Effects of occupational therapy home service on patients with rheumatoid arthritis. Immediate and short-term effects of three commercial wrist extensor orthoses on grip strength and function in patients with rheumatoid arthritis. Finger dexterity and hand function: effect of three commercial wrist extensor orthoses on patients with rheumatoid arthritis. A method to increase compliance to exercise regimens in rheumatoid arthritis patients. The efficacy of the ROM Dance Program for adults with rheumatoid arthritis. Continuous passive motion following metacarpophalangeal joint arthroplasty. A randomized controlled trial of home exercise on the rheumatoid hand. The effect of cognitive behavior therapy in patients with rheumatoid arthritis. Evaluation of assistive devices after a course in joint protection. A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis. Randomized, controlled trial of compression gloves in rheumatoid arthritis. Effect of the arthritis health professional on compliance with use of resting hand splints by patients with rheumatoid arthritis. The usefulness of nocturnal resting splints in the treatment of ulnar deviation of the rheumatoid hand. Promoting self-care in clients with arthritis. Commercial wrist extensor orthoses: a descriptive study of use and preference in patients with rheumatoid arthritis. A comparison of follow-up regimes in rheumatoid arthritis. Elastic wrist orthoses. Reduction of pain and increase in grip force for women with rheumatoid arthritis. Patient education program to teach energy conservation behaviors to patients with rheumatoid arthritis: a pilot study. The effect of a static wrist orthosis on hand function in individuals with rheumatoid arthritis. Soft versus hard resting hand splints in rheumatoid arthritis: pain relief, preference, and compliance. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Evaluation of the effectiveness of a metacarpophalangeal ulnar deviation orthosis. Joint protection behavior in patients with rheumatoid arthritis following an education program: a pilot study. Wrist splints in rheumatoid arthritis: a question of belief? "Hand gym" for patients with arthritic hand disabilities: preliminary report. A comparison of the Futuro wrist orthosis with a synthetic ThermoLyn orthosis: utility and clinical effectiveness. A program for improving energy conservation behaviors in adults with rheumatoid arthritis. Effect of energy conservation and joint protection education in rheumatoid arthritis. Effect of active hand exercise and wax bath treatment in rheumatoid arthritis patients. Assistive technology selection: a study of participation of users with rheumatoid arthritis. Air pressure splint effects on hand symptoms of patients with rheumatoid arthritis. The effect of a long-term exercise programme on the rheumatoid hand. Use of resting splints by patients with rheumatoid arthritis.
Because there is little information about the efficacy of home occupational therapy, we decided to assess the effects of a home service on patients with rheumatoid arthritis. 105 patients aged 18-70 years, on stable medical therapy, were randomised to receive a 6-week comprehensive programme of occupational therapy (experimental group, 53 patients) or to receive no such treatment (control group, 52). At 6 weeks, control patients received the experimental regimen, and experimental patients were continued on treatment as needed up to 12 weeks. Outcomes were measured at baseline, 6, and 12 weeks with a global functional capacity score (functional score). At 6 weeks the functional score for the experimental group was significantly higher than that for the control group (mean difference = 8.1, 95% Cl 1.7 to 15.8, p = 0.012). Control patients at 12 weeks showed a similar improvement to experimental patients at 6 weeks, and between 6 and 12 weeks the experimental patients were stable. Occupational therapy leads to a statistically significant and clinically important improvement in function in patients with rheumatoid arthritis. To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function.
                Thirty-six patients with definite rheumatoid arthritis participated in the randomized, controlled, cross-over design study of 3 commercial wrist extensor orthoses. Dominant-hand dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted. Functional impact was assessed using a written questionnaire.
                All 3 commercial orthoses reduced grip strength when first donned. After a 1-week adjustment period, one orthosis, the Smith and Nephew Roylan D-Ring (Roylan), afforded splinted grip strength equal to that of the nonsplinted grip strength. The other 2 orthoses continued to reduce grip strength, and afforded splinted grip strength significantly below that of the Roylan. The Roylan was deemed comfortable by more subjects than the other orthoses.
