title: Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis.
abstract: OBJECTIVE
  DIP joint OA is common but has few cost-effective, evidence-based interventions. Pain and deformity [radial or ulnar deviation of the joint or loss of full extension (extension lag)] frequently lead to functional and cosmetic issues. We investigated whether splinting the DIP joint would improve pain, function and deformity.
  
  
  METHODS
  A prospective, radiologist-blinded, non-randomized, internally controlled trial of custom splinting of the DIP joint was carried out. Twenty-six subjects with painful, deforming DIP joint hand OA gave written, informed consent. One intervention joint and one control joint were nominated. A custom gutter splint was worn nightly for 3 months on the intervention joint, with clinical and radiological assessment at baseline, 3 and 6 months. Differences in the change were compared by the Wilcoxon signed rank test.
  
  
  RESULTS
  The median average pain at baseline was similar in the intervention (6/10) and control joints (5/10). Average pain (primary outcome measure) and worst pain in the intervention joint were significantly lower at 3 months compared with baseline (P = 0.002, P = 0.02). Differences between intervention and control joint average pain reached significance at 6 months (P = 0.049). Extension lag deformity was significantly improved in intervention joints at 3 months and in splinted joints compared with matched contralateral joints (P = 0.016).
  
  
  CONCLUSIONS
  Short-term night-time DIP joint splinting is a safe, simple treatment modality that reduces DIP joint pain and improves extension of the digit, and does not appear to give rise to non-compliance, increased stiffness or joint restriction.
  
  
  BACKGROUND
  clinical trials.gov, http://clinicaltrials.gov, NCT01249391.
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK. fiona.watt@kennedy.ox.ac.uk.
authors: Fiona E
authors: FE
authors: Watt
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Donna L
authors: DL
authors: Kennedy
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Katharine E
authors: KE
authors: Carlisle
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Andrew J
authors: AJ
authors: Freidin
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Richard M
authors: RM
authors: Szydlo
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Lesley
authors: L
authors: Honeyfield
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Keshthra
authors: K
authors: Satchithananda
authors: Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
authors: Tonia L
authors: TL
authors: Vincent
mesh_terms: D000368:Aged; D005260:Female; D005384:Finger Joint / Q000503:physiopathology*; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013165:Splints; D016896:Treatment Outcome
keywords: distal; interphalangeal; non-pharmacological therapy; osteoarthritis; pain; splint