Evaluating the Usability of Alternative Shoulder Stabilization Methods

Abstract

Braces are commonly used to stabilize and restrict movement of the arm and shoulder after injury, such as dislocation (Itoi, Hatakeyama, and Kido, 2003). However, secondary pain and discomfort cause concern for clinicians when prescribing braces to patients that require shoulder stability, and may result in poor compliance by the patient if prescribed for long durations. Popularly used braces have been associated with secondary pain in surrounding areas, such as the neck and shoulders, compared to rehabilitative outcomes without the use of braces (Struijs, Kerkhoffs, Assendelft, and van Dijk, 2004). Straps are often used in conventional brace design for stability, yet they are potential sources of discomfort. Novel supporting methods used in more recently developed braces could mitigate the above concerns associated with traditional bracing methods (i.e., discomfort and low ease of use) while stabilizing the shoulder. We examined the usability of five brace designs, including a newly developed brace. Selected existing products were used to represent a spectrum of different design approaches (e.g., brace shape and coverage, connector locations, and straps) and included, in alphabetical order: 1) Bledsoe Clinic Shoulder Immobilizer (“Sling”) (Bledsoe Brace Systems, Grand Prairie, TX, bledsoebrace.net ), 2) Breg SlingShot 3 Shoulder Brace (“SlingShot”) (Breg, Inc. Carlsbad, CA, www.breg.com ), 3) Breg Straight Shoulder Immobilizer (“Straight”) (Breg, Inc. Carlsbad, CA, www.breg.com ), and 4) Bledsoe Sling and Swathe Immobilizer (“Swathe”) (Bledsoe Brace Systems, Grand Prairie, TX, bledsoebrace.net ). The new brace design ( www.kaykare.net ) includes a sleeve and single waist strap. A total of 10 young adults (M = 24.2±4.9 years old) and 10 older adults (M = 66.9±4.3 years old), gender-balanced in each group, were recruited to enhance generalizability of results. A within-subjects design was implemented to test donning/doffing performance, perceived stability and comfort of the selected arm braces. The study included controlled tasks involving donning and doffing on the self and on a simulated “patient” as the participant acted as a “caregiver,” along with simulated activities of daily living, to compare brace performance. Outcome measures included donning/doffing times, ratings and rankings of ease of use, and stability and comfort ratings and rankings, and these were compared between age, gender, and braces using Analyses of Variance. Participants had significantly lower donning and doffing times while using the new brace versus the other braces, and it was rated as having a higher level of ease when donning/doffing. The “Swathe” type of brace was rated as having the highest level of stability, while comfort ratings were not significantly different between braces. Braces more frequently selected as the preferred brace at the end of the study, such as the “Sling,” are more commonly provided braces at clinics or in emergency scenarios (Hatta, Sano, Yamamoto, and Itoi, 2013). Non-traditional strapping methods used in the new brace and the “Straight” were often perceived as being less stable due to fewer straps. Throughout data collection, it was found that as straps increase on the brace, greater stability is perceived, although application ease and donning time will likely increase. These results reveal that the newer brace design offers a potential solution to emergency shoulder immobilizing when compared to popularly supplied braces, though patients may perceive greater support while wearing a brace with more straps. However, the current work is limited by a healthy participant pool, and future work should explore patient responses to actual prescription of each brace. Long-term use should also be examined to capture experiences beyond the laboratory.