                The belief that commercial orthotic use increases grip strength, either immediately or after 1 week, is not supported by this study's data. Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength. To investigate the effect of 3 commercial wrist orthoses on finger dexterity and hand function of patients with rheumatoid arthritis (RA).
                Forty-two patients with definite RA participated in the cross-over study comparing 3 styles of commercial wrist orthoses. Finger dexterity and hand function of the dominant hand were assessed while splinted and unsplinted, at the initial session and after 1 week of intermittent orthosis use. Finger dexterity was assessed using two subtests from the Purdue Pegboard Test (Purdue) and hand function was assessed using the Jebsen-Taylor Hand Function Test (Jebsen-Taylor).
                Both finger dexterity and hand function were reduced by splinting; men and women were affected similarly. There was no difference in finger dexterity or hand function afforded by the 3 orthoses. Results on both the Purdue and Jebsen-Taylor tests showed a significant learning effect across time.
                The 3 commercial wrist orthoses studied reduce dexterity similarly and significantly. When commercial wrist orthoses are to be used during tasks that require maximum dexterity, this reduction should be weighed against the known benefits of splinting. A hand exerciser with an electronic counter and a visual display was used to measure compliance objectively, to investigate the effects of visual feedback on compliance, and to assess the impact of exercise on seven mild and five moderate rheumatoid arthritis patients. A multiple time-series design varying the onset of the visual display was utilized. Compliance was assessed weekly over the 7 weeks of the study. Pretest and posttest measures of various indicators of hand functioning were taken by an occupational therapist. Visual display of the number of exercises completed decreased the number of noncompliant patients from six to two, with the maximum degree of noncompliance reduced from 44 to 5%. Thus the use of visual display is effective in producing compliance to exercise regimens. In light of the small sample size, however, no definitive conclusions can be drawn regarding the effects of exercise on hand functioning. This study examined the efficacy of an exercise and relaxation program for adults with rheumatoid arthritis. The program integrates principles of occupational therapy and T'ai-Chi Ch'uan and was expected to be more effective than traditional exercise and rest regimens because of its expressive and pleasurable elements. There were significant differences between 17 experimental and 16 control subjects on two categories of dependent variables after the former group's participation in the experimental program. These dependent variables were range of motion measures and subject self-reports of frequency, enjoyment, and benefits of home exercise and rest routines. Pretest, posttest, and 4-month follow-up data were analyzed. Program participants showed significantly greater upper extremity range of motion 4 months after completing the program although the reported frequency of exercise and rest was greater in the control group. Postprogram reports of enjoyment were significantly higher for experimental than for control subjects. If these initial results are confirmed in further studies, the efficacy of the use of purposeful activity for exercise and rest will be supported. This study also supports the integration of Eastern and Western frames of reference in the treatment of patients with chronic illness. To determine whether a postoperative rehabilitation protocol incorporating continuous passive motion would increase the total range of motion obtained 6 months following silicone interposition arthroplasty of the metacarpophalangeal joints in patients with rheumatoid arthritis, a prospective trial randomizing patients to receive either continuous passive motion or the standard dynamic splint protocol (modified Madden protocol) was undertaken. Fifteen hands (60 joints) were treated with the modified Madden protocol and 10 hands (40 joints) had continuous passive motion. The mean 6-month postoperative range of motion was 7 degrees in the modified Madden cohort compared with 39 degrees in the continuous passive motion cohort, representing an improvement of 22 degrees in the modified Madden cohort compared with an improvement of only 5 degrees in the continuous passive motion cohort. Residual ulnar deviation 8 degrees vs 12 degrees and grip strength (2.3 kgf v 3.7 kgf) were both lower in the continuous passive motion cohort. Incorporation of the continuous passive motion machine in the postoperative rehabilitation protocol does not offer sufficient advantages to justify the added costs. To study differing home hand exercise interventions to determine effects on grip strength, and secondarily any immediate or short term effects on range of motion, pain, deformities, hand disease activity, and dexterity.
