Abstract
ObjectiveWrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.DesignRandomised comparative functional study of the wrist/hand with and without WHOs.ParticipantsTen right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measuresThe primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.ResultsFrom the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).ConclusionWHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users’ needs.
Highlights
Optimal hand function depends on many interrelated factors, including optimal skeletal integrity, joint alignment, muscle, and neurological function
A total of two participants missed each a single week of testing which corresponded to wrist-hand orthoses (WHOs)#1 and #9 which resulted on the acquisition of datasets from 9 participants for each of these orthoses
All orthoses positioned the wrist in a degree of extension at rest (1-sample T-tests; mu = 10 and 15), but none were inside the desired prescribed range of [10,11,12,13,14,15]◦ extension (Figure 2)
Summary
Optimal hand function depends on many interrelated factors, including optimal skeletal integrity, joint alignment, muscle, and neurological function All of these may be affected by rheumatological musculoskeletal and neurological conditions or injuries. Functional wrist-hand orthoses (WHOs) or “working splints” as they are often referred to, are used in the conservative management of a wide variety of conditions managed within the acute and primary care sectors but are used prophylactically in the workplace and during sporting activities. They are commonly prescribed and fitted by healthcare providers, but are available on the high street, and through online retailers. In the US, the annual conservative estimate of Medicare reimbursement within the 65+ population for the provision of these types of WHOs is $22 million, so when extrapolated to the UK population, it represents an annual cost of £3.9 million
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