Partnering with people living with rheumatoid arthritis for care of their hands: Four case reports using relative motion orthoses

• Published in: Journal of hand therapy 2023-04, Vol.36 (2), p.456-465
• Main Authors: Feehan, Lynne M., Hoens, Alison, Howell, Julianne Wright
• Format: Article
• Language: English
• Subjects: Arthritis; Autoimmune diseases; Case reports; Disease control; Fingers; Hand; Hand (anatomy); Hands; Inflammation; Narratives; Orthoses; Pain; Relative motion; Rheumatoid arthritis; Surgeons; Therapists
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2023.01.001

•Relative motion (RM) orthoses can be a useful resource for persons living with RA.•Practical RM orthoses solutions for common hand problems seen in RA are presented.•Multiple RM orthoses may be required to support long and short term self-management.•Various thermoplastic or soft materials can be used to fabricate RM orthoses.•Narrative video by a person with RA describes her use of RM orthoses. Case report. Despite better disease control with more effective medications, people with rheumatoid arthritis (RA) continue to experience persistent and fluctuating levels of pain, swelling and functional limitations in their hands. To describe therapists and people living with RA working together to understand what could be occurring in their hands because of the RA and how relative motion (RM) orthoses may be used to self-manage common hand RA related problems. Case reports are used to demonstrate how patient self-report, clinical exam, and observation of hand movement and function are integrated into the design of RM orthoses for individuals with RA. The cases are supported by photos and videos, including a personal narrative video exploring 1 persons’ personal perspective on their use of RM orthoses. Case reports illustrate adaptive and/or protective RME orthoses use for RA related finger malalignment, tendon subluxation, joint pain and instability in the hand. The narrative video also introduces a person living with RA, who speaks candidly about her multiple RM orthoses and how she decides which orthosis is “best” for a given activity and the current level of RA related problems in her hands. It is not unusual for individuals with RA to have multiple RM orthoses, made for different purposes and fabricated from different materials. Mulitple RM orthosis options allows a person to select what is “best” for them, depending on the context of use and priorities or needs. Partnering with people living with RA to understand how to use simple, low-profile, adaptive and protective RM orthoses may be an effective way to support self-management of common RA related hand problems.