Rehabilitative Services Department, Changi General Hospital, 2 Simei Street 3, 529889 Singapore.
Arthritis Res Ther. 2011 Feb 18;13(1):R28. doi: 10.1186/ar3254.
Hand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion and joint stiffness leading to impaired hand function and difficulty with daily activities. The effectiveness of different rehabilitation interventions on specific treatment goals has not yet been fully explored. The objective of this systematic review is to provide evidence based knowledge on the treatment effects of different rehabilitation interventions for specific treatment goals for hand OA.
A computerized literature search of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, the Physiotherapy Evidence Database (PEDro) and SCOPUS was performed. Studies that had an evidence level of 2b or higher and that compared a rehabilitation intervention with a control group and assessed at least one of the following outcome measures - pain, physical hand function or other measures of hand impairment - were included. The eligibility and methodological quality of trials were systematically assessed by two independent reviewers using the PEDro scale. Treatment effects were calculated using standardized mean difference and 95% confidence intervals.
Ten studies, of which six were of higher quality (PEDro score >6), were included. The rehabilitation techniques reviewed included three studies on exercise, two studies each on laser and heat, and one study each on splints, massage and acupuncture. One higher quality trial showed a large positive effect of 12-month use of a night splint on hand pain, function, strength and range of motion. Exercise had no effect on hand pain or function although it may be able to improve hand strength. Low level laser therapy may be useful for improving range of motion. No rehabilitation interventions were found to improve stiffness.
There is emerging high quality evidence to support that rehabilitation interventions can offer significant benefits to individuals with hand OA. A summary of the higher quality evidence is provided to assist with clinical decision making based on current evidence. Further high-quality research is needed concerning the effects of rehabilitation interventions on specific treatment goals for hand OA.
手部骨关节炎（OA）与疼痛、握力下降、活动范围丧失和关节僵硬有关，导致手部功能受损，日常活动困难。不同康复干预措施对特定治疗目标的效果尚未得到充分探索。本系统评价的目的是提供基于证据的知识，了解不同康复干预措施对手部 OA 特定治疗目标的治疗效果。
计算机检索 Medline、 Cumulative Index to Nursing and Allied Health Literature（CINAHL）、ISI Web of Science、Physiotherapy Evidence Database（PEDro）和 SCOPUS。纳入了证据水平为 2b 或更高，且比较了康复干预与对照组，并评估了以下至少一项结局指标的研究：疼痛、手部物理功能或其他手部受损指标。两名独立评审员使用 PEDro 量表系统评估试验的合格性和方法学质量。使用标准化均数差和 95%置信区间计算治疗效果。
纳入了 10 项研究，其中 6 项研究质量较高（PEDro 评分＞6）。综述的康复技术包括 3 项运动研究、2 项激光和热疗研究、1 项夹板、按摩和针灸研究。一项高质量试验显示，夜间夹板使用 12 个月对手部疼痛、功能、力量和活动范围具有显著的积极影响。运动对手部疼痛或功能没有影响，但可能有助于增强手部力量。低水平激光疗法可能有助于改善活动范围。没有康复干预措施被发现能改善僵硬。
有高质量证据支持康复干预措施可为手部 OA 患者带来显著益处。提供了更高质量证据的摘要，以帮助根据现有证据做出临床决策。需要进一步开展关于康复干预措施对手部 OA 特定治疗目标影响的高质量研究。
