Joint Protection Programmes for People with Osteoarthritis and Rheumatoid Arthritis of the Hand: An Overview of Systematic Reviews.

Joint protection has been introduced as a self-management strategy for people with rheumatoid arthritis (RA) and osteoarthritis (OA) of the hand. The purpose of this study was to conduct an overview of systematic reviews (SRs) and critically appraise the evidence to establish the current effectiveness of joint protection for people with hand RA and OA. A comprehensive search was conducted of six databases from January 2008 to May 2018. SRs that evaluated the effectiveness of joint protection for people with hand arthritis were eligible for inclusion. The A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 checklist was used to assess the methodological quality of each SR. Nine SRs were included: two were rated as high quality, and seven were rated as low quality. Seven of the nine did not take into account risk of bias when interpreting or discussing their findings, six did not assess publication bias, and five did not register their protocol. The high-quality reviews found no clinically important benefit of joint protection for pain, hand function, and grip strength levels. The low-quality reviews reported improvements in function, pain, grip strength, fatigue, depression, self-efficacy, joint protection behaviours, and disease symptoms in people with RA. High-quality evidence from high-quality reviews found a lack of any clinically important benefit of joint protection programmes for pain, hand function, and grip strength outcomes, whereas low-quality evidence from low-quality reviews found improvements in these outcomes.