Implications of providing wrist-hand orthoses for children with cerebral palsy : Evidence from a randomised controlled trial

Journal article


Imms, Christine, Wallen, Margaret, Elliott, Catherine, Hoare, Brian, Greaves, Susan, Randall, Melinda and Orsini, Francesca. (2022). Implications of providing wrist-hand orthoses for children with cerebral palsy : Evidence from a randomised controlled trial. Disability and Rehabilitation. 45(12), pp. 2046-2056. https://doi.org/10.1080/09638288.2022.2079734
AuthorsImms, Christine, Wallen, Margaret, Elliott, Catherine, Hoare, Brian, Greaves, Susan, Randall, Melinda and Orsini, Francesca
Abstract

Purpose
To investigate the effects of providing rigid wrist-hand orthoses plus usual multidisciplinary care, on reducing hand impairments in children with cerebral palsy.

Methods
A pragmatic, multicentre, assessor-blinded randomised controlled trial aimed to enrol 194 children aged 5–15 years, with wrist flexor Modified Ashworth Scale score ≥1. Randomisation with concealed allocation was stratified by study site and passive wrist range. The treatment group received a rigid wrist-hand orthosis, to wear ≥6 h per night for 3 years. Analysis included repeated measures mixed-effects linear regression models, using intention-to-treat principles.

Results
The trial stopped early due to insufficient recruitment: 74 children, across all Manual Ability Classification System levels, were randomised (n = 38 orthosis group; n = 36 control). Mean age was 10.2 (SD 3.1) years (orthosis group) and 9.1 (SD 2.8) years (control). Data showed some evidence that rigid wrist-hand orthosis impacted passive wrist extension with fingers extended in the first year [mean difference between-groups at 6 months: 13.15° (95%CI: 0.81–25.48°, p = 0.04); 12 months: 20.94° (95%CI: 8.20–33.69°, p = 0.001)]. Beyond 18 months, participant numbers were insufficient for conclusive findings.

Conclusion
The study provided detailed data about short- and long-term effects of the wrist-hand orthosis and highlighted challenges in conducting large randomised controlled trials with this population.

Trial Registration: Australia and New Zealand Clinical Trials Registry: U1111-1164-0572

Keywordscerebral palsy; child; randomised controlled trial; range of movement; upper limb impairment
Year2022
JournalDisability and Rehabilitation
Journal citation45 (12), pp. 2046-2056
PublisherTaylor & Francis
ISSN1464-5165
Digital Object Identifier (DOI)https://doi.org/10.1080/09638288.2022.2079734
PubMed ID35649128
Scopus EID2-s2.0-85131361331
Page range2046-2056
FunderAustralian Catholic University (ACU)
National Health and Medical Research Council (NHMRC)
Perth Children’s Hospital
Monash Health
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online01 Jun 2022
Publication process dates
Accepted15 May 2022
Deposited01 Mar 2023
Grant IDP2013000413
P1057997
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