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Meta-Analysis
. 2001 Oct 23;2001(1):CD004018.
doi: 10.1002/14651858.CD004018.

Splints/orthoses in the treatment of rheumatoid arthritis

M Egan  1 , L Brosseau, M Farmer, M A Ouimet, S Rees, G Wells, P Tugwell
Affiliations
Meta-Analysis

Splints/orthoses in the treatment of rheumatoid arthritis

M Egan et al. Cochrane Database Syst Rev. .

Abstract

Background: Splints/orthoses are often recommended to patients with rheumatoid arthritis (RA) to decrease pain, decrease 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 determine the impact of splints/orthoses on strength, mobility and function in people with RA.

Search strategy: We searched MEDLINE, EMBASE, the PEDro data base and Current Contents up to January 2002, and the Cochrane Controlled Trials Register to Issue 4, 2001 using the search strategy developed by the Cochrane Collaboration. Unpublished studies were sought by hand searching conference proceeding and contacting key experts.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 abstracted 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 working wrist splints statistically significantly decreases grip strength and does not affect pain, morning stiffness, pinch grip, quality of life after up to 6 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, patients who wore these splints for 2 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 2 months including less pain on walking and stair climbing and more minutes 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. Posted insoles prevented progression of hallux valgus angle but did not affect pain or function.