                Randomized controlled trial of 12 weeks of home hand exercise performed for 10-20 min twice daily. Study exercise interventions were range of motion exercises, balanced resistive exercises, and range of motion plus balanced resistive exercises.
                Aside from transient, mild to moderate discomfort, exercises were well tolerated. Range of motion exercises were associated with improved right hand joint count. Range of motion plus balanced resistive exercises were associated with increased left hand dexterity. Home hand exercise (exercise groups combined) significantly increased left grip strength.
                Temporary use of home hand exercise has acceptable side effects and is an effective means of increasing grip strength. In order to examine the effectiveness of cognitive behavioral therapy for patients with rheumatoid arthritis (RA) three patients groups were studied: a cognitive behavioral therapy group (CBT), an occupational therapy group (OT), and a waiting-list control group. The CBT received a comprehensive, 10-session treatment package that taught progressive relaxation, rational thinking and the differential use of pain coping strategies. CBT resulted in minor changes in pain coping behavior at posttreatment, while CBT and OT showed an increase of knowledge of RA. No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up. Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study. It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied, as well as to the rather small changes in coping behavior. This study assessed a joint protection education program and investigated the costs and effects of assistive devices. Fifty-three women with seropositive rheumatoid arthritis, whose ages ranged from 29 to 65 years, attended a standardized joint protection course (13 hours). A self-report questionnaire was constructed listing the most common devices, and the subjects were asked to check which devices they had received, which ones they used and did not use, and why. Pain during activities of daily living and when using assistive devices was measured using the visual analogue scale. Results show that the subjects reported great benefits from the joint protection course, assistive devices, and wrist orthosis. The women had tried 663 devices, 91% of which were still being used. Pain decreased significantly (p < .001) when using assistive devices. The utility of 11 devices at a cost of SEK 1,683 per person can be described as increased capacity and ability to work at home, work outside the home, and perform leisure activities with less pain. Joint protection (JP) is a self-management technique widely taught to people with rheumatoid arthritis (RA). JP education aims to enable people with RA to reduce pain, inflammation, joint stress and reduce risks of deformity through using assistive devices and alternative movement patterns of affected joints to perform everyday activities. Previous studies evaluating JP education methods common in the UK have identified JP adherence is poor. A group education programme was developed using the Health Belief Model and Self-efficacy Theory. Strategies used to maximise JP adherence included goal-setting, contracting, modelling, homework programmes, motor learning theory, recall enhancing methods and mental practice. A crossover trial (n = 35) was conducted. Adherence with JP was measured using an objective observational test (the Joint Protection Behaviour Assessment). Significant improvements in use of JP were recorded at 12 and 24 weeks post-education (P < 0.01). No significant changes in measures of pain, functional disability, grip strength, self-efficacy or helplessness occurred post-education, although this may have been due to the small sample size recruited. In conclusion, JP adherence can be facilitated through the use of educational-behavioural strategies, suggesting this approach should be more widely adopted in clinical practice. A randomized, controlled trial was conducted to determine efficacy of the Isotoner and the Futuro compression gloves in 39 patients with hand synovitis secondary to rheumatoid arthritis. After 7 days of nighttime treatment, both brands of gloves were found to decrease subjective symptoms of pain and stiffness (p < 0.05). In addition, swelling of the proximal interphalangeal joints decreased, while range of motion, rate of finger motion, and grip strength all increased (p < 0.05). Compression gloves should be used with caution in patients with bilateral carpal tunnel syndrome, because 12 of 13 such patients experienced worsening of their symptoms following one nighttime