BAOT/COT Specialist Section Rhuematology Conference 2010

1. c. Hammond, Mellson, Laver 1
Resting Splint Survey
– NW COTSS
Rheumatology Group
Survey of Information given to
support the provision of resting
splints and Focus Group results
Jo Mellson1, Alison Hammond1 Charlie Laver2
Centre for Health, Sport & Rehabilitation Research,
University of Salford1
ICATS, Pennine MSK Partnership2

2. c. Hammond, Mellson, Laver 2
Aim of study
 To investigate current practice amongst
group members related to the provision
of NRS:
 Patient instructions regarding splint wear
 Patient instructions regarding splint care
 Exercise provision

3. c. Hammond, Mellson, Laver 3
Response Rate
 24/ 35 OTs replied (69%)
 79% of respondents made splints
 Respondents (n=19)
 Majority of sample Band 7 OT’s
 13 out of the 19 respondents provided
the instruction sheets they give to
patients when submitting questionnaire

4. c. Hammond, Mellson, Laver 4
1. What information do you give to
patients about wearing their splint?
Increase time wearing splint to ensure tolerance
before wearing all night
15
Wear at night 10
If unable to tolerate at night, wear in evening 8
If provide with 2 splints, wear one at a time 7
Complete hand exercises on removal of splint 6
Check skin for problems on removal of splint 6
Wear only when resting 5
Wear as necessary to relieve pain or swelling 4

5. c. Hammond, Mellson, Laver 5
Verbal or written reasons for
supplying splint given to patient
Total 10
Decrease pain 5
Prevent further deformity 5
Decrease swelling/inflammation 5
Increase hand function 3
Maintain good hand position 2
Reduce pins and needles 2
For rest 2
To stabilise joints 1

6. c. Hammond, Mellson, Laver 6
2. What instructions do you give
about care of the splint?
Splint care Free text Sheets
Wash in warm water 16 13
Avoid direct heat 16 13
Do not alter 9 9
Washing straps 3 3
Keep away from the dog 1

7. c. Hammond, Mellson, Laver 7
3. What instructions do you give
about precautions?
Physical precautions Free text (19) Instruction Sheets (13)
Pressure 11 8
Changes in skin colour 10 10
Increased pain 9 5
Skin irritation 9 6
Pins and needles 8 6
Swelling 7 7
Numbness 5 5
Blisters 4 4
Altered sensation 3 3
Joint stiffness 2 2
Temperature changes; rash;
marking; poor fit; uncomfortable
1 1

8. c. Hammond, Mellson, Laver 8
4. Do you routinely teach patients
hand exercises when providing
resting splints?
 Yes = 13 (+1 if not taught already)
 ROM exercises = 14
 Strength exercises= 5
 No = 4
 OT does not provide the service = 2
 Refer to PT for hand exercises= 2

9. c. Hammond, Mellson, Laver 9
Focus Group recommendations
 The focus group was made up of 5
experienced Rheumatology Occupational
Therapists.
 Aim:
 To develop guidelines for provision of a resting
splints
 To develop a protocol document for provision
of resting splints for junior staff.
 To develop guidelines for information that
should be supplied to patients

10. c. Hammond, Mellson, Laver 10
Focus Group
 Agreed:
 Written information is essential
 Should include:
 Reasons for provision of splint
 Precautions
 Splint Care
 Splint wear regimen

11. c. Hammond, Mellson, Laver 11

12. c. Hammond, Mellson, Laver 12
Things to be mindful of…
 Small sample group.
 Sample group from same area of the
country.
 Questionnaire does not extract all the
reasoning behind why OT’s practice in
the way they do.

13. c. Hammond, Mellson, Laver 13
Issues raised to think about
 How do you position your splints?
 Is midline a position that you have used?
 What material do you use?
 Is it the most appropriate for the splint?
 What is on your instruction sheet?
 Is it more focused on precautions rather
than reasons?

14. c. Hammond, Mellson, Laver 14
Next steps
1. Explore use of compression gloves in a
further questionnaire – ongoing
collation
2. Recommend guidelines for RS [and
compression glove] provision based on
research and expert opinion
3. Recommend standard splint
instructions
4. Publish results

15. c. Hammond, Mellson, Laver 15
Thank you!
 To all members of North West COTSS-
Rheumatology for taking the time to:
 Contribute to methodology, responses
and focus group involvement.
 Engagement in debate and contribution
to consensus for RS provision.