Date of Award

12-2008

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Dr. Ben Atchison

Second Advisor

Dr. Diane Dirette

Third Advisor

Dr. Kieran Fogarty

Abstract

Immobilization of the wrist is a common practice throughout the healthcare industry. The main forms of wrist immobilization are short-arm casts, prefabricated wrist splints, custom volar wrist splints, and custom circumferential wrist splints. It is generally accepted, by the medical community, that each form of immobilization allows for some movement. The amount each device allows is unknown. Establishing data that accurately describe the amount of mobility in each immobilization device will allow clinicians to make an evidence-based decision each time they are confronted with the need to order an orthosis.

The purpose of this study was to identify the specific amount of motion allowed and to identify the level of function allowed by each immobilization device. For each device, the exact wrist range of motion in flexion, extension, radial deviation, and ulnar deviation was explored through radiographic analysis. In addition, functional ability was explored with the QuickDASH, Timed In-Hand Manipulation Exam (TIME), and the Jebsen-Taylor Test of Hand Function.

A convenience sample of 24 participants was recruited. All subjects wore each of the four different immobilization devices for 24 hours and then were evaluated for range of motion and functional abilities. MANOVA and post hoc testing were performed on the data to identify statistically significant differences in anterior-posterior total active motion between the cast (31.3°), the volar wrist splint (48.3°), circumferential wrist splint (54.8°), and the prefabricated wrist splint (88.5°). Statistically significant differences were also measured in lateral total active motion between the cast (27.7°), the volar wrist splint (36.7°), the circumferential wrist splint (35.4°), and the prefabricated wrist splint (51.7°). QuickDASH scores of perceived function indicated a statistically significant difference with the prefabricated wrist splint (28.24), the cast (54.6), the volar splint (41), and the circumferential splint (43.9). Similarly, the score on the TIME was statistically significantly faster for the prefabricated wrist splint with an average of 13.88 seconds.

More research should be performed to identify an ultra low profile external device that is highly conforming to maximize immobilization while allowing as close to normal functional activities as possible.

Access Setting

Dissertation-Open Access

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