wearing of compression gloves. While both gloves were found to be efficacious in improving the signs and symptoms of hand synovitis, neither glove was found to be superior to the other. Patient preferences related to glove composition and fit may ultimately determine which glove to prescribe. This study examined the effects of an occupational therapist's approach during the initial splinting session on the subsequent use of resting hand splints by patients with rheumatoid arthritis. Forty subjects were randomly assigned either to a standard treatment (control) group or to a compliance-enhancement (experimental) group, for whom the use of learning principles, sharing of expectations, use of a positive affective tone and behaviors by the therapist, and the assumption of responsibility by the patient were emphasized. During the 28-day period after splinting, patients in the experimental and control groups wore their splints an average of 23.3 and 18.1 days, respectively (p = 0.056). Nine subjects in the experimental group, but only four in the control group used their splints every day (p = 0.035). Knowledge of splint use correlated with actual use, regardless of the group assignment (p = 0.035). Change in the amount of wrist and hand pain was not significant in either group; however, the experimental group experienced a decrease in the duration of morning stiffness (p = 0.013). This intervention provides health professionals with a pragmatic and effective method to enhance compliance. Seven patients with definite RA and bilateral ulnar deviation of Fearnley grade I were included in a study of the usefulness of nocturnal resting splints. Each patient used the splint on average 17 months on one hand, randomly chosen, with the free hand as control. Joint mobility, grip strength, pain and radiographic findings were recorded at start and finish of the study. Splint treatment influenced grip strength positively, and most patients stated pain relief during the night. However, all but one patient showed progression of ulnar deviation in both hands, and there was no significant difference in progression between treated and nontreated hands. This study thus supported the use of resting splints at night for pain relief but not for prevention of ulnar deviation. Preliminary work regarding the development and pilot study of an individualized instructional program for rheumatoid arthritis clients is presented. The effect of the individualized instructional program was tested with 31 outpatients. Using analysis of covariance, the experimental group subjects scored significantly higher on the knowledge post-test when compared to scores of control group subjects (P = 0.0045). Analysis of variance for repeated measures revealed no significant difference in performance of tasks for the control group and experimental group (P = 0.08). In a follow-up study, the effect of the self-instructional program, practice time, and contracting were explored for their effect on adherence to self-care activities. Experimental groups (n = 42) scored significantly better than the control group (n = 11) on the knowledge post-test (P < 0.01), performance of joint protection practices (P = 0.01), range of motion exercises (P = 0.01), and adherence to joint protection practices at home (P < 0.01). Groups did not differ on adherence to range of motion exercises at home (P = 0.83). To describe patients' functional uses of 3 commercial wrist orthoses, to describe patients' preference patterns for the orthoses, and to clarify orthotic attributes that are viewed positively and negatively.
                Using a cross-over design, 42 patients with definite rheumatoid arthritis used each of 3 commercial orthoses for one week. There was a one-week wash-out between each week of use. At the end of the study, private semi-structured interviews were conducted with each participant. Data from close-ended questions were tabulated. Open-ended data were analyzed using qualitative methods.
                Patients reported that the 3 commercial wrist orthoses reduced wrist pain similarly, but that comfort and a sense of security during functional tasks were only found if the orthoses were comfortable and well-fitting. Most subjects preferred the padded, short forearm orthosis, though a small number found it uncomfortably warm, and many complained that it was difficult to use when wearing long-sleeved garments. Common complaints about the two elastic orthoses included chafing at the thumb webspace and chafing at the proximal closures. Longer forearm length was often perceived as providing unnecessarily high levels of wrist support.
