Affiliations: [a] Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia | [b] Strive Occupational Rehabilitation, Queensland, Australia | [c] The University of Queensland, School of Health and Rehabilitation Sciences, Division of Occupational Therapy, Queensland, Australia
Correspondence:
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Corresponding author: Kathy Kuipers, Acting Advanced Clinician and Team Leader, Geriatric and Rehabilitation University, Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, 4102, Queensland, Australia. Tel.: +61 7 3176 5008; Fax: +61 7 3176 7207; E-mail: Kathy_kuipers@health.qld.gov.au
Abstract: Aim: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. Methods: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. Results:Casting was statistically significantly likely to be chosen in the presence of moderate (CI95 1.88–39.80, p = 0.01) or severe hypertonicity (CI95 1.34–135.98, p = 0.03), and if the stated clinical aim was to reduce hypertonicity (CI95 2.01–18.10, p = 0.001) or contracture (CI95 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 (CI95 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. Conclusion: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.