Reviewer's 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 or pain, although patients preferred wearing a resting splint to not wearing one. There is evidence that extra-depth shoes and molded insoles decreases pain on weight-bearing activities such as standing, walking and stair-climbing. Posted insoles may be effective in preventing progression of hallux abductus angle but do not appear to have an impact on pain.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 1 Grip strength of dominant hand (mmHg)‐ dorsal working splint vs no splint.
1.2
1.2. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 2 Grip strength of dominant hand (mmHg) ‐ Palmar splint vs no splint.
1.3
1.3. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 3 Grip strength of dominant hand (mmHg) ‐ Plastazote and polythene sheeting custom made gauntlet vs no splint.
1.4
1.4. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 4 Grip strength of dominant hand (mmHg) ‐ Elastic with metal stay ready made gauntlet vs no splint.
1.5
1.5. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 5 Grip strength of non‐dominant hand (mmHg) ‐ Dorsal working splint versus no splint.
1.6
1.6. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 6 Grip strength of non‐dominant hand (mmHg) ‐ Palmar splint versus no splint.
1.7
1.7. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 7 Grip strength of non‐dominant hand (mmHg)‐ Plastazote and polythene sheeting custom made gauntlet vs no split.
1.8
1.8. Analysis
Comparison 1 Working wrist gauntlet versus no splint (immediate), Outcome 8 Grip strength of non‐dominant hand (mmHg) ‐ Elastic with metal stay ready made gauntlet vs no splint.
2.1
2.1. Analysis
Comparison 2 Working wrist gauntlet (elastic with metal insert) versus no splint (immediate after 1 week of wear), Outcome 1 Work performance output in 10 sec. using screwdriver (engals).
2.2
2.2. Analysis
Comparison 2 Working wrist gauntlet (elastic with metal insert) versus no splint (immediate after 1 week of wear), Outcome 2 Work performance output in 10 sec. using shears (engals).
2.3
2.3. Analysis
Comparison 2 Working wrist gauntlet (elastic with metal insert) versus no splint (immediate after 1 week of wear), Outcome 3 Dexterity (VAS 0 to 10).
2.4
2.4. Analysis
Comparison 2 Working wrist gauntlet (elastic with metal insert) versus no splint (immediate after 1 week of wear), Outcome 4 Pain on using screwdriver (VAS).
2.5
2.5. Analysis
Comparison 2 Working wrist gauntlet (elastic with metal insert) versus no splint (immediate after 1 week of wear), Outcome 5 Pain on using shears (VAS).
3.1
3.1. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 1 Pain on motion (VAS:1‐100mm).
3.2
3.2. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 2 Pain at rest (VAS:1‐100mm).
3.3
3.3. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 3 Activity pain (pouring water)(VAS:1‐100mm).
3.4
3.4. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 4 Wrist pain on motion (VAS:1‐100mm).
3.5
3.5. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 5 Grip strength (mmHg).
3.6
3.6. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 6 Morning stiffness (min.).
3.7
3.7. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 7 Active dorsal and volar joint motion (degrees).
3.8
3.8. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 8 Passive dorsal and volar joint motion (degrees).
3.9
3.9. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 9 Active ulnar and radial joint motion (degrees).
3.10
3.10. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 10 Active pronation and supination (degrees).
3.11
3.11. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 11 Pinch grip (mmHg).
3.12
3.12. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 12 Joint circumference (cm).
3.13
3.13. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 13 Forearm circumference (cm).
3.14
3.14. Analysis
Comparison 3 Working wrist gauntlet (elastic with metal insert) versus no splint (6 mos), Outcome 14 HAQ (score 0‐3).
4.1
4.1. Analysis
Comparison 4 Futuro wrist gauntlet vs Thermolyn custom made wrist gauntlet (2 weeks), Outcome 1 Pain in wrist (VAS:1‐10cm).
4.2
4.2. Analysis
Comparison 4 Futuro wrist gauntlet vs Thermolyn custom made wrist gauntlet (2 weeks), Outcome 2 Tender joint count wrist and hand (Ritchie scale).
4.3
4.3. Analysis
Comparison 4 Futuro wrist gauntlet vs Thermolyn custom made wrist gauntlet (2 weeks), Outcome 3 Number of swollen joints.
4.4
4.4. Analysis
Comparison 4 Futuro wrist gauntlet vs Thermolyn custom made wrist gauntlet (2 weeks), Outcome 4 Total passive wrist ROM (degrees).
4.5
4.5. Analysis
Comparison 4 Futuro wrist gauntlet vs Thermolyn custom made wrist gauntlet (2 weeks), Outcome 5 Grip strength (kPa) with orthosis.
4.6
4.6. Analysis
Comparison 4 Futuro wrist gauntlet vs Thermolyn custom made wrist gauntlet (2 weeks), Outcome 6 Grip strength (kPa) without orthosis.
5.1
5.1. Analysis
Comparison 5 Futuro wrist gauntlet vs Alimed wrist gauntlet (immediately after 1 week of wear), Outcome 1 Unilateral dexterity (splint on) (Purdue Pegboard placing).
5.2
5.2. Analysis
Comparison 5 Futuro wrist gauntlet vs Alimed wrist gauntlet (immediately after 1 week of wear), Outcome 2 Bilateral dexterity (splint on) (Purdue Pegboad assembly).
5.3
5.3. Analysis
Comparison 5 Futuro wrist gauntlet vs Alimed wrist gauntlet (immediately after 1 week of wear), Outcome 3 Grip strength (splint off) (kg).
6.1
6.1. Analysis
Comparison 6 Alimed wrist gauntlet vs Rolyan wrist gauntlet (immediately after 1 week of wear), Outcome 1 Unilateral dexterity (splint on) (Purdue Pegboard placing).
6.2
6.2. Analysis
Comparison 6 Alimed wrist gauntlet vs Rolyan wrist gauntlet (immediately after 1 week of wear), Outcome 2 Bilateral dexterity (splint on) (Purdue Pegboard placing).
6.3
6.3. Analysis
Comparison 6 Alimed wrist gauntlet vs Rolyan wrist gauntlet (immediately after 1 week of wear), Outcome 3 Grip strength (splint off) (kg).
7.1
7.1. Analysis
Comparison 7 Futuro wrist gauntlet vs Rolyan wrist gauntlet (immediately after 1 week of wear), Outcome 1 Unilateral dexterity (splint on) (Purdue Pegboard placing).
7.2
7.2. Analysis
Comparison 7 Futuro wrist gauntlet vs Rolyan wrist gauntlet (immediately after 1 week of wear), Outcome 2 Bilateral dexterity (splint on) (Purdue Pegboard assembly).
