Determinants of compliance with hand splinting in an acute brain injured population

Adherence behavior in an acute pediatric hand trauma population: A pilot study of parental report of adherence levels and influencing factors

INTRODUCTION

Descriptive and cross-sectional study.

PURPOSE OF THE STUDY

The hand is a common site of injury in children; however, little is known regarding adherence to hand trauma management in this population.

PURPOSE

This pilot study aimed to describe adherence to plaster slab immobilization, advice regarding return to sport, appointment attendance, and the factors influencing nonadherence.

METHOD

Forty-seven parents of children with hand trauma completed an online questionnaire reporting their child's adherence to the initial medical management.

RESULTS

Parents reported that 34% (16 of 47) of children were adherent to all aspects of management. Nonadherence with plaster slab immobilization was reported by 38% (18 of 47), and 45% (21 of 47) reported nonadherence with advice regarding return to sport. Hygiene, discomfort, and restriction were the most common reasons for plaster removal. Belief that sport would not cause harm and social factors influenced return to sport against medical advice.

CONCLUSION

Nonadherence behavior is commonly reported in children with acute hand trauma.

LEVEL OF EVIDENCE

4.

A novel splint for proximal interphalangeal joint contractures: a case report

Proximal interphalangeal (PIP) joint contractures are notoriously difficult to treat. Best results are obtained with early mobilization and splinting, though a high level of adherence is critical for a good outcome. A new roll-on splint that aims to increase motion with minimal difficulty was used. The patient described here with moderate PIP joint contractures (30°-60°) was treated successfully using this splint. The splint design and therapy protocol are described. The patient was treated for 12 weeks with good adherence to therapy and splinting. Total active motion increased by 87% in the index finger and 108% in the ring finger. Grip, pinch, and tip-pinch strengths increased. The Disabilities of the Arm, Shoulder and Hand score improved from 26.7% to 2.5%. At 3 months, the patient returned to work. Though this case illustrates some of the advantages and disadvantages of the new splint, further study is necessary to evaluate the splint and compare it with other existing forms of treatment for PIP joint contractures.

Adherence to therapeutic splint wear in adults with acute upper limb injuries: a systematic review

Introduction

Non-adherence with therapeutic splinting in acute hand injury can reduce treatment benefits, increase risk of disability and bias assessment of treatment efficacy. This systematic review aims to critically analyse the literature on splinting of acute upper limb injuries to identify key factors that could influence patient adherence with splint wear.

Methods

Trials were identified from searches of EMBASE, MEDLINE, CINAHL (to June 2009) and reference lists of articles and relevant reviews. Search terms used were patient compliance/adherence behaviour, splint/s, othosis/es and brace. Where possible, randomized controlled trials or prospective cohort studies were sought, and then cross-sectional and retrospective studies if the former were not available. Studies specifically addressing chronic conditions were excluded. All relevant trials were assessed for methodological quality by the author using explicit criteria. Data were extracted using a standardized form designed by the author.

Results

Six studies (one randomized controlled trial, two cross-sectional analytic surveys and three retrospective file reviews) involving 490 people were included. Owing to the heterogeneity of studies synthesis is narrative rather than quantitative. There was no consistent correlation between adherence and age or gender. One study found a correlation with patient perception of positive effect, and one found negative correlations with agitation and brain injury severity.

Discussion

Studies found were generally of varied quality and may be susceptible to bias. This is a field with little published scientific evidence, and future research should measure adherence relationships with socioeconomic, health-care system, therapy- and patient-related characteristics.