                No single orthosis suited all subjects. Satisfaction with an orthosis appears to be based not only on its therapeutic effect, but also the comfort and ease of its use. To maximize patient satisfaction and improve the likelihood of appropriate fit and comfort, several styles of commercial orthoses should be available. The current trend toward restricted clinic stocks appears contrary to both therapeutic goals and patient satisfaction. One hundred and thirty-two patients discharged from a rheumatology unit were randomly allocated to general practitioner care, attendance at hospital outpatient clinics, or follow-up by a senior occupational therapist attached to the hospital treatment team. At the end of 1 and 2 years a number of clinical and functional tests were applied, and information was gathered about the provision and use of aids and the provision of domestic support. In addition the standard of overall care was judged by an independent assessor. Although no significant intergroup differences in disease activity or function emerged, it is clear that patients prefer continuing contact with the hospital team, and this may lead to differences appearing in the future. The financial advantages of therapist follow-up are discussed. The aim of this study was to investigate effects of elastic wrist orthoses on pain, grip strength, and function. Twenty-two women with seropositive rheumatoid arthritis (mean age, 53 years) registered their pain on a visual analogue scale both with and without orthosis on the wrist of the dominant hand in three standardized activities of daily living (ADL) situations. Grip force at onset of pain was measured on an electronic instrument (Grippit) with three different grips. Pain was decreased by 39%, 42%, and 52% when using an orthosis in the three ADL situations. Anecdotally, the women noted that the splints provided support and decreased pain both in home, at work, and during leisure activities. Orthoses improved grip force at onset of pain by 26%, 22%, and 29%. All subjects showed reduced strength (20%-25%) when compared to grip strength in a group of women without rheumatoid arthritis. We report a prospective, randomized pilot study comparing a new workbook-based program, designed to teach patients with rheumatoid arthritis (RA) energy conservation behaviors, with standard occupational therapy (OT). Sixteen patients took part in the new program and nine received the standard therapy. Data on the number of tender or swollen joints, grip strength, walk time, activities of daily living, psychologic adjustment to illness, and daily activity log, were measured before and three months after intervention. Eleven percent of those who received standard therapy and 50% of those who received the workbook increased their amount of physically active time (p = .10). Twenty-two percent of the control group and 50% of those in the workbook group achieved a better balance of rest and physical activity (p = .07). We conclude that the adoption of energy conservation behaviors is different in the two groups. This initial study suggests that interrupting physical activity with rest periods may result in increased physical activity in patients with RA. To determine the effect of a wrist orthosis on work performance, hand dexterity, and pain during task performance, 40 individuals with rheumatoid arthritis were studied using a 2 period, crossover design.
                Each patient was fitted with a Futuro wrist orthosis. Dexterity was measured with and without the orthosis using the Jebsen Hand Function Test. Work performance was assessed using 2 tasks (one simulating the use of shears, the other the use of a screwdriver) on a work simulator. All tasks were performed both with and without the orthosis, with the order of orthosis versus no orthosis randomly assigned. Pain before and after performing tasks was assessed using a 10 cm horizontal visual analog scale.
                While on the screwdriver task work performance was less with the orthosis (p = 0.0002); on the shears task there was no significant difference in work performance with and without the orthosis. The average pain after performing both tasks was significantly less with the orthosis on. A 2 factor analysis of variance model with repeated measures suggested that taking into account the reduced work performance during splint wear, pain was still significantly reduced with splint wear. The average time to complete all 7 tasks on the Jebsen Hand Function Test was longer when the subjects wore the splint compared to when they did not (62.0 vs 57.6 s, respectively; p = 0.0086).
                The results suggest that the effect of splint wear on work performance is highly task specific, and thus the ergonomic demands of the individual's daily life must be considered if a splint is to provide maximal effectiveness. This study compared soft versus hard resting hand splints on pain and hand function in 39 persons with rheumatoid arthritis. Splint preference was also evaluated to determine its effects on splint wear compliance.
                A repeated measures research design was used to compare the two experimental conditions, wearing a soft splint versus a hard splint on the dominant hand for 28 days at night only, and an unsplinted control period of 28 days.
                Arthritis pain was considerably less during both splinted periods when compared with the pretest. Subjects identified fewer joints as being painful during the soft splint condition than during the unsplinted condition. There were no significant differences among conditions on hand function measures. Splint preference was 57% for the soft splint, 33% for the hard splint, and 10% for no splint. Splint wear compliance was significantly better with the soft splint (82%) than with the hard splint (67%).
