Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting.
L S Op de Coul, S Bleeker, J H de Groot and 2 others
PMID 36004384WHAT IT FOUND
After one year, a dynamic night orthosis and serial casting reduced elbow contractures in children with brachial plexus injury by a similar amount.
Serial casting worked faster in the first few months, but the difference disappeared by 54 weeks. Functional outcomes and adherence were comparable.
Key findings
01There was no significant difference between the dynamic orthosis and serial casting groups in the reduction of elbow flexion contractures at the 54-week follow-up.
02Serial casting provided a faster initial reduction in contracture angle during the first 8 weeks compared to the dynamic orthosis, but this difference was not present between 25 and 54 weeks.
03Both treatments resulted in similar improvements in individual functional goals, with no significant difference in Goal Attainment Scaling scores between the groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included an 'open inclusion' group where patients chose their treatment, which introduces selection bias and makes the results less robust than a pure randomized trial. Adherence and comfort were measured retrospectively at the end of the study, which may lead to recall bias. The primary outcome was measured from photographs by a blinded rater, but the treatment providers were not blinded. The study did not include a cost analysis, which may affect real-world applicability depending on insurance coverage and local resources. Improvement in functional goals may have been partly due to compensatory strategies learned over time rather than the treatment effect itself.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research.
The easy way to misread this
Do not assume the dynamic orthosis is superior for comfort based on the statistically significant one-point difference in median scores. The authors explicitly state this difference is not clinically relevant, and the comparison was retrospective and potentially biased because serial casting was only used for the first four weeks.