A systematic review on mobilization splinting for the post traumatic stiff hand

Abstract

Hand stiffness or contracture remains a common complication after a traumatic hand injury and/or surgery. The loss of range of motion (ROM) impacts on the use of the affected hand in activities of daily living (ADLs), which in turn affects one’s independence level. Traditionally, hand therapists have been using different types of mobilization splint to resolve post-traumatic hand stiffness. However, there is no clear evidence governing the splinting strategies. Hence, a systematic review was carried out to establish if mobilization splinting is an effective treatment, to explore the different types of mobilization splint believed to be the most effective, and to identify factors that can influence splinting outcomes. A systematic literature search was undertaken using AMED (1985 to May 2013), MEDLINE (1950 to May 2013), Pubmed Central (1948 to May 2013), CINAHL (1981 to May 2013), and Scopus (1996 to May 2013). Five key hand therapy and hand surgery journals were searched plus a search of conference proceedings and other grey literature. Studies of any design type were included, except for literature reviews and expert opinions. Non-English publications were excluded. Data were extracted using tool that had been developed based on Cochrane Collaboration’s guidelines. The methodological quality of the selected studies was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES) (MacDermid, 2004) and the level of evidence for each study was allocated. Six trials—4 Level 2b and 2 Level 4, were included. These involved a total of 117 participants, with 134 stiff hand joints. Overall, the available evidence provided low to moderate support for the use of mobilization splint for increasing ROM of the post-traumatic stiff hand. The evidence, however, could not address if there was any functional improvement post-mobilization splinting. Additionally, there was also little to no convincing evidence to make any conclusions about the most effective type of mobilization splint and the factors that can influence splinting outcome. Further higher quality research will be needed so as to provide more high quality evidence to establish evidence-based guidelines in this area.