Casting for upper limb hypertonia: a retrospective study to determine the factors associated with intervention...

To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture.

Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression.

Casting was statistically significantly likely to be chosen in the presence of moderate (CI(95) 1.88-39.80, p=0.01) or severe hypertonicity (CI(95) 1.34-135.98, p=0.03), and if the stated clinical aim was to reduce hypertonicity (CI(95) 2.01-18.10, p=0.001) or contracture (CI(95) 1.31-12.73, p=0.02). When reports included both these clinical aims, there was a highly significant association with the decision to cast (CI(95) 5.67-9.13, p=0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70-95 years), limited personal support and a clinical aim of comfort/hygiene maintenance.

Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol.