Splinting the rheumatoid wrist and hand: evidence for its effectiveness
Adams, J. (2003) Splinting the rheumatoid wrist and hand: evidence for its effectiveness. Rheumatology, 42, (S1), 153.
Download
Full text not available from this repository.
Description/Abstract
Background: therapeutic aims of static splinting in rheumatoid arthritis(RA)
include; supporting inflammed joints; decreasing localised pain and joint
swelling; improving wrist stability; maintaining hand function and dexterity
and preventing/correcting joint deformity. However, the theoretical biological
basis for intermittant splinting is weak and evidence to support the effectiveness
of conservative splinting in RA remains anecdotal (Akil and Amos
1995, Scott et al 1998). Synovitis, capsular weakening and instability are the
primary causes of rheumatoid hand deformity and dysfunction. Later biomechanical
disruption of the wrist and hand can lead to structural deformity in
up to 85% of individuals with RA. Structural impairment can effect functional
upper limb and hand perfomance in the later stages of the disease. This paper
dicusses the effectiveness of different types of splints, commonly used
in rheumatology practice, in preserving anatomical and functional ability.
Methods: EMBASE,PUBMED, CINAHL and MEDLINE were used to search
the splinting literature over the past 40 years. Evidence was sought for a
variety of static splints meeting the stated therapeutic aims of splinting.
Results: all studies reported hand functional ability in isolation without any
reference to overall disease activity. A minority were conducted as unblinded
RCTs, most were cross over or observational pre and post test designs.
None had power calculations or estimated effect sizes included. Certain
forms of static splinting, applied at varying stages of RA, have been demonstrated
to:
1. Provide localised pain relief
2. Improve wrist stability when worn
3. Increase functional dexterity and grip force when worn
4. Re align deviated and lax joints when worn
As yet there is no robust evidence that static splinting will prevent or delay deformity
from occurring or maintain hand function in the long term. Evidence
is also lacking as to the possible detrimental effects that splints may have.
Conclusions: static splints are designed to maintain structural and functional
ability in the rheumatoid wrist and hand. In some patients these may
work. Further well designed, well powered clinical effectiveness and efficacy
trials are required to establish which splinting protocols work, for whom and
why.
| Item Type: | Article |
|---|---|
| Additional Information: | Poster no. 442 presented at British Society for Rheumatology XX Annual General Meeting. A joint meeting with the Société Française de Rhumatologie, Manchester, UK, 01-04 Apr 2003 |
| ISSN: | 1462-0324 (print) |
| Uncontrolled Keywords: | rheumatoid |
| Related URLs: | http://rheumatology.oxfordjour.../index.dtl http://rheumatology.oxfordjour...uppl_1/145 |
| Subjects: | R Medicine |
| Divisions: | University Structure - Pre August 2011 > Superseded (SOHPRS) |
| ePrint ID: | 17772 |
| URI: | http://eprints.soton.ac.uk/id/eprint/17772 |
| Deposited On: | 16 Aug 2007 |
| Last Modified: | 02 Mar 2012 13:25 |
Associated Staff Only: edit my ePrint
