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Researches in Arthritis & Bone Study
Effectiveness of Rigid Wrist Splints on Reducing Pain and Improving Hand Function in Patients with Inflammatory Arthritis
Sarsak HI*
Department of Occupational Therapy, School of Rehabilitation Sciences, University of Jordan, Jordan
*Corresponding author:Hassan Izzeddin Sarsak, Department of Occupational Therapy, Batterjee Medical College, Jeddah, Saudi Arabia
Submission: October 10, 2018;Published: October 26, 2018
Volume1 Issue2 October 2018
Abstract
Objectives: To examine the evidence of the effectiveness of rigid wrist splints on reducing pain and improving hand function in patients with inflammatory arthritis.
Results: Our review revealed four studies suggesting that rigid wrist splints may reduce pain and improve hand function for patients with inflammatory arthritis.
Conclusion: Rigid wrist splints are effective and may result in pain reduction and improvement in hand function for patients with inflammatory arthritis.
Keywords: Rigid wrist splint; Pain; Hand function; Inflammatory arthritis; Occupational therapy
Introduction
Inflammatory arthritis affects joints and causes pain, stiffness, and deformities Fries [1] & Imboden [2]. Essential components of treatment are the prevention of hand deformities and the preservation and restoration of hand function Richardson [3] & Tassiulas [4]. Splinting reduces pain and inflammation and improves hand function. Wrist splints support the wrist joint and allows grasping and manipulating objects U.S. Department of Health and Human Services [5] & Wolff [6]. The purpose of this study was to examine the evidence of the effectiveness of rigid wrist splints on reducing pain and/or improving hand function in patients with inflammatory arthritis. For the purpose of this study, we created a clinical/research PICO question (Population, Intervention, Comparison, and Outcome), a key to evidence-based decision Richardson [3].
The PICO formed for our study is as follows:
(P): For patients with inflammatory arthritis
(I): Do rigid wrist splints
(C): No comparison
(O): Reduce pain and/or improve hand function?
Methods
Review of literature and search strategy
A research has been made in the following databases: Ovid, CINAHL, and PubMed. Keywords and Search items used to search articles for our study were rigid wrist splint, pain, hand function, inflammatory arthritis, and occupational therapy (OT). By combining the search results, we found articles on the effectiveness of rigid wrist splints on reducing pain and/or improving hand function in patients with inflammatory arthritis. Based on the format of PICO question, four most relevant articles were selected for our study. Studies cited in the reference of the four articles along with other articles were also used to collect important information. After all, the strongest evidence-based article was chosen based on level of evidence and significance level to highlight and confirm our results and conclusions.
Results
The four selected articles were related to the effectiveness of rigid wrist splints on reducing pain and/or improving hand function in patients with inflammatory arthritis. All articles were related to our PICO question. A summary of the four articles in relation to our PICO is as follows. Articles are presented and listed based on study power and sample size.
Haskett [7]
Based on the hierarchy of levels of evidence in evidence-based practice, this study was a level III evidence crossover design Hughes [8]. Number of subjects was 45 subjects with inflammatory arthritis. Three rigid wrist splints were used and fabricated 15-20° wrist extension and 5° ulnar deviation or adjusted to 20° wrist extension. Subjects wore each splint for 4 weeks with 1-week washout period in between. Subjects were asked to wear them at least 10 hours a week. Subjects perceived pain by 10cm horizontal visual analogue scale (pain VAS). The rigid splints significantly reduced pain (p=0.007). Hand function on the Arthritis Hand Function Test (AHFT) significantly improved (p< 0.02).
Stern [9]
Based on the hierarchy of levels of evidence in evidence-based practice, this study was a level III evidence crossover design Hughes [8]. Number of subjects was 42 Subjects with Rheumatoid Arthritis (RA). Three commercial rigid wrist orthoses were used and positioned with 10° wrist extension. Subjects wore each orthosis for 1 week with 1-week washout period. Subjects were directed to wear the orthoses at least 4 hours a day, 5 days a week. Finger dexterity improved significantly with faster performance in the Purdue Pegboard test. Hand function improved significantly with faster performance in the Jebsen-Taylor test. Learning effect was found in many subtests.
Stern [10]
Based on the hierarchy of levels of evidence in evidence-based practice, this study was a level III evidence crossover design Hughes [8]. Number of subjects was 36 subjects with RA. Three commercial rigid wrist orthoses were used with wrist extension of 10°. Subjects wore each orthosis for a week with 1-week washout period. Subjects were asked to wear the splints at least 4 hours a day and 5 days a week. Splinted grip strength had a significant improvement of 0.7kg. in terms of daily tasks, the orthoses interfered with hand function.
Tijhuis [11]
Based on the hierarchy of levels of evidence in evidence-based practice, this study was a level III evidence crossover design Hughes [8]. Number of subjects was 10 subjects with RA. Two rigid wrist orthoses were used and adjusted to have 15° wrist extension. Subjects wore each orthosis for 2 weeks and had a 1-week washout period. Subjects were asked to wear the orthoses as much as possible during day and night. In terms of the pain VAS and grip strength, there were no significant differences between the start and the end of treatments. In terms of hand function, only 2 of 10 subjects for each orthosis reported improvement.
Discussion
Haskett et al. [7] which examined the effectiveness of rigid wrist splints on reducing pain and/or improving hand function in patients with inflammatory arthritis was selected as the strongest evidence based article. Based on the hierarchy of levels of evidence in evidence-based practice, this study was a level III (Evidence obtained from well-designed non-randomized controlled trials, single group pre-post) Hughes [8]. Among other reviewed studies, they used the largest sample size of 45 subjects. In this study, the rigid splints significantly reduced pain (p=0.007) and improved hand function (p< 0.02). The effectiveness of rigid wrist splints in reducing pain and improving hand function for individuals with inflammatory arthritis was supported in our evidence-based review study. Thus, the following treatment plan has been developed in our study and can be applied in clinics to ensure implementation of recommendations on rigid wrist splints (Table 1).
Table 1:A summary of recommendations, plan and audit tool.
Conclusion
Our review suggested that rigid wrist splints are effective and may result in pain reduction and improvement in hand function for patients with inflammatory arthritis. Thus, clinical guidelines, recommendations, a plan and audit tool have been created in our study to implement rigid wrist splints in clinics. The clinical guidelines for recommended intervention, the plan, and the audit tool recommend therapists to apply rigid wrist splints with patients with inflammatory arthritis.
Funding Details
No funding was required
References
- Fries JF (1999) Arthritis: A take care of yourself health guide for understanding your arthritis. Perseus Publishing, USA.
- Imboden JB (2004) Approach to the patient with arthritis. In Imboden J, Hellmann DB, Stone JH (Eds.), Current Rheumatology Diagnosis & Treatment, McGraw-Hill Companies, New York, USA, pp. 27-35.
- Richardson WS, Wilson MC, Nishikawa J, Hayward RS (1995) The wellbuilt clinical question: A key to evidence-based decision. ACP J Club 123(3): 12-13.
- Tassiulas I, Paget SA (2006) Rheumatoid arthritis. In Paget SA, Beary JF, Gibofsky A, Sculco TP (Eds.), Manual of rheumatology and outpatient orthopedic disorders (5th edn), Lippincot Williams & Wilkins, Philadelphia, Pennsylvania, USA, pp. 206-220.
- US Department of Health and Human Services (2004) Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Maryland, United States.
- Wolff A (2006) Occupational therapy: Therapist’s management of rheumatologic disorders of the hand. In: SA Paget, JF Beary, Gibofsky A, Sculco TP (Eds.), Manual of rheumatology and outpatient orthopedic disorders (5th edn.), Lippincot Williams & Wilkins, Philadelphia, USA, pp. 482-489.
- Haskett S, Backman C, Porter B, Goyert J, Palejko G (2004) A crossover trial of custom-made and commercially available wrist splints in adults with inflammatory arthritis. Arthritis Rheum 51(5): 792-799.
- Hughes I (2006) Action research in healthcare: what is the evidence? ALAR Journal 11(1): 29-39.
- Stern EB, Ytterberg SR, Krug HE, Mahowald ML (1996) Finger dexterity and hand function: Effect of three commercial wrist extensor orthoses on patients with rheumatoid arthritis. Arthritis Care Res 9(3): 197-205.
- Stern EB, Ytterberg SR, Krug HE, Mullin GT, Mahowald ML (1996) Immediate and short-term effects of three commercial wrist extensor orthoses on grip strength and function in patients with rheumatoid arthritis. Arthritis Care Res 9(1): 42-50.
- Tijhuis GJ, Vliet Vlieland TP, Zwinderman AH, Hazes JM (1998) A comparison of the Futuro wrist orthosis with a synthetic ThermoLyn orthosis: Utility and clinical effectiveness. Arthritis Care and Research 11(3): 217-222.
© 2018 Sarsak HI. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
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