The Effectiveness of Static hand and Wrist Splints for People with Rheumatoid Arthritis: A Systematic Review of the Literature
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Occupational therapists commonly use static hand splints for patients with rheumatoid arthritis to improve hand function, prevent deformity, increase grip strength and relieve joint pain (Henderson & McMillan, 2002), yet the evidence to support this intervention is limited. A systematic review was conducted to assess the effectiveness of five different types of static hand and wrist splints for adults with rheumatoid arthritis. Articles were identified through a computerized search of seven bibliographic databases from their inception to June 2012. The literature search procedure was complimented by manually scanning the reference lists of retrieved articles, searching for grey literature and checking personal reference collections. Articles were evaluated according to predetermined criteria for inclusion at each of the title, abstract, and article levels. Included studies were independently scored using the Structured Effectiveness Quality Evaluation Scale (SEQES) and also graded according to Sackett’s Levels of Evidence. Fifty-one studies were identified as potentially relevant. After assessment of relevance and quality, only 18 articles fulfilled the inclusion criteria. Quality scores on the SEQES ranged from 14 to 46 out of a possible 48. The current evidence provided varied support for all five types of static splints. There is strong evidence that wearing a prefabricated wrist extension splint during certain functional tasks significantly relieves wrist pain after one month and does not compromise dexterity and grip strength. There was insufficient evidence to support or refute the role of static resting splints to reduce pain, grip strength or improve upper limb function. However, participants who wore these splints for one month preferred to wear soft splints to rigid ones. The one study of thumb splints provided evidence of statistically significant benefit in pain reduction wearing the splint for 12 weeks. Indicative findings for evidence that swan neck splints, boutonnière splints and metacarpal ulnar deviation splints improve hand function were found. In overview, until more evidence becomes available, an evidence-informed approach in which occupational therapists use their clinical experience while integrating all available levels of evidence to meet the patients’ needs and goals is recommended.
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