                The findings indicate that resting hand splints are effective for pain relief and that persons with rheumatoid arthritis are more likely to prefer and comply with soft splint use for this purpose. Individualized splint prescription that focuses on client comfort and preference may enhance splint wear compliance. Joint protection aims to reduce pain and local inflammation, preserve the integrity of joint structures and improve function. There is evidence that it can improve pain and function in the short term, but the long-term effects are uncertain. This study evaluated the effects of joint protection in early rheumatoid arthritis (RA).
                A randomized, controlled, assessor-blinded trial of duration 1 yr was conducted. Two interventions (both 8 h) were compared: standard arthritis education, including 2.5 h of joint protection education based on typical UK practice; and a joint protection arthritis education programme, using educational-behavioural teaching methods. Assessments were made at entry and 6 and 12 months.
                Sixty-five people with RA attended the joint protection programme and 62 the standard programme. The groups were matched for age (51 and 49 yr), disease duration (21 and 17.5 months) and use of non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs. In comparison with the standard group, the joint protection group significantly improved with respect to adherence to the joint protection programme (P=0.001), hand pain (P=0.02), general pain (P=0.05), early morning stiffness (P=0.01), self-reported number of disease flare-ups (P=0.004), visits to the doctor for arthritis (P<0.01), and the AIMS2 (Arthritis Impact Measurement Scales) activities of daily living scale (P=0.04). A trend to improved swollen joint counts was identified (P=0.07). Within-group analyses also showed improvements in arthritis self-efficacy and perceived control. Hand deformity scores continued to increase in both groups.
                We found significant improvements in adherence, pain, disease status and functional ability amongst those attending the joint protection programme. Benefits became more apparent with time, suggesting that joint protection can help slow the progression of the effects of RA over and above the effects of drug therapy. Rheumatoid arthritis (RA) causes structural damage that precipitates joint deformity, including metacarpophalangeal (MCP) joint ulnar drift (UD). Orthoses have been designed in order to maintain hand function by improving joint alignment, restoring biomechanical balance and reducing stress on supporting diseased tissues. This study investigated the impact an MCP UD (MUD) splint had on: pain, hand function, grip strength, and passive correction of UD when worn for function by RA patients. Twenty seven hands (26 subjects) were evaluated and performances compared with and without the splint. Results showed anatomic alignment improved significantly in all except the index finger. The mean difference for all fingers combined was 10 degrees. Observable correction of subluxation was identified from x-ray film and noted in 14.8% of index fingers, 18.5% of middle fingers, 33.3% of ring fingers, and 48.1% of little fingers. Three point pinch showed a statistically significant change, the mean difference being an improvement of 15% while wearing the splint. There was no significant change in hand function score, pain score, gross grip strength, and lateral pinch. Subjects' perceptions of the MUD splint gained from a questionnaire showed a high acceptance: 79.2% reporting minimal interference in ADL, 95.8% satisfied with cosmesis, 87.5% satisfied with comfort, and 95.8% reported continued use of the orthosis. Joint protection (JP) education is a common feature in rheumatoid arthritis (RA) treatment programs. However, no objective studies have been published demonstrating patients' behavior changes following such education. This study evaluated whether RA patients' hand movement patterns altered following a JP education program.
                An assessment procedure was constructed to assess application of four JP principles related to altering patterns of hand use during common everyday activities (making a hot drink and snack meal).
                Eleven RA patients were assessed. There was no significant behavioral change at 6 weeks post-JP education (t = 10; P > 0.1). In contrast, follow-up interviews of self-perceived JP behavior showed all subjects considered JP relevant for them and seven believed they had changed to using these techniques.
