Australasian Faculty of Rehabilitation Medicine
Recommendations from the Australasian Faculty of Rehabilitation Medicine. The Australasian Faculty of Rehabilitation Medicine (AFRM) is a Faculty of the Royal Australasian College of Physicians (RACP). AFRM provides training and continuing education for Rehabilitation Medicine Fellows and trainees throughout all stages of their career. AFRM trainees and Fellows are committed to providing high quality rehabilitation care to individuals and communities in Australia and New Zealand.
Do not routinely use splinting for prevention and/or management of contractures after stroke.
Reviews of the evidence and individual case studies on the use of hand splinting for stroke patients have been unable to find conclusive evidence that it leads to improvements in managing spasticity and preventing contractures or more generally improving upper limb function. Moreover, there is high quality evidence that stretch, whether administered from splints or other means, does not have clinically important effects on joint mobility in people with or without neurological conditions, at least for the periods it is typically prescribed of less than seven months.
- Basaran A, Emre U, Karadavut KI, et al. Hand splinting for poststroke spasticity: a randomized controlled trial. Top Stroke Rehabil 2012; 19(4):329-37.
- Harvey LA, Katalinic OM, Herbert RD, et al. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev 2017 1:CD007455.
- Lannin NA, Herbert RD. Is hand splinting effective for adults following stroke? A systematic review and methodologic critique of published research. Clin Rehabil 2003;17(8):807-16.
- Lannin NA, Cusick A, McCluskey A, et al. Effects of splinting on wrist contracture after stroke: a randomized controlled trial. Stroke 2007; 38(1):111-6.
A working group within AFRM initially identified 10 recommendations on low value practices in the field of rehabilitation medicine that may be widespread in Australia and New Zealand. Following a review of the evidence these were reduced to seven. An online survey based on these seven recommendations was distributed to all AFRM members asking them to rate these recommendations based on whether they thought they were evidence based, whether the low-value practices targeted were still being undertaken in significant numbers, and whether the recommendation was important in terms of reducing harm and unnecessary costs to patients. The working group reviewed the feedback and finalised the ‘top 5’ recommendations which were approved by AFRM Executive in mid-2017.
- 1 Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis.
- 2 Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain.
- 3 Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury.
- 4 Do not routinely use splinting for prevention and/or management of contractures after stroke.
- 5 Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags.