The effectiveness of working wrist splints in adults with rheumatoid arthritis: A mixed methods systematic review

Abstract

To evaluate the effectiveness of working wrist splints in people with rheumatoid arthritis. 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. 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. 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. Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.