Effectiveness of hand splints in children with cerebral palsy: a systematic review with meta-analysis

AimThe aim of this review was to determine the effectiveness of hand splinting for improving hand function in children with cerebral palsy (CP) and brain injury. MethodA systematic review with meta-analyses was conducted. Only randomized and quasi-randomized controlled trials in which all participants were children aged 0 to 18years with CP or brain injury and a hand splint (cast, brace, or orthosis) were included. ResultsSix studies met the inclusion criteria. No study included participants with a brain injury; therefore, the results relate only to CP. Five studies investigated non-functional hand splints' and one investigated a functional hand splint'. Moderate-quality evidence indicated a small benefit of non-functional hand splints plus therapy on upper limb skills over therapy alone (standard mean difference [SMD]=0.81, 95% confidence interval [CI]=0.03-1.58), although benefits were diminished 2 to 3months after splint wearing stopped (SMD=0.35, CI -0.06 to 0.77). InterpretationIn children with CP, hand splints may have a small benefit for upper limb skills. However, results are diminished after splint wearing stops. Given the costs - potential negative cosmesis and discomfort for the child - clinicians must consider whether hand splinting is clinically worthwhile. Further methodologically sound research regarding hand splinting combined with evidence-based therapy is needed to investigate whether the small clinical effect is meaningful.