Date Presented 04/22/2023
This systematic review critically appraised the effectiveness of upper extremity orthoses for improving performance skills, activities of daily living (ADLs), and instrumental activities of daily living (IADL) outcomes for individuals with stroke. It equips OTs with resources and tools to implement evidence-based protocols in upper extremity rehabilitation. Participants attending this session will gain a better understanding of the usage and types of static and dynamic orthoses that promote functional outcomes for individuals with stroke.
Primary Author and Speaker: Sarah Susanna Synek
Contributing Authors: Helene Lohman, Vanessa Jewell
PURPOSE: Over 795,000 individuals in the United States have a stroke each year (Centers for Disease Control and Prevention, 2022); two-thirds of individuals with stroke never fully regain hand function, impacting their ability to participate in daily activities (Camona et al., 2018). Upper extremity orthoses are a common intervention technique used by occupational therapists to increase range of motion, stabilize soft tissues, and prevent contractures (Basaran et al., 2012). Despite frequent utilization of orthoses in practice, little research examines the effect of static and dynamic orthoses on functional usage of the limb for individuals recovering from stroke. The objective of this systematic review was to determine the effectiveness of upper extremity orthoses on improving functional participation for adults with stroke.
DESIGN: This research study followed guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al., 2009). Databases searched included CINAHL, Cochrane, PubMed, and OT Seeker. The researchers and a health science librarian developed all keywords and completed the initial data search. Search terms included variations of the population and intervention parameters such as stroke, cerebrovascular accident, CVA, transient ischemic attack, TIA, upper extremity, upper limb, arm, wrist, hand, orthosis, and splint. Articles were included if they addressed a stroke population, included a static or dynamic orthotic intervention, and utilized a functional outcome measure. Articles with an elbow or shoulder orthosis, concurrent intervention technique (other than therapy as usual), or non-functional outcome measure were excluded from the review.
METHOD: Eight hundred and twenty-seven articles were identified through the initial database search. After title and abstract screening, 770 articles were removed and 57 full-text articles were sought for full-text retrieval. Six articles met all inclusion criteria; articles meeting inclusion criteria were evaluated for risk of bias.
RESULTS: Six, level 2B articles including low-quality random control trials, pilot studies, and two-group pre/post-test trials met the inclusion criteria for the review, all with low to moderate risk of bias. The researchers found moderate strength of evidence to support the usage of dynamic orthoses- SaeboFlex, the Dynamic Lycra Gauntlet orthosis, a 3D printed dynamic pulley rotational splint, and the dynamic hand orthosis- on improving performance skills of grasp, pinch, grip, coordination, dexterity, opposition, and reach for individuals with stroke. There is moderate strength of evidence to support that SaeboFlex and the Dynamic Lycra Gauntlet orthosis do not improve ADL/IADL outcomes for individuals with stroke.
CONCLUSION: This review suggests occupational therapists should use SaeboFlex, the Dynamic Lycra Gauntlet orthosis, a 3D printed dynamic pulley rotational splint, and the dynamic hand orthosis to improve performance skills for individuals with stroke. However, these orthoses should be used in conjunction with therapy as usual to maximize therapeutic benefits. Additional research with standardized, functional outcome measures is critical to determine if upper extremity orthoses improve ADL/IADL outcomes.
IMPACT STATEMENT: While range of motion, strength, and contracture prevention are critical for upper extremity rehabilitation, therapists must utilize orthotic designs that promote performance skills, ADLs, and IADLs to support occupational engagement in rehabilitation practices.
Camona, C., Wilkins, K. B., Drogos, J., Sullivan, J. E., Dewald, J. P. A., & Yao, J. (2018). Improving hand function of severely impaired chronic hemiparetic stroke individuals using task-specific training with the ReIn-Hand System: A case series. Frontiers in Neurology, 9(923), 1–9. https://doi.org/10.3389/fneur/2018.00923
Centers for Disease Control and Prevention. (2022). Stroke Facts. U.S. Department of Health and Human Services. https://www.cdc.gov/stroke/facts.htm
Moher, D. A., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Med, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Basaran, A., Emre, U., Karadavut, K. I., Balbaloglu, O., Bulmus, N. (2012). Hand splinting for poststroke spasticity: A randomized controlled trial. Topics in Stroke Rehabilitation, 19(4), 329–337. https://doi.org/10.1310/tsr1904-329