Working wrist splints are commonly used in the management of rheumatoid arthritis (RA), yet evidence for their effectiveness is inconclusive. A mixed methods, systematic review was conducted and found strong quantitative evidence, supported by qualitative literature, that working wrist splints reduce pain. The review also found moderate evidence that grip strength is improved and dexterity impaired. Insufficient evidence was found of their effect on function. The literature review exposed limited exploration of occupational therapists’ and users’ experiences and perceptions of the use and effectiveness of working wrist splints. Three focus groups were conducted with occupational therapists and revealed that therapists believed they provided a person-centred, customised service. Person- centred practice was exposed as being challenged at organisational and scope of practice levels. Focus groups identified opportunities in the field of work rehabilitation and measurement and use of activation levels to individualise self-management techniques. To explore patient perceptions and experiences of working wrist splints, a focus group and focused telephone interviews were conducted. Participants reported that splints relieved pain and improved some functional tasks while impeding others. Occupational identity influenced splint use for social and work purposes and the need for therapists to help assimilate splint use into a new occupational self-image was highlighted. Tailored patient education to maximise self-management techniques and outcomes was also highlighted. This work has strengthened the evidence for the effectiveness of working wrist splints for people with RA and variations across individuals and tasks in improving functional ability was exposed. Factors influencing splint effectiveness and implications for practice have been identified. There is scope to improve person-centred practice through enhanced training and inclusion of interventions tailored to individual activation levels. Those with RA should be supported to remain in work and increased choice of splint and improvements in design could also aid engagement and outcomes for users.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:728647 |
| Date | January 2017 |
| Creators | Ramsey, Lucia |
| Publisher | Ulster University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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