silversplint
information for professionals
Dynamic Sterling collection
Move
Beyond
This publication contains an overview of the Dynamics Sterling collection of silver orthoses by OrthoValley. In addition to providing a list of the various models and their functions and sizes, this publication also delves deeper into how OrthoValley silver orthoses work and how they are produced. At the back of this publication, you will find more information about the effectiveness of wearing a silver orthosis, based on the conclusions of an extensive PROM study conducted among persons wearing a silver orthosis from 2016. This booklet can be downloaded online or ordered at orthovalley.nl.
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WE ARE ORTHOVALLEY
THE CATALOGUE
MEASUREMENT
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Editor: Mieke Lagcher, Louis Schouwstra Design & layout: Karel van der Windt Contributors to this publication: Wouter Akkerman, Tim de Roo and Karin van Wingerden. Contact: customerservice: +31 88 245 2535 / contact@orthovalley.nl The OrthoValley editorial team put together the content of this publication with the greatest care, in collaboration with OrthoValley experts in production and orthopedic advice. Orthovalley is not responsible for any inaccuracies in this publication. No part of this publication may be reproduced or published without the prior written consent of OrthoValley.
THE COLLECTION
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PATIENT REPORTED OUTCOME MEASURES (PROM) SILVERSPLINTS
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From the editors
We are Orthovalley
OrthoValley is a progressive manufacturer and supplier of tailor-made orthopaedic aids. OrthoValley is an independent subsidiary of Livit Orthopedie that focuses solely on business customers. We have years of experience in manufacturing orthopedic aids, which we combine with state-of-the-art techniques and technologies to redefine what mobility means. New technologies, new materials, new applications. Our dream is to help you help your customers with posture and movement problems move better. So they can get on with their lives. Stronger, more independent and full of confidence. We will do everything to make this dream come true. Working towards our goal every day, with our whole heart, soul, and expertise. Our evidence-based approach and dedication to challenging ourselves with new opportunities ensure that our mobility solutions support our customers in caring for their patients. We stand for freedom of movement, driven by science, technology and an unmistakable focus on people. We develop products through close cooperation between our R&D team, clinical experts, patient groups, and customers to find solutions that deliver results. We work with universities and independent researchers to prove the medical benefits of our technology. This work provides evidence to inform best practices in the rehabilitation community and inspires healthcare providers to prescribe advanced technology to patients. What's in a name? Jan Rotmans, a professor at Rotterdam’s Erasmus University, is convinced that we are not in an era of change, but in a changing era. We couldn’t have said it better ourselves. The balance of power is set to shift and today’s top-down approach will gradually make way for bottom-up development, organisation, and management. Partnerships and networks will become more important than ever before and because knowledge and access to resources such as the Internet and technology are becoming increasingly democratic, everyone can contribute to innovation from the comfort of their own home. These are exactly the innovative forces we seek to harness to develop a new generation of movement support products. After all, orthopaedic technology will also go through a sea change in the years to come, with 3D printing and Virtual Reality becoming mainstays in society. This future is inching ever closer, and anticipating new changes and getting ahead of the curve are our greatest drivers. In our vision, there are no limits to the possibilities. Fashion has Milan and Paris, the financial markets have Wall Street, Europe has Brussels, and the tech industry has Silicon Valley. We have the lofty ambition of growing into that role for orthopaedic aids and rehabilitation technology. Hence OrthoValley, a name with a wink!
©2020 OrthoValley All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the OrthoValley. To the extent that making copies of this publication is permitted under Article 16b of the Copyright Act of 1912, in conjunction with the Decree of 20 June 1974 Stb. 351, as amended by the Decree of 23 August 1985, Stb. 471 and Article 17 of the Copyright Act, the statutory compensation must be paid to the Stichting Reprorecht (Postbus 3060, 2130 KB, Hoofddorp). For copying parts of this publication in anthologies, readers and other compilations (Article 16 of the Copyright Act), please contact the publisher. Any person using part of this publication in a compilation must be fully aware of their duty to produce a reliable publication. Nevertheless, they cannot accept liability for printing errors and other inaccuracies that may appear in this publication. Amsterdam, april 2020
the collection
An OrthoValley silver orthosis can correct, stabilise or immobilise your wrist, hand, and/or fingers, whilst also serving as a beautiful piece of jewellery. The open design of a silver orthosis makes wearing an aid on your wrist or hand considerably more pleasant.
