Adams J, Burridge J, Mullee M, Hammond A, Cooper C
School of Health Professions and Rehabilitation Sciences, University of Southampton, Highfield, Southampton, Hants SO17 1BJ, UK.
Rheumatology (Oxford). 2008 Oct;47(10):1548-53. doi: 10.1093/rheumatology/ken292. Epub 2008 Aug 13.
To evaluate the effectiveness of static resting splints in early RA.
A multicentre, randomized, trial was conducted. Patients (n = 120) received either static resting splints [positioned with the wrist in neutral, MCP joint (MCPJ) and IP joint (IPJ) in a maximum of 60 degrees and 30 degrees of flexion, respectively] plus standardized occupational therapy or standardized occupational therapy alone. Change in grip strength (Ns), structural impairment (MCPJ ulnar deviation), applied dexterity (Button Board), self-report hand ability [Michigan Hand Outcomes Questionnaire (MHQ)], hand pain and morning hand stiffness were assessed at 0 and 12 months.
Data for 56 (97%) splinted and 60 (97%) control group patients were analysed. Splint wear adherence was moderate; 24.5% 'never wore' the splints. The adjusted mean difference between groups for handgrip was -14.2 Ns (P = 0.342; 95% CI -43.7, 5.4); MCPJ ulnar deviation -1.1 degrees (P = 0.657; 95% CI = -6.2, 3.9); dexterity 0.1 s (P = 0.975; 95% CI = -6.6, 6.8) and self-report ability -3.0 on the MHQ score (P = 0.426; 95% CI -10.5, 4.5). Pain scores were unchanged in either group (P = 0.15). The occurrence of morning hand stiffness was reduced in a small group of splinted patients (P = 0.021), but the duration shortened in control patients (P = 0.010).
There was no significant difference between the two interventions on grip strength, deformity, hand function and pain. The data favoured the control group and this study suggests that resting splints should not be used as a routine treatment of patients with early RA.
评估静态休息位夹板在早期类风湿关节炎（RA）中的疗效。
开展一项多中心随机试验。患者（n = 120）被随机分为两组，一组接受静态休息位夹板（手腕处于中立位，掌指关节（MCPJ）和指间关节（IPJ）分别处于最大60度和30度屈曲位）加标准化职业治疗，另一组仅接受标准化职业治疗。在0个月和12个月时评估握力变化（牛顿）、结构损伤（MCPJ尺侧偏斜）、应用灵活性（纽扣板测试）、自我报告的手部能力[密歇根手部结果问卷（MHQ）]、手部疼痛和晨僵情况。
分析了56例（97%）佩戴夹板组和60例（97%）对照组患者的数据。夹板佩戴依从性一般；24.5%的患者“从未佩戴”夹板。两组间握力的调整后平均差异为-14.2牛顿（P = 0.342；95%可信区间-43.7，5.4）；MCPJ尺侧偏斜-1.1度（P = 0.657；95%可信区间 = -6.2，3.9）；灵活性0.1秒（P = 0.975；95%可信区间 = -6.6，6.8）以及自我报告能力在MHQ评分上为-3.0（P = 0.426；95%可信区间-10.5，4.5）。两组的疼痛评分均无变化（P = 0.15）。一小部分佩戴夹板的患者晨僵发生率降低（P = 0.021），但对照组患者晨僵持续时间缩短（P = 0.010）。
两种干预措施在握力、畸形、手部功能和疼痛方面无显著差异。数据支持对照组，本研究表明休息位夹板不应作为早期RA患者的常规治疗方法。
