The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis

• Published in: Journal of hand therapy 2019-04, Vol.32 (2), p.194-211
• Main Authors: Bobos, Pavlos, Nazari, Goris, Szekeres, Mike, Lalone, Emily A., Ferreira, Louis, MacDermid, Joy C.
• Format: Article
• Language: English
• Subjects: Activities of daily living; Arthritis; Arthritis, Rheumatoid - physiopathology; Arthritis, Rheumatoid - therapy; Bias; Biocompatibility; Biomedical materials; Confidence intervals; Ergonomics; Evaluation; Exercise Therapy; Grip strength; Hand; Hand Joints - physiopathology; Hand osteoarthritis; Hand Strength - physiology; Humans; Intervention; Joint protection; Joints (anatomy); Meta-analysis; Orthotic Devices; Osteoarthritis; Osteoarthritis - physiopathology; Osteoarthritis - therapy; Pain; Pain management; Pain Measurement; Patient Education as Topic; Performance evaluation; Quality; Quality of life; Rheumatoid arthritis; Self-Help Devices; Studies; Systematic review; Womens health
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2018.09.012

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, I2 = 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, I2 = 0) and SMD (−0.27, 95% CI: −0.41 to −0.12, I2 = 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, I2 = 34%) and SMD (−0.31, 95% CI: −0.50 to −0.11, I2 = 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, I2 = 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. •Overall, all the 17 studies were judged to be at high risk of bias.•Selection bias, performance bias, and reporting bias were the main contributors that influence our results.•Quality assessment ranged from very low to low, and most of the studies were downgraded for imprecision and high risk of bias.•The effects of joint-protection programs compared with that of usual care/control on pain and function are too small to be clinically important for people with hand arthritis.