RESEARCH - The clinical effectiveness of static resting splints in early RA: a randomized controlled trial

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Rheumatology Advance Access published online on August 13, 2008

Rheumatology, doi:10.1093/rheumatology/ken292

The clinical effectiveness of static resting splints in early

rheumatoid arthritis: a randomized controlled trial

J. 1, J. Burridge1, M. Mullee2, A. Hammond3 and C. 4

1School of Health Professions and Rehabilitation Sciences 2RDSU,

Public Health Sciences and Medical Statistics, CCS Division,

University of Southampton, Southampton 3Centre for Rehabilitation and

Human Performance Research, University of Salford, Salford and

4Medical Research Council, University of Southampton, Southampton, UK.

Abstract

Objective. To evaluate the effectiveness of static resting splints in early RA.

Methods. A multicentre, randomized, trial was conducted. Patients (n =

120) received either static resting splints [positioned with the wrist

in neutral, MCP joint (MCPJ) and IP joint (IPJ) in a maximum of 60°

and 30° of flexion, respectively] plus standardized occupational

therapy or standardized occupational therapy alone. Change in grip

strength (Ns), structural impairment (MCPJ ulnar deviation), applied

dexterity (Button Board), self-report hand ability [Michigan Hand

Outcomes Questionnaire (MHQ)], hand pain and morning hand stiffness

were assessed at 0 and 12 months.

Results. Data for 56 (97%) splinted and 60 (97%) control group

patients were analysed. Splint wear adherence was moderate; 24.5%

'never wore' the splints. The adjusted mean difference between groups

for handgrip was –14.2 Ns (P = 0.342; 95% CI –43.7, 5.4); MCPJ ulnar

deviation –1.1° (P = 0.657; 95% CI = –6.2, 3.9); dexterity 0.1 s (P =

0.975; 95% CI = –6.6, 6.8) and self-report ability –3.0 on the MHQ

score (P = 0.426; 95% CI –10.5, 4.5). Pain scores were unchanged in

either group (P = 0.15). The occurrence of morning hand stiffness was

reduced in a small group of splinted patients (P = 0.021), but the

duration shortened in control patients (P = 0.010).

Conclusions. There was no significant difference between the two

interventions on grip strength, deformity, hand function and pain. The

data favoured the control group and this study suggests that resting

splints should not be used as a routine treatment of patients with

early RA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken292v1?papetoc

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