                This suggests education led to attitudinal change but that behavioral change requires longer and more targeted input than is currently normally provided. Wrist splints are often used in the treatment of rheumatoid arthritis (RA). We applied a questionnaire to RA patients and rheumatologists to assess wrist splint use and to assess the policy of prescription. We related the reported use to patient satisfaction, severity of disease and physician's advice. Of 44 RA patients admitted to our hospital in 1990, 32 received one or more splints. Most patients (23) had both a wrist immobilization splint and a wrist activity splint (Futuro cock-up splint). The response rate to the questionnaire sent to all (n = 109) Dutch rheumatologists was 83%; 89 of 91 rheumatologists prescribed splints. Each rheumatologist prescribed yearly a mean of 30 immobilization splints (min-max: 2-120) and 51 activity splints (min-max: 4-170). Both types were mainly prescribed to relieve pain and reduce inflammation. From the patients' point of view, only the wrist activity splints were worth regular and continued use. Our findings suggest that if one prescribed splints, more attention should be paid to patient education and compliance. To improve function and to delay the tendency toward deformities of the rheumatoid arthritic hand, a new device was evaluated which enables patients to perform range of motion and isometric exercises in their home. Eighteen patients (35 hands) exercised daily for four months. Strength and range of motion showed statistically significant gains. Grip strength increased in 28 hands, volar pinch in 22 hands, lateral pinch in 21 hands. Of 140 PIP joints, 77% increased in range, indicating loosening of intrinsic muscles. Improvement in hand function was reported by most of the patients. To compare the short-term utility and clinical effectiveness of the commercial-made Futuro wrist orthosis with a newly developed, custom-made ThermoLyn wrist orthosis.
                Using a randomized cross-over trial, 10 patients with rheumatoid arthritis used each of the two orthoses for two weeks. Outcome measures were patients' judgments with respect to different statements about utility and clinical assessments including pain and swelling of the wrist and finger joints, range of motion of the wrist, and grip strength. At the end of the study the patients were asked which of the two orthoses they preferred and why.
                Patients tended to favor the Futuro wrist orthosis with respect to pain relief and to handling the orthosis. The visual analog scale score of the appearance of the ThermoLyn wrist orthosis was a little higher than that of the Futuro wrist orthosis, but the difference was not statistically significant. Clinical parameters such as pain in the wrist, swelling of the wrist and finger joints, and movements of the wrist showed that the Futuro orthosis tended to be more effective than the ThermoLyn orthosis. None of the differences reached statistical significance. At the end of the study, 5 patients preferred the Futuro and 5 patients the ThermoLyn wrist orthosis. Arguments in favor of the ThermoLyn orthosis were better hygiene, stability, and no need to remove the orthosis during dirty and wet conditions. Arguments in favor of the Futuro orthosis were greater suppleness and freedom of movement.
                The ready-made fabric Futuro wrist orthosis appears to be as good as the more expensive individually made synthetic ThermoLyn wrist orthosis with respect to short-term utility and clinical effectiveness. The conditions under which the orthosis will be worn will help to decide which orthosis is the best for the patient. In the event that the patient wants to use the orthosis in wet and dirty conditions, the ThermoLyn wrist orthosis is a good alternative to the Futuro wrist orthosis. This paper presents the design and evaluation of an occupational therapy program developed at the National Institutes of Health for teaching energy conservation and joint protection to adults with rheumatoid arthritis. An existing model for educational diagnosis in health education was used to identify program, behavioral, and educational objectives for the new program. The use of this model resulted in measurable objectives, which were used as outcome measures in the randomized research evaluation of the new program. The dependent variables measured were activity-of-daily-living status, psychosocial adjustment to illness, knowledge, disease activity, pain, and fatigue. None were significantly different after the intervention. The independent variables measured included components of balancing rest and physical activity. After 3 months, a greater percentage of the subjects receiving the workbook-based occupational therapy program than those receiving traditional occupational therapy demonstrated an application of the behaviors the intervention was designed to change. As there is relatively little information about the effectiveness of occupational therapy (OT) in RA a questionnaire was devised to assess whether patient knowledge and performance of joint protection manoeuvres improved following OT intervention and, if improved, whether this was sustained over 6 months. A photographic multiple choice questionnaire was devised covering major categories of activities of daily living. The study population consisted of 55 patients with RA