Patients in focus awards 2005
Christina Macleod, OT, Therapy Services Department, Royal Hampshire County Hospital
The Innovative collaboration between rheumatology, occupational therapy services and a high street jeweller to produce finger orthotics as silver jewellery
History of Application
Jo Adams, the Lead Therapist in a project assessing the value of night resting splints in the South of England, has a lot of energy and charisma and through her encouragement and persuasion the application for the Patients in Focus Innovation Award was put together.
Hand splints form a regular part of occupational therapy treatment for individuals with Rheumatoid Arthritis (RA). The splints are designed to decrease hand joint pain and swelling, improve joint stability and increase functional use of the hand. Frequently in RA a problem called ‘swan necking’ occurs. Swan necking is the bending of the top joint of the finger, with the next joint bending in the opposite direction than usual, making it difficult to make a fist and can occur in one or all of the fingers. Small finger splints are routinely made from thermoplastic to help support the joint and prevent further deformity.
Patients often report that the material used to make these splints is unsightly, sweaty and susceptible to breaking. People are reluctant to wear them. It is clear that an alternative should be offered.
Innovation and creativity
The consultant approached a local jeweller to see if these splints could be made in a local high street shop. Various techniques were tried by the jeweller before an acceptable design was established. Every patient has to pay for the splint themselves and the cost varies on the splint made All splints are individually measured and designed by the Occupational Therapist and Jeweller. Similar splints are manufactured in the USA and the Netherlands and can be purchased by mail order but using a local jeweller can generally ensure that the patient goes away with a splint that fits on the first day of fitting.
Informal patient feedback identified the need for a more attractive, comfortable and durable splint than those already available. Since then we have surveyed patients’ who have purchased the sliver ring splints for their opinions with questionnaires and audits. The comments include:
- Helps reduce the pain
- Brilliant Better than plastic
- Stopped the triggering completely
- Hands feel psychologically safer when wearing the splint –don’t worry about the deforming nature of the disease
- They are a good warning system if I am pushing my joint too far
- Able to bend my fingers better
- Fingers no longer collapse
- Even as a man who never wears jewellery the benefits out weight the negative
- Well worth trying
- People say how nice my hands look or “you’re cool”
- Would purchase them again
- Several people have asked about my knuckle dusters!!
A further study by the University of Southampton is planned on the biomechanical effects of these splints. How can you, as readers of this newsletter, find out more about these splints? You have to bear in mind that you will have to purchase these splints yourself. Your hospital may not have a friendly local jeweller who can help and so the splints will need to be ordered mail order. Your consultant should be able to refer you on to a therapist who can help or do contact NRAS who can put you in contact with some one to help.
Silver Ring Splints - A Patient's Perspective
Gill Chambers, Patient of Christina Macleod
My name is Gill Chambers and I am 38 years old. I have had Rheumatoid Arthritis for 17 years, starting at the age of 21.
It started in my right thumb joint and spread throughout my hands and wrists. Both shoulders are affected as are both feet. My knees and other joints are beginning to show signs of RA but do not give me too much trouble at the present time. In 1997 I had both of my wrists replaced. Although I do not have much movement in them, the replacement has eased the pain enormously.
Over the past 3 or 4 years my fingers have started to drift and I have to wear splints to help stop the drifting.
Two years ago, at my yearly joint assessment, it was noticed that some of my fingers were showing early signs of swanning. I was referred to my Occupational Therapist Christina, to make me splints to stop this happening. The finger splints were made of plastic and she had to make 3 of these for my right middle, left middle and ring fingers.
These splints were very ugly and looked like pieces of chewing gum. I must admit when I got home I was very upset at the look of them and threw them across the room! I couldn’t wear them out as they drew attention to my hands and it upset me when people stared.
I now enjoy wearing my silver splints. I now have four, two on each hand, and wear them 24/7. They not only do the job intended, (to help with the swanning) but they look like jewelry rather than medical splint. I am often told ‘how nice your rings are’ and get great pleasure in telling people that they are made especially for me!
I would encourage other RA sufferers with swanning problems to wear these splints. My last point is that these silver splints will encourage younger RA sufferers to wear their splints and so help stop deformity in later life.
The experience of running a Silver Ring Splint workshop with the team at NRAS in 2008
04/09/08 : By Christina Macleod, Occupational Therapist, Winchester
How did the idea come into being?
First be careful who you talk to at NRAS, I mentioned to Ailsa that I was considering organising a workshop on silver ring splints, but didn’t have all the skills or resources easily available.
No sooner than the words were out of my mouth than Ailsa picked up on the idea and offered the support of the NRAS team. There was no going back even if I wanted to, Ailsa had got the wheels in motion and I couldn’t put on the brakes!!!
What happened next?
NRAS provided all the admin support, and came up with the idea of holding it at the British Health Professionals in Rheumatology annual conference in Liverpool in April, 2008 when lots of allied health professionals would all be in the same place at the same time. NRAS arranged the room hire, date, time etc. I got the programme together and contacted colleagues to ask for help. This came about as a team eff ort and I needed the team around me.
NRAS organised volunteer candidates for the workshop in order that therapists could practice measuring for the splints.
The workshop was a success, despite the room being very hot and very crowded. We were fortunate to have representatives from the two companies that supply the splints by mail order present so that everyone could see the products available.
The first half focused on the splints, with various speakers looking at different aspects. Alice Peterson talked about the patient experience of wearing the splints, Jo Adams ( Professional Lead for Occupational Therapy School of Health Professions and Rehabilitation Sciences University of Southampton) about the latest research regarding the silver ring splints and Sandi Derham (Occupational Therapist from Bath and Chair of the College of Occupational Therapists Specialist Section in Rheumatology) and I discussed the considerations for assessment of the silver ring splints.
During the second half we divided in to small groups each with an Occupational Therapist experienced in this type of splinting, together with a patient for ‘hands on’ experience in measuring the splints.
The feedback from the therapists and patients was good. The majority of therapists said that they would now consider issuing these splints. Some of the comments were that it was “very well organised and presented, a really useful and informative presentation followed by good opportunity to asses and fit on “real Patients” hands.
What happens next?
Well any ideas need to be kept quiet until I have the time to cope with Ailsa’s energy for getting things done!!
But in reality we would like to have the opportunity to do more research and to run another workshop in a similar way. I was amazed that it all went so smoothly and it was good to see so many people so enthusiastic about these splints.
Thank you everyone for all there help, especially Emma in the NRAS office and all the others behind the scenes at NRAS and in Southampton and Winchester. I must also say a big thank you to Janet Harkess from Dumfries who helped with the small groups. Without all your help the workshop wouldn`t have been such a success.