The collection: The Dynamics Sterling line of silver orthoses by OrthoValley
Dynamics Sterling In 2017, OrthoValley designed its own line of silver orthoses, boasting various carefully designed, unique models: Dynamics Sterling. The arch design is a prototypical feature of the line’s dynamic signature and all edges are rounded. This allows the wearer to move their hand as freely as possible, without causing any skin irritation or pressure points. All designs feature flowing lines, creating a dynamic look and optimising functionality. The thumb sections of wrist orthoses are optimally adjusted to the needs of the customer, allowing for a pen grip, tweezer grip or key grip, for instance. As a result, our orthoses offer maximum comfort and freedom of movement, giving them a great advantage over all other silver orthoses created before 2017.
The Dynamics Sterling line of silver orthoses gives users complete freedom and comfort and all orthoses can be worn as a piece of jewellery. Our dynamic silver orthoses are custom-made from 925 silver, a hypoallergenic material. We only use highly pure Sterling 925 silver in our orthoses, which has hypoallergenic and antibacterial properties. Silver does not block the skin, preventing excessive perspiration and the possible odours and rashes that this can result in. Unlike silicone or leather orthoses, a silver orthosis can be worn as a piece of jewellery. Our orthoses can be finished according to your personal preferences and come in polished or matt silver, for instance. Our silver department only works with highly qualified goldsmiths and silversmiths, who partner up with our hand specialists to deliver perfect, beautiful and custom pieces of jewellery.
sizing model: Simple sizing system based on a single model Abbreviations used for wrist/hand model: DP = Distal phalange MP = Middle phalange PP = Proximal phalange MCP = Meta Car Pal joint DIP = Distal InterPhalangeal joint PIP = Proximal InterPhalangeal joint IP = Inter Phalangeal joint CMC = Carpo Meta Carpal joint Thumb position: A = Opposition B = Intermediate position C = Reposition Wrist position: 1 = 30º dorsal 2 = 15º dorsal 3 = 0º (180º) 4 = 15º palmar
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Type: LTSS2006 Indication: Osteoarthritis, Rheumatism, Ehlers-Danlos, Hyperextension and chronic wrist and thumb complaints Function: Resting splint for wrist, hand, and thumb and ulnar deviation correction. Sizing: Poximal MCP circumference Proximal MCP width Wrist and arm circumference Arm to prox. MCP distance CMC and PP ring sizes
Type: LTSS2003 Indication: Osteoarthritis, rheumatism and chronic wrist complaints Function: Resting splint for wrist and hand and ulnar deviation correction. Sizing: Proximal MCP circumference Proximal MCP width Wrist and arm circumference Arm to Prox. MCP distance Options: LTSS4011 - wrist bracelet with lock
Wrist/Hand Brace with thumb: Resting splint for wrist/hand and thumb support
Wrist/hand brace: Resting splint to support wrist/hand
example:
illustration
Type: LTSS2001 Indication: MCP flexion pain Function: Supports MCP joint and keeps it extended Sizing: Proximal MCP circumference Proximal MCP width PP ring size Distance between both parts
MCP extension splint: Supports MCP joints and keeps them extended
Extension: Blocks flexion of the DIP or PIP joint
Extension splint ring: Blocks flexion of the DIP or PIP joint
Type: LTSS3009 Indication: Extensor tendon injury Function: Blocks both flexion and extension of the DIP and PIP joint Sizing: PP - MP - DP ring sizes Length at bar
top
Type: LTSS2002 Indication: DIP or PIP hyperextension Function: Inhibits extension of the DIP or PIP joint Sizing: Proximal MCP circumference Proximal MCP width CMC and PP ring sizes
Type: LTSS3005 Indication: Extensor tendon injury Function: Blocks flexion of the DIP or PIP joint Sizing: PP/MP or MP/DP ring sizes Length at bar
bottom
Thumb stabiliser: Supports the thumb in its most functional position
Type: LTSS2000 Indication: Median or Ulnar nerve injury Function: Relieves, supports, and flexes MCP joints Sizing: Proximal and distal MCP circumference Proximal and distal MCP width MCP circumference Proximal-distal distance
