Hand function in early rheumatoid arthritis
This thesis is about what people can do with their hands in the early stages of rheumatoid arthritis (RA). The wrist and hand are affected early in RA. Wrist and hand joint swelling, pain and deformity are all likely to contribute to the functional performance of the hand. Static splinting alongside joint protection education and active exercise is one of the most common conservative intervention strategies used by therapists. Splinting attempts to reduce local inflammation and pain, correctly position joints, minimise the occurrence or progression of deformity and maintain hand function. This thesis reviews the impact that RA can have on the hands and upper limb, examines what factors may influence function and compares the outcome measures that are used to measure this. A clinical effectiveness randomised controlled trial, examining the effectiveness of static hand splinting in early RA is described. A total of one hundred and sixteen patients with early RA were recruited onto the main trial and randomly allocated to either a splint or non-splint group. Assessments were carried out at baseline, six and 12- months. There was insufficient evidence from the results of this 12 month randomised controlled trial to suggest that using static splinting alongside standardised occupational therapy intervention was any more effective than standardised occupational therapy intervention alone in the maintenance of hand functional ability. However, when male and female participants were analysed separately young male participants could potentially experience clinically significant deleterious effects when issued with static resting splints.