Resting splint provision: a survey of practice among North-West region rheumatology occupational therapists

Laver, Charlotte; Mellson, Jo-Anne; Hammond, Alison

Abstract

ABSTRACT BODY:
Background: Resting splints (RS) in rheumatoid arthritis (RA) are commonly provided by OTs for hand pain and inflammation. Recent trials identify effectiveness in established but not early RA. This prompted the North West (NW) COTSS-Rheumatology Group to survey current RS practice: frequency of and clinical indicators for RS provision; assessment; joint positioning; wearing regimens; splint instructions; review and costs.

Methods: Survey items were generated by NWCOTSSR members, a questionnaire formulated, reviewed by the group and piloted. Following University of Salford ethics approval, it was sent to 35 NW Rheumatology OTs.

Results: 24 (69%) replied: 19 (ie 79%) make RS, to 25% of early (<2y duration) and 22.5% (>2y) of established RA patients. For both groups the three most important: a) aims of RS provision were: to reduce night pain; rest weakened joint structures to reduce local inflammation; and correctly position joints; b) clinical indicators were for night-time: high levels of pain; ‘clawing’/ strong finger flexion; and to maintain comfortable hand positions.
All used interview/ observation to assess for RS; 10 using standardized measures, eg pain VAS, goniometer, tape measure, DASH and dynamometer. Reasons for non-provision were: psychological (eg patient not yet ready to accept), physical (eg skin integrity), difficulty don/doffing RS at night and recent joint injections.
Average RS positioning was 20° wrist extension (IQR 15-25°), 40° MCP flexion (IQR 30-46.25°) and 20° PIP flexion (IQR 11.5-30°), ie similar to Rheumatology OT guidelines (2003). 10 usually splint the forearm in midline and 8 in pronation. 10 splint the thumb in abduction and 4 in extension. Common materials were Orfilight (n=10) and Orthoplast (n=7). 14 taught hand exercises alongside RS provision (as per guidelines).
All gave verbal RS instructions and most written. All gave some advice on RS wear regimens: gradually increase time to tolerance (n=15); at night (n=10) and/or evenings (n=8); and splint care (n=16). Only 8 gave information on RS aims: decrease pain (n=5); and decrease swelling (n=5). Only a minority advised when to cease wear (at night if uncomfortable n=3; if problems worsen n=2). Precautionary advice included to check for: pressure, skin colour changes, increased pain, skin irritation, pins and needles, swelling. 14 conducted short-term splint review at 2 weeks; 3 only did telephone reviews. Long-term, all relied on patients making contact if problems occurred although guidelines recommend regular review. On average it took 75 mins. to provide an RS (assess, make, instruct re splint and exercise, review) at a cost of £64/splint.


Conclusions : RS provision was reported as less frequent following changing disease management and recent research. Splint positioning varied considerably as did splint information. We will next develop a consensus for RS provision and information.

• Presentation Conference Type: Conference Paper (published)
• Publication Date: 2011
• Deposit Date: Oct 23, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed