Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 10 , Pages 1857-1862, October 2008

Neutral Functional Realignment Orthosis Prevents Hand Pain in Patients With Subacute Stroke: A Randomized Trial

Presented to the Congrès multidisciplinaire du Groupe Suisse de Travail pour la Réadaptation, de la Société Suisse de Médecine Physique et Réhabilitation, April 28, 2006, Interlaken, Switzerland; Congrès Commun de Rhumatologie et de Médecine Physique et de Réhabilitation, September 29, 2006, Genève, Switzerland; Expériences en Ergothérapie XIX° série, September 28, 2006, Montpellier, France; and the International Bobath Instructor Tutor Association, September 11, 2006, Barcelona, Spain.

  • Elisabeth Bürge, MPTSc

      Affiliations

    • Haute école de santé Geneva, HES-SO/University of Applied Sciences Western Switzerland, Geneva, Switzerland
    • Corresponding Author InformationReprint requests to Elisabeth Bürge, MPTSc, 98, Haute école de santé, filière physiothérapie, Rue des Caroubiers 25, CH-1227 Carouge, Switzerland
    • ,
  • Danièle Kupper, OT

      Affiliations

    • Division of Neuro-Rehabilitation, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
    • ,
  • Axel Finckh, MD, MSc

      Affiliations

    • Division of Rheumatology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
    • ,
  • Susan Ryerson, PT, ScD

      Affiliations

    • Center for Applied Biomechanics and Rehabilitation Research, National Rehabilitation Hospital, Washington, DC
    • ,
  • Armin Schnider, MD

      Affiliations

    • Division of Neuro-Rehabilitation, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
    • ,
  • Béatrice Leemann, MD

      Affiliations

    • Division of Neuro-Rehabilitation, Geneva University Hospitals, University of Geneva, Geneva, Switzerland

Abstract 

Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.

Objective

To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.

Design

Randomized trial.

Setting

Rehabilitation center.

Participants

Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.

Intervention

The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.

Main Outcome Measures

Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.

Results

At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.

Conclusions

Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.

Key Words: Biomechanics, Hand, Occupational therapy, Physical therapy techniques, Rehabilitation, Stroke

List of Abbreviations: FMA, Fugl-Meyer Assessment, MAS, Modified Ashworth Scale, ROM, range of motion, VAS, visual analog scale

 

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)00505-4

doi:10.1016/j.apmr.2008.03.023

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 10 , Pages 1857-1862, October 2008

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