A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females: Wrist Range of Motion and Grip Strength Analysis

Abstract

Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.Design: Randomised comparative functional study of the wrist/hand with and without WHOs.Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.

A comparative study of the efficacy and functionality of 10 commercially available wrist-hand orthoses in healthy females during activities of daily living

“…Two of these, at 18 cm in length (WHO#6 and 10), were the two shortest WHOs tested. This is in line with previous findings where from a biomechanical efficiency perspective, a longer WHO may better control wrist flexion motion (20).…”

“…These WHOs are 23 cm in length, constructed from a two-way stretch fabric with Velcro® fastenings and an aluminium volar bar. In line with previous research investigating the efficacy of these 10 WHOs in controlling wrist motion, it was concluded that the same WHOs (#1 and 3) performed better in controlling wrist flexion, which was attributed to the improved biomechanical efficiency related to the increased length of these WHOs and the ability to achieve a good fit due to the material of construction (20). In addition, this research has demonstrated that in addition to the aforementioned, the addition of a wrist strap provides enhanced flexion control through activities that require the wrist to be in flexion.…”

“…Similar to previous work exploring the impact of 10 commercially available WHOs on wrist range of motion and grip strength (20), a repeatable and comprehensive testing protocol was developed to investigate the impact of 10 WHOs during a set of five ADLs: ADL1, pouring water from a jug into a cup; ADL2, turning a key in a lock; ADL3, cutting a putty block with a knife; ADL4, zipping up and down a jacket; and ADL5, moving a laden plate. The order of the WHOs to be tested, order of the condition (with/without the WHOs), and sequence of the ADLs were randomised for each individual and followed the Standards for Quality Improvement Reporting Excellence 2.0 (21).…”

“…The resulting mean resting position in the sagittal plane with WHOs across all participants, as shown in Table 2 and Figure 2, ranged from 1.25°extension (± 6.05°) for orthosis #4 to 8.87°e xtension (± 5.13°) for orthosis #6, with WHO#1, 2, 3, 6, and 9 positioning the wrist within the desired prescribed range of [10][11][12][13][14][15]°extension. Similar to previous research, each WHO was fitted as supplied by the manufacturer (20), with no contouring of the volar bar to alter the alignment of the wrist where this was an option to do so (WHO#1, 2, 3, 5, 6, 7, 8, and 9). These results emphasise that clinicians must not assume that manufacturers provide these WHOs with a volar bar contoured to hold the wrist at a suitable angle at rest and should be adjusted if possible.…”

“…Previous studies have investigated the impact on performance during everyday functional tasks in the RA population (13)(14)(15)(16)(17)(18). However, there is a variability seen across the results, which may be attributable to several factors such as the following: inconsistencies and/or incomplete reporting of the methodology (19), participant characteristics, WHO/s tested, the contour and fit of the WHO in the palmar region impeding grip patterns and the ability to perform ADLs, and the reporting of wrist motion control, which is often suboptimal and could be related to the design of WHOs (20).…”