Splint satisfaction in the treatment of traumatic radial nerve injuries

Evaluation of User's Satisfaction With Orthotic and Prosthetic Devices and Services in Orthotics and Prosthetics Center of Iran University of Medical Sciences

BACKGROUND

The number of patients receiving orthotics and prosthetic services is increasing globally. A way to investigate patients' insight about services provided to them is to evaluate their satisfaction with the received services. Furthermore, incorporating patients' preferences into practice is an inseparable part of evidence-based practice. Applying such information in practice can contribute to the enhancement of the quality of services, the effectiveness of therapeutic interventions, and finally, the economic growth of service centers.

OBJECTIVES

To evaluate patients' satisfaction with the orthotic and prosthetic devices and services provided by the orthotics and prosthetics clinic of Iran University of Medical Sciences.

METHODOLOGY

In this study, 173 people referring to the orthotics and prosthetics clinic of Iran University of Medical Sciences were recruited, and their satisfaction level was examined using the Orthotics and Prosthetics Users' Survey questionnaire (OPUS) through a phone interview.

FINDINGS

Concerning the devices, the mean value of total satisfaction score was 74:00±19.80 and the highest score belonged to no wear or rupture of the clothes with their devices (mean value = 4.76±0.84). In terms of services, the mean value of total satisfaction score was 72.12 ± 15.90 with the highest score belonging to the politeness of the clinic staff (mean value = 4.92±0.57). When the time point from receiving service was taken into account, the patients who received the service for less than a year showed higher satisfaction level with the service (p=0.024). Although satisfaction with the device was slightly higher among the participants who used the devices for more than a year, no significant difference was observed between the two groups in terms of device satisfaction.

CONCLUSIONS

The overall satisfaction level from the devices and services was relatively high. However, the satisfaction level with the costs and coordination of the staff with the physicians showed a decline.

Enhancing function after radial nerve injury with a high-profile orthosis and a bio-occupational orthotic framework

STUDY DESIGN

Case report.

INTRODUCTION

Radial nerve injury can cause severe functional impairment due to paralysis of wrist and digit extensors. Various orthotic designs have been described, including static, dynamic, and tenodesis. All provide wrist stabilization or extension assistance. Some, but not all, also provide extension assistance to the wrist, thumb, and fingers.

PURPOSE AND METHODS

This article tells the story of Max, a 27-year-old male university student, who sustained a radial nerve injury after a left humeral shaft fracture. He was treated at a Brazilian tertiary hospital, where the choice of thermoplastics and dynamic components resulted in limited options for orthotic fabrication. Max was provided with custom-molded static wrist orthosis and a bulky, older style, high-profile dynamic forearm-based wrist-finger-thumb assistive-extension orthosis.

RESULTS AND DISCUSSION

Grip strength and functional status improved, and Max was completely satisfied because with the dynamic orthosis, he could play the guitar again, which was his favorite activity.

CONCLUSION

Max's story illustrates that a convenient functionally oriented orthotic intervention can be performed even in resource-limited environments by following the client-centered bio-occupational orthotic framework proposed by McKee and Rivard. This framework addresses the client's biological needs (addressing paralyzed muscles and maintaining length of soft tissues) and occupational/functional needs.

Design of a 3D-printed, open-source wrist-driven orthosis for individuals with spinal cord injury

Assistive technology, such as wrist-driven orthoses (WDOs), can be used by individuals with spinal cord injury to improve hand function. A lack of innovation and challenges in obtaining WDOs have limited their use. These orthoses can be heavy and uncomfortable for users and also time-consuming for orthotists to fabricate. The goal of this research was to design a WDO with user (N = 3) and orthotist (N = 6) feedback to improve the accessibility, customizability, and function of WDOs by harnessing advancements in 3D-printing. The 3D-printed WDO reduced hands-on assembly time to approximately 1.5 hours and the material costs to $15 compared to current fabrication methods. Varying improvements in users' hand function were observed during functional tests, such as the Jebsen Taylor Hand Function Test. For example, one participant's ability on the small object task improved by 29 seconds with the WDO, while another participant took 25 seconds longer to complete this task with the WDO. Two users had a significant increase in grasp strength with the WDO (13–122% increase), while the other participant was able to perform a pinching grasp for the first time. The WDO designs are available open-source to increase accessibility and encourage future innovation.

A systematic review of questionnaires to assess patient satisfaction with limb orthoses

BACKGROUND

Assessment of patient satisfaction with orthosis is a key point for clinical practice and research, requiring questionnaires with robust psychometric properties.

