Adherence to therapeutic splint wear in adults with acute upper limb injuries: a systematic review

Abstract

Introduction Non-adherence with therapeutic splinting in acute hand injury can reduce treatment benefits, increase risk of disability and bias assessment of treatment efficacy. This systematic review aims to critically analyse the literature on splinting of acute upper limb injuries to identify key factors that could influence patient adherence with splint wear. Methods Trials were identified from searches of EMBASE, MEDLINE, CINAHL (to June 2009) and reference lists of articles and relevant reviews. Search terms used were patient compliance/adherence behaviour, splint/s, othosis/es and brace. Where possible, randomized controlled trials or prospective cohort studies were sought, and then cross-sectional and retrospective studies if the former were not available. Studies specifically addressing chronic conditions were excluded. All relevant trials were assessed for methodological quality by the author using explicit criteria. Data were extracted using a standardized form designed by the author. Results Six studies (one randomized controlled trial, two cross-sectional analytic surveys and three retrospective file reviews) involving 490 people were included. Owing to the heterogeneity of studies synthesis is narrative rather than quantitative. There was no consistent correlation between adherence and age or gender. One study found a correlation with patient perception of positive effect, and one found negative correlations with agitation and brain injury severity. Discussion Studies found were generally of varied quality and may be susceptible to bias. This is a field with little published scientific evidence, and future research should measure adherence relationships with socioeconomic, health-care system, therapy- and patient-related characteristics.