Casting for upper limb hypertonia: A retrospective study to determine the factors associated with intervention decisions

Aim: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture.Methods: Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression. Results: Casting was statistically significantly likely to be chosen in the presence of moderate (CI_{95} 1.88-39.80, p=0.01) or severe hypertonicity (CI_{95} 1.34-135.98, p=0.03), and if the stated clinical aim was to reduce hypertonicity (CI_{95} 2.01-18.10, p=0.001) or contracture (CI_{95} 1.31-12.73, p=0.02). When reports included both these clinical aims, there was a highly significant association with the decision to cast (CI_{95} 5.67-9.13, p=0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70-95 years), limited personal support and a clinical aim of comfort/hygiene maintenance. Conclusion: Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol