Splints and Orthosis for treating rheumatoid arthritis

Abstract

Background: Splints/orthoses are often recommended to patients with rheumatoid arthritis (RA) to decrease pain, reduce swelling, and/or prevent deformity. These orthoses include resting hand splints, wrist supports, finger splints, and special shoes and shoe inserts. Objectives: To assess the effectiveness of splints/orthoses in relieving pain, decreasing swelling, and/or preventing deformity, and to determine the impact of splints/orthoses on strength, mobility, and function in people with RA. Search methods: We searched the Cochrane Field of Physical and Related Therapies Register, Cochrane Musculoskeletal Group Register, Cochrane Controlled Trials Register to issue 4, 2001, MEDLINE, EMBASE, the PEDro data base, and Current Contents up to January 2002, using the search strategy developed by the Cochrane Collaboration. Unpublished studies were sought by handsearching conference proceedings and contacting key experts. Selection criteria: All randomized control trials (RCTs) and controlled clinical trials (CCTs), case-control and cohort studies comparing the use of specific orthoses against placebo, another active intervention (including another type of orthoses), or regular treatment were selected according to an a priori protocol. Data collection and analysis: Two reviewers independently selected the studies and extracted data. The methodological quality of the RCTs and CCTs was assessed using a validated scale. Main results: Twelve papers reporting on 10 studies met the inclusion criteria. These studies dealt with the following: working wrist splints (5), resting hand and wrist splints (2), special shoes and insoles (3). There is evidence that wearing wrist splints during work statistically significantly decreases grip strength and does not affect pain, morning stiffness, pinch grip, or quality of life after up to six months of regular wear. We found no evidence that resting wrist and hand splints change pain, grip strength, Ritchie Index, or number of swollen joints. However, participants who wore these splints for two months reported that they preferred use to non-use, and padded resting splints to unpadded ones. The one study of special shoes provided evidence of significant benefits of wearing extra-depth shoes for two months, including less pain on walking and stair climbing, and more minutes of pain free walking time. Extra-depth shoes with semi-rigid insoles provided better pain relief than extra-depth shoes alone when worn over 12 weeks. Supporting insoles prevented progression of hallux valgus angle but did not affect pain or function. Authors' conclusions: There is insufficient evidence to make firm conclusions about the effectiveness of working wrist splints in decreasing pain or increasing function for people with RA. Potential adverse effects, such as decreased range of motion, do not seem to be an issue although some of these splints decrease grip strength and dexterity. Similarly, preliminary evidence suggests that resting hand and wrist splints do not seem to affect range of motion (ROM) or pain, although participants preferred wearing a resting splint to not wearing one. There is evidence that extra-depth shoes and molded insoles decrease pain during weight-bearing activities such as standing, walking, and stair-climbing. Supported insoles may be effective in preventing progression of hallux abductus angle but do not appear to have any impact on pain.