Background The use of working wrist splints is extremely common in the management of adults with RA and splints are recommended in treatment guidelines, yet there is limited and often conflicting evidence as to their effectiveness. Additionally, literature reviews published to date have not examined the full breadth of the literature, most have been unsystematic in their approach and frequently fail to adequately report results or present conflicting interpretation of the same studies. Consequently there is no clear guidance for clinicians on the effectiveness and use of working wrist splints in RA.
When attempting to answer questions of effectiveness, the statistical combination of numerical effects as is common in systematic reviews, could be criticized as lacking context and explanation. Similarly, qualitative studies can only provide insight to develop an understanding of lived experiences. Theories generated from these insights however, can be examined for evidence of their effect in the quantitative literature and a deeper understanding of the impact of splinting can be gained through a combined synthesis of the breadth of literature available. This mixed methods systematic review aimed to evaluate the evidence for the effectiveness of working wrist splints in the management of pain, function and quality of life in people with RA. By including evidence from diverse study types this review aims to provide a much richer and meaningful answer to the question; are working wrist splints effective in the management of patients with RA?
Objectives To evaluate the effectiveness of working wrist splints in the treatment of people with rheumatoid arthritis.
Methods A mixed methods systematic literature review was conducted. Ten electronic databases were searched for both quantitative and qualitative studies. Quantitative studies provided evidence for the effectiveness of working wrist splints amongst people with RA and qualitative studies provided contextual evidence of experiences and perceptions of working wrist splints for people with RA. Experimental studies were evaluated using the van Tulder (1) and the Cochrane Risk of Bias tools (1) and summarized using best evidence synthesis. A narrative approach to data synthesis from the quantitative studies was used. A meta-ethnographical approach was used to synthesize qualitative evidence. Quantitative and qualitative syntheses were then combined.
Results Twenty two studies were included (n=1404 participants) 9 RCTs, 4 quasi-experimental studies, 3 observations studies, 4 surveys and 2 qualitative studies. There is strong quantitative evidence, supported by conclusions drawn from qualitative literature, that working wrist splints reduce pain,. There is moderate evidence that grip strength is improved and dexterity impaired with the use of a working wrist splints, and insufficient evidence of the effect of working wrist splints on upper limb function due to conflicting results in the literature.
Conclusions Working wrist splints are effective in reducing pain and may moderately improve grip and impair dexterity, however there is insufficient and conflicting evidence of their effect on upper limb functional activity.
Furlan AD, Peenick V, Bombardier C, van Tulder M. Updated method guidelines for systematic reviews in the Cochrane back review group. Spine 2009 34:1929-1941
Disclosure of Interest None Declared