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Effectiveness of hand splints in children with cerebral palsy: a systematic review with meta-analysis
Michelle Jackman1, Iona Novak, Natasha Lannin
1School of Medicine, University of Notre Dame, Sydney, NSW, Australia.
Insights
Hand splints may offer a small benefit for upper limb skills in children with cerebral palsy (CP). However, these effects diminish after splint removal, questioning their long-term clinical value.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Orthopedics
Background:
- Cerebral palsy (CP) often impacts hand function in children.
- Hand splinting is a common intervention, but its effectiveness requires rigorous evaluation.
Purpose of the Study:
- To systematically review the effectiveness of hand splinting for improving hand function in children with CP and brain injury.
Main Methods:
- A systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Included studies focused on children aged 0-18 years with CP or brain injury using hand splints.
- Six studies met the inclusion criteria, with results pertaining only to CP.
Main Results:
- Moderate-quality evidence suggests non-functional hand splints combined with therapy provide a small benefit to upper limb skills.
- This benefit was reduced 2-3 months after splint cessation.
- No studies included participants with brain injury.
Conclusions:
- Hand splints may offer a modest, short-term improvement in upper limb function for children with CP.
- The clinical significance is questioned due to diminishing effects and potential drawbacks like discomfort and cosmesis.
- Further high-quality research is needed to determine the meaningfulness of hand splinting combined with evidence-based therapy.
Aim:
The aim of this review was to determine the effectiveness of hand splinting for improving hand function in children with cerebral palsy (CP) and brain injury.
Method:
A systematic review with meta-analyses was conducted. Only randomized and quasi-randomized controlled trials in which all participants were children aged 0 to 18 years with CP or brain injury and a hand splint (cast, brace, or orthosis) were included.
Results:
Six studies met the inclusion criteria. No study included participants with a brain injury; therefore, the results relate only to CP. Five studies investigated 'non-functional hand splints' and one investigated a 'functional hand splint'. Moderate-quality evidence indicated a small benefit of non-functional hand splints plus therapy on upper limb skills over therapy alone (standard mean difference [SMD]=0.81, 95% confidence interval [CI]=0.03-1.58), although benefits were diminished 2 to 3 months after splint wearing stopped (SMD=0.35, CI -0.06 to 0.77).
Interpretation:
In children with CP, hand splints may have a small benefit for upper limb skills. However, results are diminished after splint wearing stops. Given the costs - potential negative cosmesis and discomfort for the child - clinicians must consider whether hand splinting is clinically worthwhile. Further methodologically sound research regarding hand splinting combined with evidence-based therapy is needed to investigate whether the small clinical effect is meaningful.
