Abstract
Background
Static progressive orthoses are commonly used in the treatment of stiff joints or joint contractures of the upper extremity, but there are few high-quality studies to support this intervention. In addition, there has not been a recently published review of the current literature describing this treatment technique and the outcomes achieved. The specific purpose of this comprehensive literature review is to investigate the current levels of evidence supporting the use of static progressive orthoses in the treatment of joint stiffness or contracture in clients with orthopedic conditions of the upper extremity. This review will also discuss common diagnoses of patients and outcomes achieved, as well as provide recommendations for future hand therapy practice.
Methods
A computerized database search of publications incorporating the use of static progressive orthoses for the upper extremity was conducted, dating from January 1979 through January of 2011. The search was limited to studies in English of adults with orthopedic conditions.
Results
A total of 65 publications were located. However, only 16 of these studies met this review’s inclusion criteria of level 4 evidence or above. Each of the articles was critically appraised using the Structured Effectiveness for Quality Evaluation of Study (SEQES) and the Oxford Center for Evidence-Based Medicine 2011 Level of Evidence. Total SEQES scores ranged from 17 to 39. The majority of the studies are level 4 evidence.
Conclusions
Although the overall level of evidence is low, the inclusion of static progressive orthoses as an intervention appears to result in positive outcomes, including increased active range of motion, increased grip strength, improved DASH scores, and improved patient satisfaction as well as reduced pain medications during orthotic intervention. The current evidence supports static progressive orthoses as an intervention for patients with upper extremity joint stiffness or contractures due to orthopedic conditions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alsancak S, Altinkaynak H, Kinik H. Elbow orthosis to re-establish elbow extension motion. J Prosthet Orthot. 2006;18(4):106–10.
Bhat A, Bhaskaranand K, Nair G. Static progressive stretching using a turnbuckle orthosis for elbow stiffness: a prospective study. J Orthop Surg. 2010;18(1):76–9.
Bonutti PM, Windau JE, Ables BA, Miller BG. Static progressive stretch to reestablish elbow range of motion. Clin Orthop Relat Res. 1994;303:128–34.
Doornberg J, Ring D, Jupiter J. Static progressive splinting for posttraumatic elbow stiffness. J Orthop Trauma. 2006;20(6):400–4.
Farmer SE, James M. Contractures in orthopedic and neurological conditions: a review of causes and treatment. Disabil Rehabil. 2001;23(13):549–58.
Flowers K, LaStayo P. Effect of total end range time on improving passive range of motion. J Hand Ther. 1994;7(3):150–7.
Gelinas JJ, Faber KJ, Patterson SD, King GJW. The effectiveness of turnbuckle splinting for elbow contractures. J Bone Joint Surg Br. 2000;82-B1:74–8.
Glasgow C, Wilton J, Tooth L. Optimal daily total end range time for contracture: resolution in hand splinting. J Hand Ther. 2003;16:207–18.
Glasgow C, Wilton J, Tooth L. Which splint? Dynamic versus static progressive splinting to mobilize stiff joints in the hand. Br J Hand Ther. 2008;13(4):2104–10.
Green DP, McCoy H. Turnbuckle orthotic correction of elbow flexion contractures after acute injuries. J Bone Joint Surg Br. 1979;61-A(7):1092–5.
Lucado AM, Li Z. Static progressive splinting to improve wrist stiffness after distal radius fractures: a prospective case series study. Physiother Theor Pract. 2009;25(4):297–309.
Lucado AM, Li Z, Russell G, Papaadonikolakis A, Ruch D. Changes in impairment and function after static progressive splinting for stiffness after distal radius fracture. J Hand Ther. 2008;21:319–25.
MacDermid JC. An introduction to evidence based practice for hand therapists. J Hand Ther. 2004;17:105–17.
McGrath M, Ulrich S, Bonutti P, Smith J, Seyler T, Mont M. Evaluation of static progressive stretch for the treatment of wrist stiffness. J Hand Surg. 2008;33A:1498–504.
McGrath M, Ulrich S, Bonutti P, Marker D, Johanssen H, Mont M. Static progressive splinting for restoration of rotational motion of the forearm. J Hand Ther. 2009;22:3–9.
Michlovitz SL, Harris BA, Watkins MP. Therapy interventions for improving joint range of motion: a systematic review. J Hand Ther. 2004;17:118–31.
OCEBM Levels of Evidence Working Group*. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653.
Parent-Weiss N, King J. Static progressive forearm rotation contracture management orthosis design: a study of 28 patients. J Orthot Prosthet. 2006;18(3):63–7.
Schulz-Johnson K. Static progressive splinting. J Hand Ther. 2002;15:163–78.
Ulrich SD, Bonutti PM, Seyler TM, Marker DR, Morrey BF, Mont MA. Restoring range of motion via stress relaxation and static progressive stretch in posttraumatic elbow contractures. J Should Elb Surg. 2010;19:196–201.
Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther. 2010;23:334–51.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Schwartz, D.A. Static progressive orthoses for the upper extremity: a comprehensive literature review. HAND 7, 10–17 (2012). https://doi.org/10.1007/s11552-011-9380-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11552-011-9380-2