Upper limb splinting for people following spinal cord injury: A scoping review

Upper limb (UL) splinting interventions are commonly delivered to people following spinal cord injury (SCI) as part of multi-modal rehabilitation; however, their clinical efficacy remains unclear and a wide variety of splinting interventions are used in clinical practice and described in the literature. This study aimed to map out the available evidence and guidelines on the topic, to summarize the breadth of knowledge and identify knowledge gaps. A scoping review was conducted using the Arksey & O’Malley’s methodological framework. Seven electronic databases were searched for literature evaluating upper limb splinting interventions for SCI rehabilitation. Two independent reviewers screened results. Findings were synthesized narratively and reported according to the PRISMA-ScR checklist. 21 primary studies evaluating traditional (n = 13) and non-traditional (n = 3) splints, five qualitative studies and 15 clinical guidelines were included. Most studies evaluated hand and wrist-based splints, which were predominantly used to optimize hand function. Large variations in terms of purpose, type, dosage, outcome assessment and impact of splinting interventions were identified. All clinical guidelines lacked detail and acknowledged the need for tailoring. Considerable heterogeneity amongst the UL splinting literature and guidelines for SCI rehabilitation exists, with sub-optimal reporting of recommendation for the interventions. Studies were limited by weak methodological designs and small samples sizes, highlighting the need for high-quality mixed-methods trials that have been co-designed by patient and clinical stakeholders. There is a need to develop more robust clinical guidelines specifically for SCI rehabilitation.