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. Level of Evidence 2b.