van der Giesen F J, van Lankveld W J, Kremers-Selten C, Peeters A J, Stern E B, Le Cessie S, Nelissen R G H H, Vliet Vlieland T P M
Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Rheum. 2009 Aug 15;61(8):1025-31. doi: 10.1002/art.24866.
To compare the effectiveness and acceptability of silver ring splints (SRS) and commercial prefabricated thermoplastic splints (PTS) in treating swan neck deformities in patients with rheumatoid arthritis (RA).
Consecutive patients with RA and a mobile swan neck deformity were included in a randomized, crossover trial. In 2 different sequences, patients used both splints for 4 weeks, with a washout period of 2 weeks. Afterward, patients used the preferred splint for another 12 weeks. The primary outcome measure was dexterity measured with the Sequential Occupational Dexterity Assessment (SODA). Secondary outcome measures included other measures of hand function, satisfaction with the splints, and splint preference.
Fifty patients were included, and 47 (94%) of those completed the study. Eighteen patients (36%) had 1 swan neck deformity, whereas the other patients had 2 or more. The improvement of the total SODA score with the SRS (11.2; 95% confidence interval [95% CI] 8.1, 14.3) and PTS (10.8; 95% CI 7.5, 14.1) was similar (difference -0.5; 95% CI -2.2, 1.2). In addition, there were no significant differences in change scores regarding the other clinical outcome measures, or satisfaction. Twenty-four patients preferred the SRS, 21 preferred the PTS, and 2 patients chose neither. A comparison in the 12-week followup period yielded similar clinical outcomes, with the exception of a significantly higher score in 3 items of satisfaction in the SRS group.
For patients with RA and a mobile swan neck deformity, SRS and PTS are equally effective and acceptable.
比较银环夹板（SRS）和商用预制热塑性夹板（PTS）在治疗类风湿关节炎（RA）患者鹅颈畸形方面的有效性和可接受性。
连续纳入患有RA且存在可活动鹅颈畸形的患者，进行一项随机交叉试验。患者按两种不同顺序使用两种夹板各4周，洗脱期为2周。之后，患者使用其偏好的夹板再持续12周。主要结局指标是用序贯职业灵巧性评估（SODA）测量的灵巧性。次要结局指标包括手部功能的其他测量指标、对夹板的满意度以及夹板偏好。
纳入50例患者，其中47例（94%）完成了研究。18例患者（36%）有1处鹅颈畸形，其余患者有2处或更多。SRS组（11.2；95%置信区间[95%CI]8.1，14.3）和PTS组（10.8；95%CI 7.5，14.1）的SODA总分改善情况相似（差异为-0.5；95%CI -2.2，1.2）。此外在其他临床结局指标或满意度的变化分数方面无显著差异。24例患者偏好SRS，21例偏好PTS，2例患者未作选择。12周随访期的比较产生了相似的临床结局，但SRS组在3项满意度指标上的得分显著更高。
对于患有RA且存在可活动鹅颈畸形的患者，SRS和PTS同样有效且可接受。