7.3
7.3. Analysis
Comparison 7 Futuro wrist gauntlet vs Rolyan wrist gauntlet (immediately after 1 week of wear), Outcome 3 Grip strength (splint off) (kg).
8.1
8.1. Analysis
Comparison 8 Resting hand and wrist splint vs no splint (1‐6 months), Outcome 1 Preference (1 month) (# of patients prefering soft or hard splint vs no splint).
8.2
8.2. Analysis
Comparison 8 Resting hand and wrist splint vs no splint (1‐6 months), Outcome 2 Grip strength (6 months).
8.3
8.3. Analysis
Comparison 8 Resting hand and wrist splint vs no splint (1‐6 months), Outcome 3 Number of swollen joints (6 months).
8.4
8.4. Analysis
Comparison 8 Resting hand and wrist splint vs no splint (1‐6 months), Outcome 4 Ritchie Index (6 months).
8.5
8.5. Analysis
Comparison 8 Resting hand and wrist splint vs no splint (1‐6 months), Outcome 5 Pain score (out of 48).
9.1
9.1. Analysis
Comparison 9 Circumferential cotton‐padded splint wrap versus pan‐type hard thermoplastic splint (1 month), Outcome 1 Preference (# of patients prefering the soft splint vs the hard splint).
10.1
10.1. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 1 change on Stanford Health Assessment Questionnaire (HAQ).
10.2
10.2. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 2 change on Pain on walking (VAS).
10.3
10.3. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 3 change on Pain on stair climibing (VAS).
10.4
10.4. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 4 change on Pain on non‐weight bearing (VAS).
10.5
10.5. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 5 change in Fatigue (VAS).
10.6
10.6. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 6 change in Subjective well‐being (VAS).
10.7
10.7. Analysis
Comparison 10 Extra‐depth shoes versus regular footwear (2 months), Outcome 7 change in Pain free walking time (minutes).
11.1
11.1. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 1 Pain (VAS: 1‐10cm).
11.2
11.2. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 2 RB Walking (sec.).
11.3
11.3. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 3 RB Stairs (sec.).
11.4
11.4. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 4 RB Stand (sec.).
11.5
11.5. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 5 Toronto Activities of Daily Living measure (TADL) walking.
11.6
11.6. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 6 TADL stairs.
11.7
11.7. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 7 50' walking (sec.).
11.8
11.8. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 8 Lower extremity joint count (# of painful joints).
11.9
11.9. Analysis
Comparison 11 Semi‐rigid insoles vs extra‐depth shoes (12 weeks), Outcome 9 MTP joint count (# of painful joints).
12.1
12.1. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 1 Pain (VAS: 1‐10 cm).
12.2
12.2. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 2 RB Walking (sec).
12.3
12.3. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 3 RB Stairs (sec).
12.4
12.4. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 4 RB Stand (sec.).
12.5
12.5. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 5 Toronto Activities of Daily Living measure (TADL) walking.
12.6
12.6. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 6 TADL stairs.
12.7
12.7. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 7 50' walking (sec.).
12.8
12.8. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 8 Lower extremity joint count (# of painful joints).
12.9
12.9. Analysis
Comparison 12 Soft insoles versus extra‐depth shoes (plastazote) (12 weeks), Outcome 9 MTP joint count (# of painful joints).
13.1
13.1. Analysis
Comparison 13 Rohadur posted foot orthosis vs placebo insole (End of therapy ‐ 3 yrs), Outcome 1 Hallux abductus angle remained < 21 degrees.
13.2
13.2. Analysis
Comparison 13 Rohadur posted foot orthosis vs placebo insole (End of therapy ‐ 3 yrs), Outcome 2 Painful foot joint count.
13.3
13.3. Analysis
Comparison 13 Rohadur posted foot orthosis vs placebo insole (End of therapy ‐ 3 yrs), Outcome 3 Foot Function Index.
13.4
13.4. Analysis
Comparison 13 Rohadur posted foot orthosis vs placebo insole (End of therapy ‐ 3 yrs), Outcome 4 Foot pain (adapted from Melzack).
See this image and copyright information in PMC

References

References to studies included in this review

Anderson 1987 {published data only}
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Budiman‐Mak 1995 {published data only}
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Callinan 1996 {published data only}
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Chalmers 2000 {published data only}
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Fransen 1997 {published data only}
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Kjeken 1995 {published data only}
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Rennie 1996 {published data only}
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Stern 1996a {published data only}
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Stern 1996b {published data only}
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Stern 1997 {published data only}
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Swigart 1999 {published data only}
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Tijhuis 1998 {published data only}
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References to studies excluded from this review

Backman 1988 {published data only}
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Bennett 1965 {published data only}
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Convery 1967 {published data only}
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Craxford 1982 {published data only}
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Gumpel 1981 {published data only}
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Kim 1995 {published data only}
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McKnight 1982 {published data only}
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McKnight 1992 {published data only}
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Moncur 1990 {published data only}
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