Cheryl Metcalf
Silver Ring Splints
Principal Investigator: Dr Jo Adams
Project Team: Caroline Spicka, Christina MacLeod & Dr Cheryl Metcalf
Date: 2007 - 2008
This project, funded by Wessex Medical Research was instigated by Caroline Spicka, an MSc project student and Occupational Therapist with Southampton University Hospital's Trust. The project was a collaboration between the Faculty of Health Sciences and the Royal Hants County Hospital in Winchester. The project comprised a qualitative interview, undertaken by Caroline Spicka (UoS) on patient satisfaction, a number of clinical tests (also undertaken by Caroline) and 3D motion capture using the HAWK measurement. The objective of this project was to assess the efficacy of silver ring splints to correct swan-neck deformity.
Silver Ring Splints
Following the suggestion of a Rheumatology Consultant, a local jeweller was approached to provide high quality silver ring splints. The patients are always assessed for silver ring splinting by an occupational therapist and undergo a short trial wearing thermoplastic ring splints to check for adherence, tolerance, comfort and efficacy. It should be noted that patients with unstable digital oedema and/or rheumatoid nodules find these ring splints to be ineffective. An independent contract is agreed, between the patient and the jeweller; the patient is charged for the first hour of labour and materials. The patient is fully responsible for meeting this cost.

Patient Feedback
A convenience sample of 11 patients were surveyed for feedback on silver ring splints. All confirmed that they found the silver ring splints more comfortable and more attractive than thermoplastic splints. All patients reported that they wore silver ring splints for longer than the thermoplastic splints. The majority were more comfortable in wearing the silver splints during the day and 7 reported that they wore the silver splints for 24 hours. Those patients involved in manual occupations reported that they were unable to wear the thermoplastic ring splints for as long due to the fact that they 'kept breaking' and that they were 'impractical'. The silver ring splints were reported by most patients as being functional and assisting with power grip and individual finger mobility.

Patients concluded that they felt happy with the splint provision, felt that they 'looked more like jewellery than medical aids', 'very attractive', 'trendy and unusual' and found the collaboration with the local high street jeweller most satisfactory. None of the patients reported concern about having to fund the splints themselves.

Silver ring splints have proved to be highly successful with this patient group. The occupational therapist remains directive in the assessment, prescription and measurement of the splints, and this is coupled with the expert skills of the jeweller to provide a high quality, attractive and well worn hand splint.
This research is funded by the research charity Wessex Medical Trust.
Wessex Medical Trust

The team working on this project were nominated by the College of Occupational Therapists Specialist Section on Rheumatology and were awarded an ARC silver medal award for research excellence.
Metcalf, C.D., Spicka, C., Adams, J. & Macleod, C., 2009. Quantifying the Effectiveness of Silver Ring Splints to Correct Swan-Neck Deformity. XXII Congress of the International Society of Biomechanics. Cape Town: South Africa. 5 - 9 July. ISBN: 978-0-620-44037-0.

Spicka, C., Macleod, C., Adams, J. & Metcalf, C.D. Effect of silver ring splints on hand dexterity and grip strength in patients with rheumatoid arthritis: an observational pilot study. Hand Therapy. 14(2), 53-57.

Gallos, Z., Adams, J. & Metcalf, C.D., 2009. Three-Dimensional Motion Analysis of the Rheumatoid Proximal Interphalangeal Joint with a Silver Ring Splint in Situ: A Matched Case Study. Rheumatology: British Society of Rheumatology Annual Meeting. Glasgow: UK. 28 Apri - 1 May. 48 (Supp 1), ii54.

Adams, J., Macleod, C., Metcalf, C.D. & Spicka, C., 2008. ARC Silver Medal Award: A Research Report on the Effectiveness of Silver Ring Splints in Preventing Proximal Interphalangeal Joint Hyperextension during Functional Activity. The Journal of Rheumatology Occupational Therapy. 23(1), 19-21.

Adams, J., Metcalf, C. D., Macleod, C., Spicka, C., Burridge, J. H., Cooper, C. & Cox, N., 2008. Three Dimensional Functional Motion Analysis of Silver Ring Splints in Rheumatoid Arthritis. Rheumatology: British Society of Rheumatology Annual Meeting. Liverpool: UK. 22-25 April. 47 (Supp 2), ii154-ii155.

Spicka, C., Adams, J., Macleod, C. & Metcalf, C. D., 2008. A Study Examining the Effectiveness of Silver Ring Splints for Hand Function in Adult Patients with Arthritis. Rheumatology: British Society of Rheumatology Annual Meeting. Liverpool: UK. 22-25 April. 47 (Supp 2), ii33-ii34.

Metcalf, C. D. & Adams, J. A., 2007. The Development and Clinical Application of a New, Small Hand Joint, Functional 3D Motion Analysis Assessment System for Rheumatology and Musculoskeletal Rehabilitation Research. International Journal of Rehabilitation Research: Proceedings of the 9th Congress of the European Federation for Research in Rehabilitation. Budapest: Hungary. 26-29 August. 30 (Supp 1), 24-25.

Spicka, C., Adams, J., MacLeod, C. & Metcalf, C., 2007. The Use of Clinical Assessment and Novel 3D Motion Analysis to Examine the Effectiveness of Silver Ring Splints in RA. Proceedings of the 3rd LSI Conference. 15 March. Southampton, UK. p17.
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