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Static Wrist Splint Use in the Performance of Daily Activities by Individuals with Rheumatoid Arthritis
ADA PAGNOTTA, NICOL KORNER-BITENSKY, BARBARA MAZER, MURRAY BARON, and SHARON WOOD-DAUPHINEE
ABSTRACT.
Objective. In individuals with rheumatoid arthritis (RA), to identify the influence of wrist splint wear on pain, work performance, endurance, perceived task difficulty, and perceived splint benefit while performing various upper limb tasks. Methods. This crossover study included 30 individuals with wrist involvement. Pain, work performance, endurance, and perceived task difficulty were assessed with the splint on and off. Using a work simulator, participants performed 14 tasks, 10 assessing work performance and 4 assessing endurance. A visual analog scale (VAS) was used to rate pain, task difficulty, and perceived splint benefit. Results. With the splint on, pain was significantly lower in 5 tasks, as was perceived difficulty in task performance. Work performance did not differ significantly with the splint on versus off. While mean endurance scores were always better with the splint on, differences reached significance on only one task. The task with greatest overall perceived splint benefit was "chopping with a knife." Conclusion. Results revealed that for most tasks, there was generally a positive effect of splint use on hand function; however, perceived splint benefit was marginal. For most tasks splint use improved or did not change pain levels, did not interfere with work performance, increased or maintained endurance, and did not increase perceived task difficulty. The findings suggest that wrist splint prescription is not a simple process; clinicians and clients need to work together to determine the daily wear pattern that maximizes benefit and minimizes inconvenience according to the client's individual needs. (J Rheumatol 2005;32:2136-43) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Department of Occupational Therapy and Department of Rheumatology, Jewish Rehabilitation Hospital, Chomedey, Laval; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal; and Jewish General Hospital, Montreal, Quebec, Canada. Supported by a grant from the Réseau de recherche en réadaptation de Montréal et de l'ouest du Québec. A. Pagnotta, MSc, Occupational Therapist, Jewish Rehabilitation Hospital; N. Korner-Bitensky, PhD, Associate Professor, Physical and Occupational Therapy, McGill University; B. Mazer, PhD, Physical and Occupational Therapy, McGill University, Research Associate, Jewish Rehabilitation Hospital site — CRIR; M. Baron, MD, Associate Professor of Medicine, McGill University; S. Wood-Dauphinee, PhD, Professor, Physical and Occupational Therapy, McGill University. Address reprint requests to A. Pagnotta, Department of Occupational Therapy, Jewish Rehabilitation Hospital, 3205 place Alton-Goldbloom, Laval, Québec H7V 1R2. E-mail: adapagnott_hjr@ssss.gouv.qc.ca Accepted for publication June 20, 2005. |