A systematic review of the factors associated with hand functional disability in people with Rheumatoid Arthritis

Arab Alkabeya, Hisham, Hughes, Ann-Marie and Adams, Joanna (2018) A systematic review of the factors associated with hand functional disability in people with Rheumatoid Arthritis. In The British Association of Hand Therapists. (In Press)

Abstract

Aim: to systematically review the factors associated with hand functional disability in adults with Rheumatoid Arthritis (RA).

Methods: an extensive systematic literature search was conducted in MEDLINE, EMBASE, CINAL, AMED, PsychINFO, and Web of Science database for peer-reviewed English-language observational studies exploring the factors associated with hand function for people with rheumatoid arthritis. Factors related to hand function were classified under the domains of the International Classification of Functioning, Disability and Health (ICF) framework and health related factors. The methodological quality was determined using the quality of cross-sectional studies (AXIS) tool. Factors related to hand function that were investigated in two or more studies were explored using a best-evidence synthesis.

Results: twenty articles met the inclusion criteria from 1,271 citations. All presented cross-sectional data (five high quality and 15 low quality articles), resulting in at most limited evidence in the best-evidence synthesis. For the factors classified under the ICF domains, the best-evidence synthesis indicated that a diverse range of positive and negative factors were associated with hand function. However, key factors were hand strength, disease activity, and pain intensity. For personal factors and environmental factors, few factors have been explored for the association with hand function.

Conclusion: studies focused predominantly on body structure and function factors, highlighting a lack of consideration of, and investigation into personal and environmental factors when considering the impact of RA on hand function. The level of evidence which exists was limited, but identified that modifiable factors such as grip or pinch strength, disease activity and pain are the most influential factors on hand function in people with RA. The review findings suggest that well-designed longitudinal, preferably cohort, studies are now needed to better understand the influence of personal and environmental factors on hand functional disability in people with RA.

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Contributors

Author: Ann-Marie Hughes

Author: Joanna Adams

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