Determinants of compliance with hand splinting in an acute brain injured population

Poor compliance with hand splinting treatment in the acute injury stage increases the risk of ongoing disability by affecting recovery and functioning. The aims of this study were to identify key predictors of splinting non-compliance in acute traumatic brain injury (TBI) patients and to determine the suitability of the Westmead PTA scale for predicting splinting compliance in TBI.

Retrospective medical record review of all patients who were (1) admitted to a major adult trauma hospital in 2005-2006 and (2) flagged as having concurrent brain and upper limb injuries. Data extracted included demographic information, co-morbidity, injury mechanism, TBI severity, incidence and duration of agitation. Compliance data included loss, removal or agitation with the splint or brace.

Of the 71 subjects, 39.5% (n = 28) were non-compliant with their splint or brace; 60.5% (n = 43) were compliant. The presence and duration of agitation were the strongest predictors of non-compliance with splinting (p = 0.001 and p = 0.003, respectively).

PTA status at splint application does not accurately predict compliance with splinting. This highlights a specific clinical gap in the management of hand injuries against a background of agitation and cognitive impairment.