OBJECTIVES

To identify which validated questionnaires are used to investigate patient satisfaction with orthosis in limb orthotics and to analyse (1) their main fields of clinical application, (2) the orthosis-related features analysed by the questionnaires and (3) the strength of their psychometric properties.

STUDY DESIGN

Systematic review.

METHODS

A literature search using MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases for original articles published within the last 20 years was performed.

RESULTS

A total of 106 papers pertaining to various clinical fields were selected. The main features of patient satisfaction with orthosis analysed were as follows: aesthetic, ease in donning and doffing the device, time of orthotic use and comfort.

CONCLUSION

Of the questionnaires used to investigate patient satisfaction with orthosis, only four are adequately validated for this purpose: two for generic orthotic use (Quebec User Evaluation of Satisfaction with assistive Technology 2.0 and Client Satisfaction with Device of Orthotics and Prosthetic Users' Survey) and two for specific application with orthopaedic shoes (Questionnaire for the Usability Evaluation of orthopaedic shoes and Monitor Orthopaedic Shoes). Further development, refinement and validation of outcome measures in this field are warranted.

CLINICAL RELEVANCE

Given the importance of analysing patient satisfaction with orthosis (PSwO), appropriate instruments to assess outcome are needed. This article reviews the currently available instruments and reflects on how future studies could be focused on the development, refinement and validation of outcome measures in this field.

User satisfaction with orthotic devices and service in taiwan

User satisfaction is afforded considerable importance as an outcome measurement in evidence-based healthcare and the client-centered approach. Several studies have investigated user satisfaction with orthoses. Few studies have investigated user satisfaction with orthoses in Taiwan. Therefore, the purpose of this study was to investigate the user satisfaction with orthotic devices and service using the Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology. We conducted a cross-sectional study of 280 subjects who had used orthoses and received services. The results showed that the mean satisfaction score was 3.74 for the devices and 3.56 for service. Concerning the participants, 69.1% and 59.6% were quite satisfied or very satisfied with their devices and service, respectively. The satisfaction score of orthotic service was lower than that of the devices. Regarding demographic characteristics, participants living in different areas differed only in service score (p = 0.002). The participants living in eastern area and offshore islands were the least satisfied with the orthotic service. For clinical characteristics, there was a significant difference in satisfaction scores among severity of disability (all p = 0.015), types of orthoses (all p = 0.001), and duration of usage (all p = 0.001). The participants with mild disability, wearing the pressure garment and using the orthosis for less than one year, were the most satisfied with their orthotic devices and service. There is a need for improved orthotic devices and services, especially with respect to the comfort of the devices and the provision of subsidy funding.

Developmental and biomechanical considerations in the provision of wrist orthoses in children with obstetrical brachial plexus palsy

Introduction

Children with obstetrical brachial plexus palsy may have motor deficits in wrist extension that impact optimal hand function. Wrist orthoses are recommended for such impairment to address biomechanical and functional needs. The functional need of the child should be considered within the context of their developmental expectation.

Methods

A review of the literature pertaining to brachial plexus, wrist joint and injuries, orthotics devices and splints in children was conducted. The databases MEDLINE, AMED (Allied and Complementary Medicine) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched from 1950, 1985 and 1981, respectively, to July 2009 using the Medical Subject Headings (MeSH) brachial plexus, wrist joint and injuries, orthotics devices and splints under the limits of children aged 0–18 years.

Results

There is a paucity of literature on the orthotic management for this impairment. Therefore, an evaluation of the literature on development and the biomechanics of the wrist joint is necessary to develop clinical guidelines for the provision of wrist orthoses in children with obstetrical brachial plexus palsy. An algorithm for providing wrist orthoses in this population is proposed.

Discussion

A balance between biomechanical risks and functional needs at each developmental stage is needed to optimize hand function in the prescription of wrist orthoses.

Customized dynamic splinting: orthoses that promote optimal function and recovery after radial nerve injury: a case report

Radial nerve injury is a relatively common occurrence and recovery depends on the level of injury and extent of connective tissue damage. Orthoses (splints) are often provided to compensate for lost motor power. This article chronicles the recovery, over 27 months, of a 76-year-old woman who sustained a high radial nerve injury of her dominant arm during surgery for total shoulder replacement (Delta Reverse). Customized, low-profile dynamic splints, unlike any previously published design, were developed to address her goals for functional independence and the biological needs of the tissues. Dynamic power was provided to the wrist, fingers, and thumb by elastic cords and thin, flexible thermoplastic, without the need of an outrigger, thus avoiding the need for wire bending and cutting. At the outset, the splint was forearm-based and when wrist extension power was recovered, a hand-based splint was designed. Eventually, a circumferential hand-based thumb-stabilizing splint fulfilled most of the remaining orthotic requirements.