (31%) and outpatient (24%) occupational therapists (95%) from the northeast (69%) with greater than 10 years’ experience (45%) and entry level Masters degrees (50%) completed the survey. Interview participants’ (two with doctoral degrees and two with advanced training) experience ranged from .5 to 26 years. Survey results revealed that 22% of respondents frequently used WHO and when used, prefabricated static volar WHO were more commonly used. Respondents perceived WHO to be effective in managing soft-tissue shortening (64%) and contractures (55%) greater than spasticity (37%) though many were unsure of the evidence. Qualitative themes revealed variable practice patterns and no standard protocol, subjective outcomes, and factors such as reimbursement, practice setting/culture, and time constraints influenced WHO use. Factors such as client tolerance, fit/comfort, and independent use were key considerations especially with spasticity3 suggesting WHO may pose more harm than good for the neurological hand. Experience and advanced training in this study contributed to more evidence-based client-centered practice and custom WHO use implying that WHO use poststroke may require advanced training. Additionally, objective functional measures are needed.

References

Kerr, L., Jewell, V. D., & Jensen, L. (2020). Stretching and splinting interventions for poststroke spasticity, hand function, and functional tasks. American Journal of Occupational Therapy, 74, 7405205050. https://doi.org/10.5014/ajot.2020.029454

Andringa, A., van de Port, I. & Meijer, J. (2013). Long-term use of a static hand-wrist orthosis in chronic stroke patients: A pilot study. Stroke Research and Treatment., 2013, 1–5. https://doi.org/10.1155/2013/546093

Plantin, J., Pennati, G. V., Roca, P., Baron, J.-C., Laurencikas, E., Weber, K., Godbolt, A. K., Borg, J., & Lindberg, P. G. (2019). Quantitative assessment of hand spasticity after stroke: Imaging correlates and impact on motor recovery. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.00836