Dynamic splinting for the stiff hand after trauma: Predictors of contracture resolution

Abstract

Study Design: Prospective cohort. Introduction: Many variables are believed to influence the success of dynamic splinting, yet their relationship with contracture resolution is unclear. Purpose of the Study: To identify the predictors of outcome with dynamic splinting of the stiff hand after trauma. Methods: Forty-six participants (56 joints) completed eight weeks of dynamic splinting, and the relationship between 13 clinical variables and outcome was explored. Results: Improvement in passive range of motion, active range of motion (AROM), and torque range of motion averaged 21.8°, 20.0°, and 13.0°, respectively (average daily total end range time, 7.96 hours). Significant predictors included joint stiffness (modified Weeks Test), time since injury, diagnosis, and deficit (flexion/extension). For every degree change in ROM on the modified Weeks Test, AROM improved 1.09° (standard error, 0.2). Test-retest reliability of the modified Weeks Test was high (intraclass correlation coefficient [2, 1] = 0.78). Conclusions: Better progress with dynamic splinting may be expected in joints with less pretreatment stiffness, shorter time since injury (<12 weeks), and in flexion rather than extension deficits. Further research is needed to determine the accuracy with which the modified Weeks Test may predict contracture resolution. © 2011 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.