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Open Access Highly Accessed Research article

Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review

Liuzhen Ye12, Leonid Kalichman3, Alicia Spittle245, Fiona Dobson67 and Kim Bennell6*

Author Affiliations

1 Rehabilitative Services Department, Changi General Hospital, 2 Simei Street 3, 529889 Singapore

2 Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Victoria, 3010, Australia

3 Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer Sheva, 84105, Israel

4 Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, 3052, Australia

5 Newborn Research, Royal Women's Hospital, Melbourne, Grattan Street & Flemington Road, Parkville, 3052, Australia

6 Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Victoria, 3010, Australia

7 Murdoch Childrens Research Institute, Flemington Road, Parkville, 3052, Australia

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Arthritis Research & Therapy 2011, 13:R28  doi:10.1186/ar3254

Published: 18 February 2011

Abstract

Introduction

Hand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion and joint stiffness leading to impaired hand function and difficulty with daily activities. The effectiveness of different rehabilitation interventions on specific treatment goals has not yet been fully explored. The objective of this systematic review is to provide evidence based knowledge on the treatment effects of different rehabilitation interventions for specific treatment goals for hand OA.

Methods

A computerized literature search of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, the Physiotherapy Evidence Database (PEDro) and SCOPUS was performed. Studies that had an evidence level of 2b or higher and that compared a rehabilitation intervention with a control group and assessed at least one of the following outcome measures - pain, physical hand function or other measures of hand impairment - were included. The eligibility and methodological quality of trials were systematically assessed by two independent reviewers using the PEDro scale. Treatment effects were calculated using standardized mean difference and 95% confidence intervals.

Results

Ten studies, of which six were of higher quality (PEDro score >6), were included. The rehabilitation techniques reviewed included three studies on exercise, two studies each on laser and heat, and one study each on splints, massage and acupuncture. One higher quality trial showed a large positive effect of 12-month use of a night splint on hand pain, function, strength and range of motion. Exercise had no effect on hand pain or function although it may be able to improve hand strength. Low level laser therapy may be useful for improving range of motion. No rehabilitation interventions were found to improve stiffness.

Conclusions

There is emerging high quality evidence to support that rehabilitation interventions can offer significant benefits to individuals with hand OA. A summary of the higher quality evidence is provided to assist with clinical decision making based on current evidence. Further high-quality research is needed concerning the effects of rehabilitation interventions on specific treatment goals for hand OA.