The long-term outcomes from a randomized controlled trial of an educational–behavioural joint protection programme for people with rheumatoid arthritis

Objective: To evaluate the long-term effects of joint protection on health status of people with early rheumatoid arthritis (RA). Design: A four-year follow-up of a randomized, controlled, assessor-blinded trial was conducted. Setting: Two rheumatology outpatient departments. Participants: People with rheumatoid arthritis less than five years since diagnosis. Interventions: Two 8-hour interventions were originally compared: a standard arthritis education programme, including 21/2 hours of joint protection based on typical UK occupational therapy practice (plus 51/2 hours on RA, exercise, pain management, diet and foot care); and a joint protection programme, using educational-behavioural training. Main measures: Adherence to joint protection, pain, hand pain on activity, Arthritis Impact Measurement Scales 2 and Arthritis Self-efficacy were recorded at 0 and 4 years. Results: Sixty-five people attended the joint protection and 62 the standard programmes. Groups at entry were similar in age (51 years; 49 years), disease duration (21 months: 17.5 months) and use of nonsteroidal anti-inflammatory and disease-modifying drugs. At four years, the joint protection group continued to have significantly better: joint protection adherence (p=0.001); early morning stiffness (p=0.01); AIMS2 activities of daily living (ADL) scores (p=0.04) compared with the standard group. The joint protection group also had significantly fewer hand deformities: metacarpophalangeal (MCP) (p=0.02) and wrist joints (p=0.04). Conclusion: Attending an educational=behavioural joint protection programme significantly improves joint protection adherence and maintains functional ability long term. This approach is more effective than standard methods of training and should be more widely adopted

The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial

Objective. To evaluate the effectiveness of static resting splints in early RA. Methods. A multicentre, randomized, trial was conducted. Patients (n = 120) received either static resting splints [positioned with the wrist in neutral, MCP joint (MCPJ) and IP joint (IPJ) in a maximum of 60 degrees and 30 degrees of flexion, respectively] plus standardized occupational therapy or standardized occupational therapy alone. Change in grip strength (Ns), structural impairment (MCPJ ulnar deviation), applied dexterity (Button Board), self-report hand ability [Michigan Hand Outcomes Questionnaire (MHQ)], hand pain and morning hand stiffness were assessed at 0 and 12 months. Results. Data for 56 (97%) splinted and 60 (97%) control group patients were analysed. Splint wear adherence was moderate; 24.5% 'never wore' the splints. The adjusted mean difference between groups for handgrip was -14.2 Ns (P = 0.342; 95% CI -43.7, 5.4); MCPJ ulnar deviation-1.1 degrees (P = 0.657; 95% CI =-6.2, 3.9); dexterity 0.1 s (P = 0.975; 95% CI =-6.6, 6.8) and self-report ability -3.0 on the MHQ score (P = 0.426; 95% CI -10.5, 4.5). Pain scores were unchanged in either group (P = 0.15). The occurrence of morning hand stiffness was reduced in a small group of splinted patients (P = 0.021), but the duration shortened in control patients (P = 0.010).Conclusions. There was no significant difference between the two interventions on grip strength, deformity, hand function and pain. The data favoured the control group and this study suggests that resting splints should not be used as a routine treatment of patients with early R