The effectiveness of working wrist splints in adults with rheumatoid arthritis: a mixed methods systematic review.
OBJECTIVE
To evaluate the effectiveness of working wrist splints in people with rheumatoid arthritis.


METHODS
This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Ten databases were searched from inception until September 2012 for quantitative and qualitative studies on the effectiveness of working wrist splints in rheumatoid arthritis.


METHODS
Data was extracted on participants, interventions, outcome measures and results. Experimental studies were evaluated using the van Tulder scale and the Cochrane Risk of Bias tool. Data was extracted by a single reviewer and all studies were reviewed by two blind reviewers.


RESULTS
Twenty-three studies were included in the review (n = 1,492), 13 experimental studies including 9 randomized controlled trials (RCTs) and 2 qualitative studies. Data was summarized using best evidence synthesis and a meta-ethnographical approach guided qualitative evidence synthesis. There is strong quantitative evidence (including 9 RCTs), supported by conclusions from qualitative literature, that working wrist splints reduce pain (d = 0.7-0.8), moderate evidence that grip strength is improved (d = 0.3-0.4) and dexterity impaired and insufficient evidence of their effect on function.


CONCLUSIONS
Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.
Centre for Health and Rehabilitation Technologies (CHaRT), School of Health Sciences, University of Ulster, , Shore Road , BT370QB UK, United Kingdom. l.ramsey@ulster.ac.uk.
Lucia
L
Ramsey
Robert John
RJ
Winder
Joseph G
JG
McVeigh
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D013165:Splints; D014953:Wrist