title: Oedema in the hands of people with tetraplegia post spinal cord injury: building the evidence
Creators: name: Oh, Soo Y
Publisher: name: Griffith University
Year: 2021
Subjects: subject: Oedema
subject: management of oedema
subject: tetraplegia
subject: clinical expertise
subject: research evidence
subject: patient’s perspectives
subject: Australia

description: Oedema in the hands of people with tetraplegia may occur in the early stages of rehabilitation and if left untreated, can cause joint stiffness, pain and decreased range of motion, subsequently affecting hand function (Boomkamp-Koppen et al., 2005; Faghri, 1997; Guerts, 2000; Howard &amp; Krishnagiri, 2001; Villeco, 2012). Optimal hand and arm function has been considered as one of the most important factors in improving quality of life of people with tetraplegia (Anderson, 2004; Simpson et al., 2012; Snoek et al., 2004; Wagner et al., 2007). It is therefore important that secondary consequences, such as oedema, are managed effectively. However, there is a significant lack of research evidence specific to the management of oedema in the hands of people with tetraplegia. In response, the aim of this thesis was to build the evidence for improved oedema management in the hands of people with tetraplegia. The evidence-based practice (EBP) framework by Hoffmann et al. (2017) guided the development of the research questions within this research program. The first research question sought to explore clinical expertise and asked: What is the current clinical practice for the management of oedema in the hands of people with tetraplegia in Australia? The second research question sought to develop objective research evidence for the management of oedema and asked: What are the effects of two treatment methods (the Boxing Glove [BG] compression bandaging and Coban™ compression bandaging) for the management of oedema in the hands of people with tetraplegia? Finally, the patient’s perspectives were explored with the third research question: What is the experience of the two treatment methods from the perspective of people with tetraplegia? The research program included two studies. Firstly, an online survey of clinicians addressed the first research question and collected data regarding their perception of cause and prevalence of oedema, assessment and treatment methods, and challenges with oedema management and impacts on rehabilitation. The survey findings identified inconsistent practice methods for the management of oedema in the hands of people with tetraplegia and use of common practices that were not supported by evidence. For example, the BG splint, which is unique to the spinal cord injury (SCI) population, was reportedly used by 53% of the participants of the survey, was considered effective by no participants, and is not supported by any evidence. Compression bandaging, which has shown to be effective amongst other clinical areas, was only considered to be effective by 41% of the participants of the survey and again, lacked any evidence specific to people with tetraplegia. These survey findings informed the second study, which addressed the second and third research questions. A convergent mixed methods design focused on exploring the effects and experiences of two treatment methods used in current clinical practice: the BG compression bandaging and Coban™ compression bandaging. An ABA single case design (SCD) study measured changes in circumferential measurements following application of either the BG compression bandaging or Coban™ compression bandaging. Interpretative description (ID) (Thorne, 2016) guided semi-structured interviews that explored the experience of the two treatment methods from the perspective of people with tetraplegia. Five people with tetraplegia with oedema in their hands, participated in the mixed methods study and the converged analysis of the quantitative and qualitative results led to four key findings. Firstly, there was minimal treatment effect measured and described by participants for the BG compression bandaging. Secondly, Coban™ compression bandaging showed a promising treatment effect in reducing oedema in the hands and was the preferred treatment method among people with tetraplegia. Thirdly, oedema returned once Coban™ compression bandaging was removed and some people with tetraplegia were disappointed as they felt that they could do more with their hands when applied. Finally, people with tetraplegia expressed various priorities for rehabilitation, and managing oedema was not always the focus especially for those with other priorities relating to medical issues. The findings from this research program have contributed to an important first step in building the evidence for oedema management of the hands of people with tetraplegia. The findings provide low-level evidence in regards to the application of two commonly used treatment methods to manage oedema in the hands of people with tetraplegia. This research program identified implications to clinical practice, as well as an evidence-to-practice gap, and provide clear directions for future research and knowledge translation.