Type: LTSS3000, (incl. hinge and lock LTSS4010) Indication: Tendon injury Function: Eliminates bowstringing of the flexor tendon Sizing: PP ring size
Type: LTSS3008 Indication: Tendosynovitis, Tendovaginitis Function: Restricts the movement of the MCP joint Sizing: PP ring size Proximal length Distal length
Pulley ring: Eliminates bowstringing of the flexor tendon
Trigger splint: Restricts the movement of the MCP joint
Knuckle bender: Supports, relieves, and flexes MCPs
Type: LTSS3011 Indication: Dropping fingers Function: Supports the drop finger, with adjacent fingers supporting unstable fingers Sizing: PP ring sizes Width at PP level
Type: LTSS3010 Indication: Dropping finger Function: Supports the drop finger, with adjacent fingers supporting unstable fingers Sizing: PP ring sizes Width at PP level
3-finger buddy splint: Supports the drop finger(s) and keeps all fingers aligned
Double swan neck: Supports DIP and PIP joint against hyperextension
4-finger buddy splint: Supports the drop finger(s) and keeps all fingers aligned
Type: LTSS3003 Indication: DIP or PIP hyperextension Function: Inhibits extension of the DIP or PIP joint, whilst still allowing flexion Sizing: PP/MP or MP/DP ring sizes Options: LTSS4001 - Medial or lateral support arch LTSS4002 - Medial and lateral support arch
Type: LTSS3007 Indication: DIP and PIP hyperextension Function: Blocks DIP and PIP-joint extension Sizing: PP/MP and MP/DP ring sizes
Swan neck: Prevents hyperextension of the DIP and/or PIP joint
Type: LTSS3006 Indication: Rheumatoid nodules Function: Supports lateral instability of the IP joint Sizing: PP/DP ring sizes
Boutonnière: Blocks flexion of the PIP or DIP joint
Type: LTSS3001 Indication: MCP joint instability Function: Unstable MCP joint is supported by an adjacent stable joint Sizing: PP ring sizes
3-finger coupling ring: Harnesses the neighbouring joints to support the unstable joint
Type: LTSS3002 Indication: MCP joint instability Function: Unstable MCP joint is supported by an adjacent stable joint Sizing: PP ring sizes
Type: LTSS3004 Indication: Extensor tendon injury or instability Function: Blocks flexion of the DIP or PIP joint or provides support in case of lateral instability (also suitable for ulnar or radial deviation) Sizing: PP/MP or MP/DP ring sizes Spacer width including ring thickness Options: LTSS4001 - Medial or lateral support arch LTSS4002 - Medial or lateral support arch
Coupling ring: Harnesses the adjacent joints to support the unstable joint
Spiral ring: Provides support for lateral instability, especially of the thumb
Thumb swan neck: Inhibits extension of the IP joint
Type: LTSS1000 Indication: IP hyperextension Function: Inhibits extension of the IP joint Sizing: PP/DP ring sizes Options: LTSS4008 - Medial or lateral support arch
Anti-deviation brace: Finger correction hinge allows finger flexion
Thumb splint: Blocks extension of both the MCP and IP joint
Type: LTSS1001 Indication: Hyperextension of MCP + IP joint Function: Blocks extension of the MCP and IP joint Sizing: PP ring size IP and MCP width Proximal and distal ring length
Type: LTSS2005 Indication: Osteoarthritis, Ehlers-Danlos syndromes, EDS, and Hypermobility Function: Supports the hand arch Sizing: Proximal MCP circumference Proximal MCP width
Hand arch brace: Supports the hand arch
Type: LTSS2004 Indication: Ulnar deviation of the fingers Function: Corrects fingers to radial side Sizing: Proximal MCP circumference Proximal MCP width PP ring sizes MCP - prox. MCP distance MCP – PP distance
LTSS2000 Knucklebender LTSS2001 MCP Extension splint LTSS2002 Thumbstabilizer LTSS2003 Wrist Hand brace LTSS2004 Anti Deviation brace LTSS2005 Hand Arch brace LTSS2006 Wrist Hand brace with thumb LTSS3000 Pulleyring LTSS3001 Coupling ring 2 fingers LTSS3002 Coupling ring 3 fingers LTSS3003 Swanneck splint LTSS1000 Swanneck Thumb splint LTSS3004 Boutonniere splint LTSS3005 Extension splint LTSS3006 Spiral splint LTSS3007 Double Swanneck splint LTSS3008 Trigger finger splint LTSS3009 Extension splint LTSS3010 Buddy splint 3 fingers LTSS3011 Buddy splint 4 fingers
articlecodes
functionality of silver splints
wrist/handmodels
Silver splints contribute significantly to improved functioning for activities of daily living (ADL).
