SHORT-TERM EFFECTS AND LONG-TERM USE OF A HYBRID ORTHOSIS FOR NEUROMUSCULAR ELECTRICAL STIMULATION OF THE UPPER EXTREMITY IN PATIENTS AFTER CHRONIC STROKE

Objective: To associate the short-term effects of the Hand-master (R) orthosis on disabling symptoms of the affected upper extremity with long-term Handmaster (R) orthosis use after stroke. Design: Historic cohort study. Patients: Patients with chronic stroke. Methods: The Modified Ashworth Scale (0-5) for wrist (primary outcome) and elbow flexor hypertonia, visual analogue scale (0-10) for pain, oedema score (0-3), and passive range of wrist flexion and extension (pROM, degrees) were assessed prior to Handmaster (R) orthosis prescription (T0), after 6 weeks try-out (T1) and a subsequent 4 weeks withhold period (T2). Long-term use was evaluated using a questionnaire. Non-parametric analyses and predictive values were used for statistical analyses. Results: Of the 110 included patients 78.2% were long-term Handmaster (R) orthosis users. Long-term users showed significant short-term (T0-T1) improvements on all impairment scores and a significant relapse of wrist and elbow Modified Ashworth Scale (T1-T2). Non-users showed significant short-term effects on elbow Modified Ashworth Scale and visual analogue scale only. Positive predictive values of short-term effects for long-term use varied between 75% and 100%, with 85% (95% confidence interval (CI) 0.72-0.93) for wrist Modified Ashworth Scale. Negative predictive values were low (11-27%). Conclusion: Short-term Handmaster (R) orthosis effects were generally beneficial for hypertonia, pain, oedema, and pROM, especially in long-term users. Short-term beneficial effects were highly predictive for long-term use, but not for non-use.