Splints combined with exercises may be effective in improving dexterity and pain in the hands of patients with rheumatoid arthritis (RA), a pilot study has shown.
RA frequently results in the intrinsic-plus posture of the fingers, or “rheumatic hand,” whereby patients flex their fingers at the metacarpal phalangeal (MP) joints while the interphalangeal joints are extended. This results in an abnormal pattern of hand movement that can cause significant problems in daily life.
In the present study, S Formsma (University Medical Centre, Groningen, The Netherlands) and team evaluated the effect of a novel MP-blocking splint designed to inhibit the activity of the intrinsic muscles and to facilitate the activity of the extrinsic muscles.
They recruited 23 patients with RA and the intrinsic-plus posture in one or both hands. Treatment involved wearing the MP-blocking splint for 30 minutes three times a day during activities such as washing the dishes, folding laundry, or preparing meals. The patients were also instructed to perform a set of hand exercises three times daily while wearing the splint.
After 3 months of treatment, patients showed significant improvements in dexterity and use of their hands, Formsma et al report in the Journal of Hand Therapy.
Mean total scores on the Sequential Occupational Dexterity Assessment (SODA) increased from 88.0 at baseline to 97.5 at 6 months, while mean scores on the SODA pain subscale fell from 2.7 to 0.8.
There were also non-significant improvements in other outcome measures, including grip strength, pinch strength, range of motion, the Michigan Hand Outcomes Questionnaire, and Disability of the Arm, Shoulder, and Hand scores.
The authors conclude that the combination of a MP-blocking splint plus exercise is an innovative, promising treatment for RA patients with an intrinsic-plus posture of the hands.
“Because of the small sample size, the clinical nature, and lack of control, further research is needed to support these findings,” they add.