The efficacy of wrist working splints in patients with non-destructive wrist arthritis.

Wrist arthritis, which is characterized by inflammation of the wrist, is a prevalent health care problem in patients with rheumatoid arthritis (RA). Clinical features are pain and swelling. As the disease progresses, joint destruction (deformities) occur. Pain due to inflammation of the wrist or joint destruction contributes to a reduction in hand strength and a decrease in function. In the early stages of the disease, when inflammation is the most important pathophysiological phenomenon and joint destruction is at the point of occurring, conventional therapies are aimed at decreasing inflammation and pain. As adjunct to drug treatment, wrist working splints are often prescribed. This type of splint provides rest and support and stabilizes the wrist. Rest is known to reduce inflammation. So, it is supposed that in the early stages of the disease, wrist working splints could reduce local inflammation, with beneficial effects on pain and function. Although recognized by patients and health professionals these effects have never been rigorously studied.



The aim of this study is to investigate the efficacy of wrist working splints in patients with non-destructive wrist arthritis in a randomized controlled trial. Sixty patients with RA will randomly be allocated to an experimental group or a control group. Patients in the experimental group will wear a wrist working splint for 4 weeks as adjuvant to usual treatment. To improve compliance with splint wearing, compliance enhancing measures will be included. Patients in the control group receive treatment as usual. Patients will be measured twice: at baseline and 4 weeks later. The primary outcome measure is pain in the wrist. Secondary outcome measures are: number of swollen and painful joints, synovial swelling, grip strength, and dexterity.

We expect a reduction of pain in de wrist, measured with a Visual Analogue Scale, after 4 weeks of wrist working splint wearing, and a difference in pain score between the experimental group (splinting intervention as adjuvant to usual treatment) and the control group (usual treatment).

N/A

Patients are randomly allocated to the experimental group (splinting intervention as adjuvant to usual treatment) or the control group (usual treatment). Patients in the experimental group receive a wrist working splint for their most painful hand. The splint is fitted by an occupational therapist who also gives education on splint wearing. To optimize compliance with splint wearing, compliance enhancing measures are included in this education. Patients are asked to wear the splint by day as much as possible (especially during activities) for four weeks.