attending a rheumatology clinic who had not previously had OT treatment. Patients had a single instruction/treatment session with an occupational therapist of 1-h duration. Prior to treatment the questionnaire was administered by an independent assessor who re-administered the questionnaire 1 month and 6 months after the OT session. Following treatment there was a significant increase in scores at 1 month compared with pre-treatment (P < 0.001). There was no significant change in score at 6 months compared with 1 month. Qualitative analysis of age and sex showed no significant effects. OT leads to sustained improvement in patient knowledge and probably performance of joint protection manoeuvres in RA. The effect of active hand exercise and warm wax treatment was evaluated in 52 rheumatoid arthritis patients randomized into four groups: (1) both exercise and wax bath, (2) exercise only, (3) wax bath only, and (4) controls. Treatment was given three times a week for 4 weeks. Deficits in flexion and extension in digits II-V bilaterally, grip function, grip strength, pain, and stiffness were measured before and after the treatment period. The control group was measured at corresponding times. Wax bath treatment followed by active hand exercise resulted in significant improvements of range of motion (ROM) and grip function. Active hand exercise alone reduced stiffness and pain with nonresisted motion and increased ROM. Wax bath alone had no significant effect. A new program based on improved user participation for the selection of assistive devices was implemented and its effectiveness and efficiency assessed. The intervention was compared with traditional routines. The study population comprised persons with rheumatoid arthritis who lived in two communities in Sweden. The selection process yielded increased user participation, user satisfaction, an increased number of prescriptions, and consequently also higher costs. The outcome measures showed more vague improvements. No improvement in functional ability was found regarding pain and difficulty with daily activities in the two study groups, but an increased use of assistive devices was found among women below 64 years in the intervention group (p = 0.001). Women below 64 years in the intervention group rated an improved health-related quality of life regarding both the total score (p = 0.017) and the underlying dimensions of physical function (p = 0.012). Even though the intervention yielded positive results on process-variables as increased user participation and an increased number of prescribed assistive devices, only women below 64 years showed an increased use of assistive devices in daily activities and an improved health related quality of life. Thirty patients with symptomatic rheumatoid arthritis (RA) of both hands were treated with an air pressure splint. Evaluations were made by measuring ring size, hand volume, range and rate of finger motions, grip strength and degree of pain and stiffness. One hand was randomly assigned to the treatment group while the other served as a control. Patients received the air splint treatment for 5 consecutive days. Data were analyzed by a 2-factor repeated analysis of variance to determine the effectiveness of 1 treatment, the cumulative effect of 5 treatments, the effect of the 5th treatment, and whether the results after the 1st treatment lasted until the 5th treatment. All measurements except hand volume significantly improved with the 1st treatment. Furthermore, the beneficial effects persisted throughout the treatment period. These data indicate the air splint treatment is effective in reducing swelling and other symptoms of RA in the hands. Forty-four female patients with sero-positive active RA participated in a 48-month trial to assess the effect of simple hand exercises. Twenty-two patients in the test group were given a daily exercise regime of six exercises. The control group were not given any exercises. At the end of 48 months there was a statistically significant improvement in grip strength (P < 0.0001) and pincer grip strength (P < 0.0005) in the test group. There was a significant deterioration in the control group (P < 0.0000). A simple exercise programme is beneficial for the rheumatoid hand as far as grip and pincer grip strength are concerned. A follow-up evaluation of 50 patients with rheumatoid arthritis who were fitted with full bilateral wrist and hand resting splints revealed that 62 percent wore them most or all of the prescribed time. Patients deviated from the prescribed splint program when their symptoms remitted or diminished, and adhered more closely to the program when they experienced persistent inflammation. Patients splinted during a hospital stay were somewhat more compliant than those splinted as outpatients. Patients judged to be noncompliant discontinued splint usage because of a decrease of joint pain or stiffness, or both. Their decision did not appear detrimental, since, during the course of the study, there was no significant difference between compliant and noncompliant patients in range of motion of hand or wrist joints at followup evaluation and, when range of motion at the time of initial evaluation was compared with that at the follow-up examination, a higher proportion of noncompliant (37%) than compliant patients (16%) showed improvement.
There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis.