Effectiveness of Nighttime Orthoses in Controlling Pain for Women With Hand Osteoarthritis: A Randomized Controlled Trial.

ABSTRACT

IMPORTANCE Hand osteoarthritis is a musculoskeletal problem that is associated with hand pain, stiffness, functional limitation, decreased grip strength, and reduced quality of life. OBJECTIVE: To evaluate the effectiveness of nighttime orthoses on the second or third finger of the dominant hand in controlling pain in women with symptomatic osteoarthritis (OA) in the interphalangeal joint. DESIGN: Randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Fifty-two women with symptomatic OA and presence of Heberden's and Bouchard's nodes, allocated randomly to the intervention group or the control group. INTERVENTION The intervention group used a nighttime orthosis on the second or third finger of the dominant hand. Both groups participated in an educational session. OUTCOMES AND MEASURES: The following parameters were measured pain (numerical rating scale, Australian/Canadian Osteoarthritis Hand Index), grip and pinch strength, function (Cochin Hand Functional Scale), and manual performance (Moberg Pick Up Test). RESULTS: The intervention group showed a statistically significant improvement in pain (p < .001) and hand function. The improvement in pain correlated with Cochin Hand Functional Scale scores and the absence of Bouchard's nodes in the third finger, which are predictors of the best prognosis for treatment with a nighttime orthosis. CONCLUSIONS AND RELEVANCE This study demonstrates that nighttime orthoses are effective in reducing pain and lead to improvement in hand function in women with hand OA. They are therefore specifically recommended for nonpharmacological treatment of hand OA. WHAT THIS ARTICLE ADDS Orthoses can be considered, together with manual exercises and joint protection, as an intervention to reduce symptoms and improve hand function in people with hand OA. This study is an important step in empowering occupational therapists to determine appropriate and effective intervention for clients with OA.