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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence

MY Egan and L Brousseau.

Review published: 2007.

CRD summary

This review concluded that splinting may help to relieve pain and improve function in patients with carpometacarpal osteoarthritis, but there was no clear evidence of the superiority of one type of splint over another. In view of the weak study design and small sample size of the included studies, the authors’ conclusions seem appropriately cautious.

Authors' objectives

To review the effectiveness of splinting for carpometacarpal (CMC) osteoarthritis.

Searching

MEDLINE (from 1962), EMBASE (from 1988), CINAHL (from 1982), the Cochrane Controlled Trials Register, HealthSTAR (from 1975), the Cochrane Rehabilitation and Related Therapies Field’s database, PEDro, PsycINFO, REHABDATA and Dissertation Abstracts International were searched up to June 2006. Studies published in English or French were sought. The search terms used are available on request from the authors.

Study selection

Study designs of evaluations included in the review

All studies that addressed the study question, regardless of design, were eligible for inclusion.

Specific interventions included in the review

Studies investigating splinting for osteoarthritis of the CMC joint were eligible for inclusion. Studies were excluded if they reported on the effectiveness of post-surgical splinting, or the effectiveness of splinting as an adjunct to a medical procedure (e.g. cortisone injection). The included studies compared splinting with no treatment or compared different types of splint.

Participants included in the review

Studies of adults with osteoarthritis of the CMC joint were eligible for the review. Most of the participants in the included studies were women. The average age, where reported, ranged from 53 to 67 years.

Outcomes assessed in the review

The outcomes reported were pain, comfort, function and pinch strength.

How were decisions on the relevance of primary studies made?

One reviewer screened titles and abstracts. One reviewer selected studies that met the inclusion criteria.

Assessment of study quality

Study quality was assessed according to the American Occupational Therapy Association’s Evidence-Based Practice Project schema, which grades studies for design, sample size, internal validity (high, moderate or low) and external validity. One author performed the validity assessment.

Data extraction

One reviewer abstracted the data, which were tabulated in a matrix form. Effect sizes were calculated for three studies with a control group and with outcomes based upon a continuous scale.

Methods of synthesis

How were the studies combined?

A narrative synthesis was provided, grouped by splinting compared with no treatment or alternative treatment and by a comparison of different types of splints.

How were differences between studies investigated?

Differences in the study characteristics were presented in a table and were discussed in the text.

Results of the review

Seven studies were included in the review (258 participants received treatment). These comprised one randomised controlled trial (RCT), one pre-test post-test study, one retrospective cohort study, one post-test only study that examined the effectiveness of splint use, and three randomised controlled crossover head-to-head trials that examined the relative effectiveness of different types of splints.

Five studies found that wearing a splint appeared to decrease the pain for many patients, and one study found that it appeared to decrease subluxation on pinch for those with stage I and II CMC osteoarthritis. However, three studies found that it did not decrease the eventual requirement for surgery. Where different types of splints were compared, there was no evidence that one type of splint was more effective than another.

Authors' conclusions

Splinting may help relieve pain in persons with CMC osteoarthritis.

CRD commentary

The review addressed a clear question with exclusion criteria clearly stated for the intervention; criteria were not well-defined for study design. The authors undertook a thorough search for published literature, but unpublished studies were not sought and the search was limited to English and French publications, thereby increasing the potential for publication and language bias. Study quality was assessed against standardised criteria and the results were used in assessing the evidence. One reviewer performed the study selection, validity assessment and data extraction, which increases the risk of error and bias during the review process. The use of a narrative synthesis seems appropriate given the heterogeneity of the included studies. In view of the weak study design and small sample size of the included studies, the authors’ conclusions seem appropriately cautious.

Implications of the review for practice and research

Practice: The authors recommended that patients be given the opportunity to try a splint, and that the type of splint used should be determined by patient preference.

Research: The authors recommended further study using a high-quality RCT of splinting with waiting-list controls and extended follow-up, and with detailed information on the stage of disease and detailed diagnostic information.

Funding

Arthritis Society (Canada), grant number TAS-319.

Bibliographic details

Egan M Y, Brousseau L. Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence. American Journal of Occupational Therapy 2007; 61(1): 70-78. [PubMed: 17302107]

Indexing Status

Subject indexing assigned by NLM

MeSH

Canada; Carpometacarpal Joints /physiopathology; Evidence-Based Medicine; Humans; Osteoarthritis; Splints; Treatment Outcome

AccessionNumber

12007005236

Database entry date

03/11/2008

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 17302107

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