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Splinting for Contractures in Adults with Neurological Dysfunction: Practice Guideline

This practice guideline aims to promote best practices in using splinting for the prevention and correction of contractures in adults with neurological dysfunction. It provides evidence-based recommendations, step-by-step considerations, and impact for practitioners, managers, commissioners, and service users.

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Splinting for Contractures in Adults with Neurological Dysfunction: Practice Guideline

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  1. Splinting for the prevention and correction of contractures in adults with neurological dysfunction Practice guideline for occupational therapists and physiotherapists

  2. Learning outcomes • To explore aspects of the practice guideline recommendations in relation to current practice. • To develop an understanding of the importance of using practice guidelines to inform practice. • To explore and develop an understanding of how to use the Audit Form for use with the evidence-based recommendations.

  3. Practice question: What is the evidence for the use of splinting in adults with neurological dysfunction for the prevention and correction of contractures?

  4. Key objective of guideline To promote best practice in the use of splinting in adults with neurological dysfunction for the prevention and correction of contractures. To assist clinicians with their clinical reasoning, an exploration of the physiological background to the development of contracture has been included in the guideline.

  5. Methodology 2. Guideline scope defined involving stakeholders 1. Guideline development group established 4. Screen findings 3. Literature search 5. Critically appraise articles 7. Peer review, stakeholder and service user consultation 6. Development of practice guideline recommendations 8. Final draft approved by COT Practice Publications Group 9. Published by COT 2015

  6. Evidence-based recommendations Recommendations are based on the evidence available within 33 critically appraised papers. Each recommendation is assigned: • A strength scoring 1 or 2 (Strong or Conditional) • A quality grading A, B, C or D (High, Moderate, Low or Very Low)

  7. Recommendation areas Lower limb • Ankle– contracture correction, contracture prevention • Knee– contracture correction, contracture prevention Upper limb • Wrist and hand – contracture correction, contracture prevention • Elbow– contracture correction

  8. Lower limb

  9. Lower limb

  10. Lower limb

  11. Upper limb

  12. Upper limb

  13. Key steps for consideration when splinting adults with contractures (COT and ACPIN 2015 p40)

  14. (COT and ACPIN 2015 p41)

  15. (COT and ACPIN 2015 p41)

  16. Upper limb

  17. Impact of practice guideline for you: the practitioner • Challenges / affirms your current practice. • Informs your practice. • Provides evidence to support your practice (completion of Audit Form). • Provides a vehicle for you to justify your practice.

  18. Impact of practice guideline for managers • Articulates the need for splinting as a useful adjunct in the therapist’s toolbox in the prevention and correction of contractures. • Provides a structure to audit the work of occupational therapists and physiotherapists within the service to improve service quality. • Provides a vehicle for justifying service provision.

  19. Impact of practice guideline for commissioners • Provides evidence of the need for occupational therapy and physiotherapy for adults who have or are at risk of contracture from neurological dysfunction and require splinting as one part of a comprehensive goal-directed neurological rehabilitation or management programme. • Provides guideline recommendations developed by a NICE Accredited process.

  20. Impact of practice guideline for service users • The recommendations reinforce the fundamental importance of the service user perspective. • In being adopted by services and occupational therapists, the guideline should improve the consistency and quality of intervention for users of services. • Gives assurance that practitioners use the available evidence to support interventions.

  21. “This one is sporty looking… put on a pair of shorts and you look like you have had a sports injury” “. . . in hospital I was really skinny, when I got out I put on weight and the splint was too tight and had to stop wearing it.” “Until the serial casting started, getting my left heel down was always a struggle” “. . . can’t wear nice shoes, having to buy two pairs, one pair bigger to get the splint in; it’s expensive and embarrassing, I wouldn’t want to take a splint to a shop.”

  22. Practice guideline resources • College of Occupational Therapists and Association of Chartered Physiotherapists in Neurology (2015) Splinting for the prevention and correction of contractures in adults with neurological dysfunction: practice guideline for occupational therapists and physiotherapists. London: COT. • Audit tool • Quick Reference Guide • Feedback form The full practice guideline together with implementation resources can be accessed from the Royal College of Occupational Therapists website: www.rcot.co.uk and ACPIN website: www.acpin.net.

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