Hand therapists need to understand the basic science behind the therapy they carry out and the current evidence to make the best treatment decisions. The purpose of this article was to review the patient reported outcome of current conservative therapeutic management with silver splints of patients with osteoarthritis (OA) of the hand. Treatment intervention with silver splints are discussed from a basic science and evidence-based practice perspective. Pain, stiffness, and joint deformity may cause a serious decrease in hand function for people with osteoarthritis. Characteristic finger deformities in OA are swan neck deformity, boutonnière deformity, and ulnar deviation and subluxation of metacarpophalangeal joints. In some cases, finger orthoses like silver splints may be a good alternative to surgery. Several studies have reported that an orthosis decreases pain and increases function during daily activities in patients with arthritis. This study builds on these insights and specifies the relief in daily activities.With this large-scale PROM study into the patient feedback of silver orthoses, we hope to contribute to better care for patients with this type of osteoarthritis. The results show that in addition to surgical procedures, the combination of splints and hand therapy is a realistic option in the treatment of osteoarthritis in the hand. Silver orthoses reduce pain symptoms and improve (ADL) functioning in people diagnosed with osteoarthritis of the hand and wrist. A silver orthosis appears to serve as a very suitable support for joints, providing pain relief and greater freedom of movement. Wearing the silver orthosis restricts movement, preventing the joint from moving along its full range of motion and improving people’s ability to carry out all ADL’s included in the study.
Since 2018, Livit has investigated how satisfied customers are with their silver orthoses. 2,231 customers with osteoarthritis were asked about the effectiveness of the orthosis, 3 weeks after they first started wearing it, measured as ADL (Activities of Daily Living) function gained. The response rate of this patient-reported outcome information was 38%. Period:October 2018 - June 2020 # Customers approached: 2231 # responses:850(38% response rate) With Medical Diagnosis:Osteoarthritis Outcome indicators Guidelines, outcome indicators, reference values, and context information are essential for interpreting PROM information. This section explains how this study approached these topics. An outcome indicator is a specification of the outcomes (effects) of care that provides an indication of the quality of the care provided. It is therefore very important to interpret these outcome indicators in order to assess the quality of healthcare providers. The ADL factor has been defined as an outcome indicator in this study. Activities of Daily Living (ADL) are activities that people perform in everyday living, and the term is mainly used in healthcare to determine the extent of a person’s self-reliance. Someone who can perform relatively few ADLs will need relatively much assistance. Improving ADLs by means of an orthopedic aid contributes directly to increasing a person’s self-reliance. The ADL factor is the outcome indicator for impaired ADL function with and without the use of an aid. The survey employed a qualitative ordinal measurement method, with respondents asked to answer questions by means of a 5-point scale in terms of mobility (expressed in metres), discomfort (great discomfort to no discomfort) and pain (very significantly worse to very significantly improved). The results are presented in a bar chart, frequency tables and a cumulative stacked bar chart in order to compare the differences between ADLs with and without silver orthoses. The PROM questions in this study were drawn up on the basis of standard orthopedics questionnaires and are therefore in line with scientifically accepted and validated PROM questions. To improve quality, information is needed about health prior to and after an intervention. In this study, we compare feedback from customers about function gained with and without a silver orthosis. As there are no comparable studies into the effectiveness of orthopedic aids, there are no externally oriented standard or target values to use. All clients and patients included in the study use orthopedic aids and are therefore qualified experts by experience in the use and effectiveness of these aids. Patients throughout the country and in various institutions, ranging from university hospitals and rehabilitation centres to nursing homes have been included in this study. As such the population of this study can be considered representative for users of silver splints in the Netherlands. outcomes and the effectiveness of wearing a silver orthosis The PROM questions in this study were drawn up on the basis of standard orthopedics questionnaires and are therefore in line with scientifically accepted and validated PROM questions. The ADL (Activities of Daily Living) factor has been defined as an outcome indicator in this study. The effectiveness of the treatment will be assessed by comparing ADL function impairment with and without the use of an aid. Activities of Daily Living (ADL) are activities that people perform in everyday living, and the term is mainly used in healthcare to determine the extent of a person’s self-reliance. Someone who can perform relatively few ADLs will need relatively much assistance. Improving ADLs by means of an orthopedic aid contributes directly to increasing a person’s self-reliance. How has your overall daily functioning changed since you started wearing your silver orthosis? 79% of respondents reported that their overall daily functioning improved after they started wearing their silver orthosis. 50% even report that their functional status improved significantly to very significantly. How have your pain symptoms changed since you started wearing your silver orthosis? 