Estudiante

Disability and Rehabilitation, 2008; 30(4): 286 – 295

RESEARCH PAPER

The usage of functional wrist orthoses in patients with rheumatoid
arthritis

´
INGEBORG G. DE BOER1, ANDRE J. PEETERS2, H. KAREL RONDAY3,
4
BART J. A. MERTENS , FERDINAND C. BREEDVELD1 &
THEODORA P. M. VLIET VLIELAND1
1

Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, TheNetherlands, 2Department of
Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands, 3Department of Rheumatology, Haga-Leyenburg Teaching
Hospital, The Hague, The Netherlands, and 4Department of Medical Statistics, LUMC, Leiden, The Netherlands
Accepted February 2007

Abstract
Objective. To describe the usage of functional wrist orthoses and to identify factors contributing to usage in patientswith
rheumatoid arthritis (RA).
Methods. A multicentre, cross-sectional study, including a random selection of patients with RA visiting outpatient clinics.
A total of 240/362 eligible patients (66%) completed questionnaires, a semi-structured interview and a clinical assessment.
Usage was registered according to eight categories ranging from ‘always’ to ‘never’. Factors potentiallyassociated with usage
included demographic variables, the presence of wrist and hand complaints, general disease characteristics, mental and
physical functioning, coping strategies and satisfaction with functional wrist orthoses. Logistic regression analyses were used
to determine which factors were associated with the usage of wrist splints.
Results. One hundred twenty-eight patients (53%) possessedfunctional wrist orthoses, whereas 74/128 (58%) were actually
using them. Patients used them mainly during house keeping and cycling/driving. Main reasons for using the orthoses were
relief of pain and joint protection, and main reasons for not using them were no need and problems with ease of use. Factors
significantly associated with usage included the presence of wrist and hand complaints,worse physical functioning and
greater satisfaction with comfort of the wrist orthoses.
Conclusion. About half of patients with RA possessed functional wrist orthoses, with 58% of them actually being used. Apart
from local complaints and general functional ability, satisfaction with comfort of the functional wrist orthoses appears to be
an important factor for their usage. These results point atthe need for additional research regarding modifiable factors
associated with compliance, such as comfort and ease of use.

Keywords: Rheumatoid arthritis, cross-sectional study, wrist orthoses, compliance

Introduction
In patients with rheumatoid arthritis (RA), functional wrist orthoses are often prescribed with the
aim to reduce wrist pain and inflammation [1] as
they support the wristjoint and restrict its motion
while leaving the fingers and thumb free to move. It
is generally advised to wear functional wrist orthoses
intermittently during activities in which resistance,
object weight, or protracted positioning are likely to
stress the wrist [2,3]. Functional wrist orthoses can
be custom-made from thermoplastic material, but

are usually ready-made fabric orthoses with apalmar
steel reinforcement. In The Netherlands, health insurance companies reimburse the costs of wrist
orthoses in case of prescription by a physician.
Two systematic reviews, one on occupational
therapy [4] and one on splints and orthoses [5] in
RA, included in total nine studies, all consistently
demonstrating a beneficial effect on wrist pain and
grip strength. The results of twoadditional clinical
trials that were published after the inclusion periods
of the systematic reviews [6,7] confirmed these
results.

Correspondence: I. G. de Boer, Department of Rheumatology (C1-R), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Tel: þ31 71 526 3598. Fax: þ31 71 526 6752. E-mail: i.g.de_boer@lumc.nl
ISSN 0963-8288 print/ISSN 1464-5165 online ª...