Extension orthoses and the stiff proximal interphalangeal joint following hand trauma: A review of current clinical practice in the Australian context

Abstract

Introduction Extension orthoses are frequently prescribed by hand therapists to treat fixed flexion deformity of the proximal interphalangeal joint. A wide variety of proximal interphalangeal joint extension orthoses exist, but there is limited research evidence to guide implementation in clinical practice. Consequently, effective management of fixed flexion deformity of the PIP joint remains a challenge. Method An electronic survey was distributed to members of the Australian Hand Therapy Association. The survey included two case scenarios, (including a fixed flexion deformity of 30° and 55°) and participants were asked to identify their preferred orthosis for each case. Responses to closed questions were analyzed descriptively. Thematic analysis for open-ended questions was completed by two experienced hand therapists. Results One hundred ninety-five therapists completed the electronic survey. Handmade capener (21.7%), pre-fabricated capener (22.2%), and static finger troughs (21.1%) were the preferred orthoses for treatment of contractures of 30°. Serial casts (60.9%) were the preferred choice for a contracture of 55°. Key themes influencing choice of orthosis reflected an evidence-based practice approach to clinical reasoning that combined use of available evidence with therapists’ experience and the needs of the patient. Therapists’ interpretation and application of research differed according to their unique situation. Conclusion Orthotic prescription is a multifaceted process that combines therapists’ interpretation of evidence with their experience and the needs of the patient. Further research is needed to evaluate and clarify current theories that are used to guide intervention.