73% of respondents reported that their pain symptoms improved after they started wearing their silver orthosis. Almost half (46%) reported that their pain symptoms had abated significantly to very significantly by wearing a silver orthosis. 8% indicated that their pain had worsened. To what extent do you have problems with writing with/without a silver orthosis? The group of people experiencing no problems or minor problems with writing increased from 35% of the population without an aid to 62% of the population with an aid. Almost no one was entirely unable to write when wearing an aid (down from 7% to 2%) and the number of people experiencing major problems with writing dropped by more than half. To what extent do you have problems with buttoning clothes with/without a silver orthosis? The group experiencing no problems or minor problems increased from 34% of the population without an aid to 62% with an aid. Almost no one was entirely unable to button clothes when wearing an aid (down from 4% to 2%) and the number of people experiencing major problems dropped from 24% of the population to 9%, amounting to a 63% decrease. To what extent do you have problems with holding a book while reading with/without a silver orthosis? It is striking that the group of people who do not experience any problems grew from 18% to 42% of the population, representing a 132% increase for this ADL category. The group experiencing no problems or minor problems increased from 35% of the population without an aid to 72% with an aid. The group of people who were unable to hold a book dropped by more than half, from 6% to 2%, and the number of people experiencing major problems dropped from 24% of the population to 6%, amounting to a 76% decrease. To what extent do you have problems picking up the phone with/without a silver orthosis? It is striking that the group of people who do not experience any problems grows from 30% to 52% of the population, representing a 71% increase for this ADL category. The group experiencing no problems or minor problems increased from 52% of the population without an aid to 80% with an aid. The group that had serious problems picking up the phone fell from 13% to 3%, representing a 75% drop. To what extent do you have problems withopening jars with/without a silver orthosis? The group experiencing no problems or minor problems increased from 14% of the population without an aid to 35% with an aid, which means this group has more than doubled in size. It is striking that the group of people experiencing major problems fell by 40%, from 44% of the population to 26%. The group of people who were unable to open a jar also fell by 40%, from 23% to 14%. To what extent do you experience problems when performing household chores with/without a silver orthosis? The group experiencing no problems or minor problems increased from 14% of the population without an aid to 48% with an aid, which means this group has more than doubled in size. It is striking that the group of people experiencing major problems fell by 70%, from 41% of the population to 12%, representing a 70% drop. Virtually no change was observed in the group that was entirely unable to perform household chores, which was down from 7% to 5%. To what extent do you experience problems with lifting groceries with/without a silver orthosis? The group experiencing no problems or minor problems increased from 21% of the population without an aid to 51% with an aid, which means this group has more than doubled in size. It is striking that the group of people who experienced major problems fell by 65%, from 36% of the population to 13%. The group of people who were unable to lift groceries changed from 12% to 7%. To what extent do you experience problems with showering, bathing, and getting dressed with/without a silver orthosis? The group experiencing no problems or minor problems increased from 48% of the population without an aid to 73% with an aid, marking a significant improvement. The group experiencing major problems fell by 58%, from 36% of the population to 20%. The group of people who were unable to shower, bathe and get dressed changed from 14% to 6%. Silver orthoses reduce pain symptoms and improve (ADL) functioning in people diagnosed with osteoarthritis of the hand and wrist. A silver orthosis appears to serve as a very suitable support for joints, providing pain relief and greater freedom of movement. Wearing the silver orthosis restricts movement, preventing the joint from moving along its full range of motion and improving people’s ability to carry out all ADLs included in the study. Table X shows function status improvement depending on the mode. A clear improvement can be seen in all categories, but holding a book while reading, picking up the phone, and showering, bathing, and getting dressed show the greatest improvement. Conclusion With this large-scale PROM study into the effectiveness of silver orthoses, we hope to contribute to better care for patients with this type of osteoarthritis. The results show that in addition to surgical procedures, the combination of splints and hand therapy is a realistic option in the treatment of CPC-I osteoarthritis. Silver orthoses reduce pain symptoms and improve (ADL) functioning in people diagnosed with osteoarthritis of the hand and wrist. A silver orthosis appears to serve as a very suitable support for joints, providing pain relief and greater freedom of movement. Wearing the silver orthosis restricts movement, preventing the joint from moving along its full range of motion and improving people’s ability to carry out all ADLs included in the study.
Figuur 2: resultaten Livit PROM onderzoek gemeten in ADL factor voor periode '18 - '19
Mode
without aid
with aid
+
Writing
moderate problems
minor problems
+1
Buttoning clothes
+2
Holding a book when reading
no problem
+3
Picking up the phone
Opening jars
major problems
Domestic chores
Lifting groceries
Showering, bathing, getting dressed
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