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Splinting the rheumatoid wrist and hand: evidence for its effectiveness

Splinting the rheumatoid wrist and hand: evidence for its effectiveness
Splinting the rheumatoid wrist and hand: evidence for its effectiveness
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 Amos1995, Scott et al 1998). Synovitis, capsular weakening and instability are theprimary 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 performance in the later stages of the disease. This paper discusses 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. Evidenceis 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.
rheumatoid
1462-0324
153
Adams, J.
6e38b8bb-9467-4585-86e4-14062b02bcba
Adams, J.
6e38b8bb-9467-4585-86e4-14062b02bcba

Adams, J. (2003) Splinting the rheumatoid wrist and hand: evidence for its effectiveness. Rheumatology, 42 (S1), 153.

Record type: Article

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 Amos1995, Scott et al 1998). Synovitis, capsular weakening and instability are theprimary 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 performance in the later stages of the disease. This paper discusses 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. Evidenceis 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.

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More information

Published date: April 2003
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
Keywords: rheumatoid

Identifiers

Local EPrints ID: 17772
URI: https://eprints.soton.ac.uk/id/eprint/17772
ISSN: 1462-0324
PURE UUID: 9143461f-a0b0-46c5-8d39-920a7f6b92b0
ORCID for J. Adams: ORCID iD orcid.org/0000-0003-1765-7060

Catalogue record

Date deposited: 16 Aug 2007
Last modified: 20 Jul 2019 01:18

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Author: J. Adams ORCID iD

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