The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis

Pavlos Bobos; Goris Nazari; Mike Szekeres; Emily A Lalone; Louis Ferreira; Joy C MacDermid

doi:10.1016/j.jht.2018.09.012

The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis

J Hand Ther. 2019 Apr-Jun;32(2):194-211. doi: 10.1016/j.jht.2018.09.012. Epub 2018 Dec 23.

Authors

Pavlos Bobos¹, Goris Nazari², Mike Szekeres³, Emily A Lalone⁴, Louis Ferreira⁵, Joy C MacDermid⁶

Affiliations

¹ Department of Health and Rehabilitation Sciences, Western's Bone and Joint Institute, Western University, London, ON, Canada. Electronic address: pbobos@uwo.ca.
² Department of Health and Rehabilitation Sciences, Western's Bone and Joint Institute, Western University, London, ON, Canada.
³ Hand Therapy Canada, London, ON, Canada.
⁴ Faculty of Engineering, Department of Mechanical and Materials Engineering, Western University, ON, Canada.
⁵ Roth | McFarlane Hand & Upper Limb Centre (HULC) St. Joseph's Health Care, London, ON, Canada.
⁶ Physical Therapy and Surgery, Western University, London, ON and Co-director Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON; Rehabilitation Science McMaster University, Hamilton, ON, Canada.

PMID: 30587434
DOI: 10.1016/j.jht.2018.09.012

Abstract

Study design: Systematic review with meta-analysis.

Introduction: Joint protection (JP) has been developed as a self-management intervention to assist people with hand arthritis to improve occupational performance and minimize joint deterioration over time.

Purpose of the study: We examined the effectiveness between JP and usual care/control on pain, hand function, and grip strength levels for people with hand osteoarthritis and rheumatoid arthritis.

Methods: A search was performed in 5 databases from January 1990 to February 2017. Two independent assessors applied Cochrane's risk of bias tool, and a Grading of Recommendations Assessement, Development and Evaluation (GRADE) approach was adopted.

Results: For pain levels at short term, we found similar effects between JP and control standardized mean difference (SMD; -0.00, 95% confidence interval [CI]: -0.42 to 0.42, I² = 49%), and at midterm and long-term follow-up, JP was favored over usual care SMD (-0.32, 95% CI: -0.53 to -0.11, I² = 0) and SMD (-0.27, 95% CI: -0.41 to -0.12, I² = 9%), respectively. For function levels at midterm and long-term follow-up, JP was favored over usual care SMD (-0.49, 95% CI: -0.75 to -0.22, I² = 34%) and SMD (-0.31, 95% CI: -0.50 to -0.11, I² = 56%), respectively. For grip strength levels, at long term, JP was inferior over usual care mean difference (0.93, 95% CI: -0.74 to 2.61, I² = 0%).

Conclusions: Evidence of very low to low quality indicates that the effects of JP programs compared with usual care/control on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis.

Keywords: Hand osteoarthritis; Joint protection; Meta-analysis; Rheumatoid arthritis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Arthritis, Rheumatoid / physiopathology
Arthritis, Rheumatoid / therapy*
Ergonomics
Exercise Therapy
Hand Joints / physiopathology*
Hand Strength / physiology*
Humans
Orthotic Devices
Osteoarthritis / physiopathology
Osteoarthritis / therapy*
Pain Measurement
Patient Education as Topic
Self-Help Devices