Casting for upper limb hypertonia: A retrospective study to determine the factors associated with intervention decisions

Kuipers, Kathy, Burger, Laura and Copley, Jodie (2012) Casting for upper limb hypertonia: A retrospective study to determine the factors associated with intervention decisions. Neurorehabilitation, 31 4: 409-420. doi:10.3233/NRE-2012-00811


Author Kuipers, Kathy
Burger, Laura
Copley, Jodie
Title Casting for upper limb hypertonia: A retrospective study to determine the factors associated with intervention decisions
Journal name Neurorehabilitation   Check publisher's open access policy
ISSN 1053-8135
1878-6448
Publication date 2012-01
Sub-type Article (original research)
DOI 10.3233/NRE-2012-00811
Volume 31
Issue 4
Start page 409
End page 420
Total pages 12
Place of publication Amsterdam, Netherlands
Publisher I O S Press
Collection year 2013
Language eng
Formatted abstract
Aim: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture.
Methods: Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression.
Results: Casting was statistically significantly likely to be chosen in the presence of moderate (CI95 1.88–39.80, p = 0.01) or severe hypertonicity (CI95 1.34–135.98, p = 0.03), and if the stated clinical aim was to reduce hypertonicity (CI95 2.01−18.10,
p = 0.001) or contracture (CI95 1.31–12.73, p = 0.02). When reports included both  these clinical aims, there was a highly significant association with the decision to cast (CI95 5.67–9.13, p = 0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70–95 years), limited personal support and a clinical aim of comfort/hygiene maintenance.
Conclusion: Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol.
Keyword Hypertonicity
spasticity
upper limb
casting
clinical decision
Cerebral-Palsy
Children
Adults
Spasticity
Stroke
Dysfunction
Therapy
Rules
Trial
Care
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Health and Rehabilitation Sciences Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 5 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 27 Jan 2013, 00:56:13 EST by System User on behalf of School of Health & Rehabilitation Sciences