Virgil Mathiowetz Virgil Mathiowetz. Catherine, St. Paul, Minnesota. Online Issn: Cite Icon Cite. Abstract Objectives. You do not currently have access to this content. View full article. Sign in Don't already have an account? Pay-Per-View Access. Their designs make sure you position your wrist and hands correctly. These splints are sometimes used for conditions other than arthritis, such as carpal tunnel syndrome. They can be useful if you have a painful flare-up of rheumatoid arthritis or a period of joint discomfort, when you may need to rest your hands for short spells during the day or night.
Resting splints are usually made from a moulded thermoplastic and are fitted with Velcro fastening straps. You may find it helpful to leave the strap over the fingers done up so that you can slide your hand in or out.
They can be worn when you carry out daily tasks and should make the job less painful. They can also help by keeping your wrist joint in an efficient position when doing a job and may help to make your wrist and hand feel stronger.
However, because these splints support your wrist and hand firmly they may also make these joints feel a little less flexible. Working splints are usually made of an elastic or light synthetic rubber-type fabric e. If you want to wear any type of working splint while driving, contact your insurance company first for advice about whether your cover will be affected.
All patients received similar outpatient occupational therapy intervention that had been agreed and standardized between all of the participating rheumatology departments.
This included 1 : 1 education and practice regarding joint protection and hand and wrist exercises with provision of two separate written booklets; and activities of daily living assessment, provision of assistive devices as necessary and assessment provision of other wrist- and hand-based splints.
This positioning reflected the consensus position agreed upon by the study's steering committee of collaborating expert clinical occupational therapists across the eight regional hospital departments. Patients allocated to the treatment group were given standardized verbal and written instructions on splint wear. Nightwear was encouraged starting by alternating splints for consecutive nights and patients were checked if they could use the splints correctly.
At 1 week and 1 month following initial therapy appointment, all patients were telephoned by their clinical occupational therapist to check progress. Measuring adherence in rehabilitation is predominantly reliant on self-report. Self-report is likely to overestimate real adherence levels [ 29 ]. As diarized options for measuring adherence were poorly received in this pilot study, an ordinal questionnaire was used.
The primary outcome measure was grip strength 12 months after intervention, measured in newtons using an MIE digital grip analyser MIE Medical Research, Leeds, UK and standardized measurement protocols [ 30 ]. Handgrip strength has been validated as a sound indicator of broader objective hand function, strongly correlated with hand pain [ 31 ], hand deformities, hand inflammation [ 32 ] and hand stiffness [ 33 ].
Secondary outcome measures evaluated structural impairment and hand functional ability. Hand function was measured using the applied dexterity task the Button Board from the Arthritis Hand Function Test [ 35 ]. The MHQ [ 36 ] measured self-report hand function.
Baseline disease characteristics recorded included: time since symptomatic onset and diagnosis; joint articular index [ 38 ]; current medications; general functional ability using the HAQ [ 39 ]; and socio-demographic data. Sample size was informed by published month grip strength longitudinal data from two studies of early RA recruiting a similar UK RA population [ 6 , 40 ]. In the absence of similar longitudinal rehabilitation intervention trials, a clinically useful difference between treatments was informed by the steering committee for this trial.
Clinical effectiveness of the splints was analysed by comparing the two groups at 12 months for differences in grip strength, structural impairment, functional dexterity and self-report function and impairment. All outcomes were analysed on an intention to treat basis. The ANCOVA adjusted for baseline outcome measures and any potential confounders that differed between the groups by chance. These included baseline joint articular index and number of wrist and hand IA steroidal injections.
Mann—Whitney U-tests were used to compare ordinal, scaled self-report responses and Spearman's r s to explore correlations between self-report splint wear adherence and splint effectiveness. McNemar's test compared changes from baseline to follow-up for binary outcomes. One hundred and forty-eight patients were assessed for eligibility; were accepted and randomized. One hundred and eleven patients Baseline demographic data and disease characteristics are shown in Table 1. There were no substantial clinical differences between groups at study entry in demographic and disease prognostic factors.
