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(Stroke. 2008;39:e46.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Splinting Poststroke: the Jury Is Still Out

Jeno E. Marossezky, MBBS; Joseph A. Gurka, MBBS Ian J. Baguley, MBBS

Department of Rehabilitation Medicine, Westmead Hospital, Westmead, NSW, Australia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

In the article abstract by Lannin et al,¹ the authors claim "the practice of routine splinting soon after stroke should be discontinued." Their presented data does not show this.

The stated aim was to determine the effect of splinting "on contracture in the wrist and long finger flexor muscles"¹ without defining ‘contracture’. Participant inclusion criteria required an absence of active wrist extension as the single physiological consideration for inclusion. The average wrist extensibility across groups was 58.4° (SD 14.6°) with patients exhibiting minimal spasticity. Baseline measures suggest the patient group did not appear to have, nor be at risk of, developing excessive wrist or finger contracture. It is unlikely that in this acute stage of stroke rehabilitation against a background of minimal muscle activity with fair range of passive wrist extensibility that contracture would develop.

The study design lacks consideration of the effects of imbalanced muscle overactivity (rather than spasticity) on development of contracture, muscle length, and hand function. A high proportion of participants reported rest pain both before and after intervention, with clinical differences evident between controls and splinted groups (not statistically significant). The wide standard deviation band suggests marked heterogeneity within the sample with subsequent potential for type II error. However, the authors do not discuss this finding. Furthermore, there appeared to be no attempt to classify patients at risk of contracture due to muscle overactivity or pain which may have revealed a benefit for some patient types. That the sample size precluded subgroup analysis . . . [Full Text of this Article]

Related Article:

Response to Letter by Marossezky et al

Natasha Lannin, Annie McCluskey, Robert Herbert, and Anne Cusick
Stroke 2008 39: e47. [Extract] [Full Text] [PDF]