Department of Health and Rehabilitation Sciences, Western's Bone and Joint Institute, Western University, London, ON, Canada.
Department of Health and Rehabilitation Sciences, Western's Bone and Joint Institute, Western University, London, ON, Canada.
J Hand Ther. 2019 Apr-Jun;32(2):194-211. doi: 10.1016/j.jht.2018.09.012. Epub 2018 Dec 23.
Systematic review with meta-analysis.
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.
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.
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.
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, I = 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, I = 0) and SMD (-0.27, 95% CI: -0.41 to -0.12, I = 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, I = 34%) and SMD (-0.31, 95% CI: -0.50 to -0.11, I = 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, I = 0%).
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.
系统评价与荟萃分析。
关节保护（JP）作为一种自我管理干预措施，旨在帮助手部关节炎患者提高职业表现并最大限度地减少关节随时间的恶化。
我们研究了 JP 与常规护理/对照组在手关节炎和类风湿关节炎患者的疼痛、手部功能和握力水平方面的效果。
从 1990 年 1 月至 2017 年 2 月，我们在 5 个数据库中进行了检索。两位独立评估者应用了 Cochrane 偏倚风险工具，并采用了推荐分级评估、制定与评价（GRADE）方法。
在短期随访中，我们发现 JP 与对照组之间的疼痛水平的效果相似标准化均数差（SMD；-0.00，95%置信区间[CI]：-0.42 至 0.42，I = 49%），在中期和长期随访中，JP 优于常规护理 SMD（-0.32，95%CI：-0.53 至-0.11，I = 0）和 SMD（-0.27，95%CI：-0.41 至-0.12，I = 9%）。在中期和长期随访中，JP 在手功能水平上优于常规护理 SMD（-0.49，95%CI：-0.75 至-0.22，I = 34%）和 SMD（-0.31，95%CI：-0.50 至-0.11，I = 56%）。对于握力水平，在长期随访中，JP 优于常规护理平均差异（0.93，95%CI：-0.74 至 2.61，I = 0）。
证据质量非常低至低表明，与常规护理/对照组相比，JP 方案在手关节炎患者的短期、中期和长期随访中对疼痛和手部功能的影响太小，在临床中无重要意义。