The majority of patients were women, not currently employed and had left full-time education before 16 yrs of age. There were no substantial differences between groups for changes in medication and intramuscular steroidal injections over the study duration. There were no losses to follow-up and progress through the trial is shown in Fig. Eighty patients Data were not imputed and a responder's analysis was carried out for self-report MHQ data.
Allocation concealment was lost when patients were wearing splints, had left these in view during assessment home visits or had requested assistance in completing the splint adherence section of the questionnaire. None of the control group had worn static resting splints over the study duration. Self-reported adherence to resting splint wear was moderate.
Of the 49 Table 2 presents the main results. Baseline values for grip strength were comparable in both groups: the splint group had a lower mean baseline grip s. There was no evidence of significant adjusted differences in grip strength at 12 months between groups — There was no evidence of significant differences in ordinal pain levels reported over the month follow-up. The splint group and control group reported identical final pain levels 2.
For the subgroup of patients reporting the occurrence of early morning stiffness, those within the control group reported a decrease in the median duration of early morning wrist and hand stiffness over 12 months 2. No statistically significant differences in the structural impairment and functional hand ability outcomes were found between patients receiving occupational therapy and static resting splints and occupational therapy alone over 12 months.
Where clinical significant ranges have already been defined [ 41 ] there was no clinically significant difference in functional change between groups. The data showed that the control group improved when compared with the splint group in almost all outcomes. For a small subgroup of individuals the splints appeared to contribute towards a reduction in the occurrence of early morning stiffness. But for those people who continued to report early morning stiffness after 12 months the duration was significantly lowered in the control group.
This study indicates that static splinting provides no incremental beneficial effects in improving hand function in early RA. These results add further confirmation to the most recent systematic reviews [ 24—26 , 42 ] that the current evidence to support static resting splints in early RA is lacking.
However, clinicians have continued to provide these splints for many years and there must be confidence that they contribute to patient care in some way. The trial recruited patients during early-stage RA disease. This has been seen to be a difficult time to establish the effectiveness of conservative rehabilitation therapies when disease activity is likely to be poorly controlled [ 43 ].
Uncontrolled disease activity will likely have a large effect on the measurement of functional performance and has the potential to contaminate results. Yet the aims of static splinting are pathophysiologically based, including the reduction of localized pain and inflammation control; these are early symptoms of the disease and ones that are likely to be present when the disease is less well controlled. The trial reflected the clinical practice and timing of static splint provision and controlled for baseline disease activity and localized IA injections in the ANCOVA analysis.
Additionally, this trial was a relatively large longitudinal study when compared alongside other conservative rehabilitation studies, and was sufficiently powered to detect a clinically important difference if one existed. When you have rheumatoid arthritis RA and experience a flare, your rheumatologist might prescribe one to help support a weak or inflamed joint. Splints and braces work by giving a joint support when in use, and letting it rest when you're sleeping or sitting down.
They can also help in the case of contracture, the shortening of the muscles, tendons, and tissues that results in rigidity and deformity of joints. Wrist splints reduce pain and help improve grip strength for people with rheumatoid arthritis , according to a review published in the Journal of Rehabilitation Medicine. A Polish study published in Reumatologia in demonstrated that hand function of women with RA was limited due to reduction in grip quality and manual dexterity, but that wrist stabilization with wrist braces improves hand function in patients with RA.
The decision to use a supportive device is something to discuss with your rheumatologist. In general, says Dr. The goal is to have you independent without a splint for as long as possible. It allows you to use your own strength and it is less cumbersome. Often your rheumatologist will start you with one part time, only when using that joint, to see if you can keep up your strength. We want your muscles to be as strong as possible.
We want to build strength over time, because that is what will give you your best control and defenses against pain. You need to use splints in conjunction with your exercise program — range of motion, flexibility, and strengthening, and ideally in conjunction with cardiovascular exercise. If you need to wear a splint every day, you will be given a very specific on-off program to make sure joints and muscles are moving appropriately, and to give the skin time to breath, and to avoid pressure points and irritations.
0コメント