The Open Orthopaedics Journal




ISSN: 1874-3250 ― Volume 13, 2019
REVIEW ARTICLE

A Scoping Review of Joint Protection Programs for People with Hand Arthritis



Pavlos Bobos1, *, Goris Nazari1, Emily A Lalone2, Louis Ferreira2, Ruby Grewal3, Joy C MacDermid4
1 Western’s Bone and Joint Institute, Department of Health and Rehabilitation Sciences, Western University, 1151 Richmond Street, London, Ontario, Canada
2 Faculty of Engineering, Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Street, Ontario, Canada
3 Western University, Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care London, 268 Grosvenor St, London, Ontario, Canada
4 Physical Therapy and Surgery, Western University, St. Joseph’s Health Centre, 268 Grosvenor St, London, Canada

Abstract

Background:

Joint Protection (JP) can be enhanced by incorporating recent evidence and innovations in collaboration with people with hand arthritis to be salient, useful and effectively implemented.

Objective:

The purpose of this study is to map the current research on JP principles and guide future research on JP programs for the management of hand arthritis.

Methods:

A search was performed in 4 databases (PubMed, EMBASE, Google SCHOLAR, CINHAL) from January 1990 to February 2017. A Grey literature was also conducted through the Google web search engine. A combination of search terms was used such as hand osteoarthritis, rheumatoid arthritis, joint protection and/or self-management strategies.

Results:

Our search found 8,788 citations in which 231 articles were deemed relevant and after duplication 111 articles were retrieved for a full-text review. In total, 40 articles were eligible for data extraction. The majority of the articles were randomized controlled trials (RCTs), systematic reviews and overviews of reviews that investigated joint protection for hand arthritis. Joint protection was tested mostly in rheumatoid arthritis (RA) population and to a lesser extent on hand osteoarthritis and was provided mainly by an occupational therapist.

Conclusion:

This review synthesized and critically examined the scope of JP for the management of hand arthritis and found that RCTs, systematic reviews and overviews of reviews constituted two-thirds of the current body of literature. Furthermore, it identified a lack of clarity regarding the specific elements of joint protection programs used in clinical studies.

Keywords: Joint protection, Rheumatoid arthritis, Hand osteoarthritis, Hand arthritis.


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 500
Last Page: 513
Publisher Id: TOORTHJ-12-500
DOI: 10.2174/1874325001812010500

Article History:

Received Date: 12/8/2018
Revision Received Date: 11/11/2018
Acceptance Date: 19/11/2018
Electronic publication date: 30/11/2018
Collection year: 2018

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© 2018 Bobos et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Western’s Bone and Joint Institute, Department of Health and Rehabilitation Sciences, Western University, 1151 Richmond Street, London, Ontario, Canada; Tel: 519 661 2111; E-mail: pbobos@uwo.ca




1. INTRODUCTION

Hand osteoarthritis (h-OA) is one the most common type of osteoarthritis (OA), and it is a leading cause of disability in the elderly population around the world [1Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258] ]. Asymptomatic h-OA is characterized by nodes and deformities in the finger joints. Symptomatic h-OA is usually associated with pain, stiffness and limited functional ability [2Moe RH, Iversen MD. Active approach to hand osteoarthritis. Rheumatology (Oxford) 2016; 55(3): 389-90.[PMID: 26615028] ]. Reports from “The Framingham study” in 2002 showed that the prevalence of symptoms in h-OA was higher than the symptoms in the knee [1Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258] ]. Management of h-OA typically includes pharmacological (medications) and/or non-pharmacological interventions such as joint protection programs, assistive devices, and hand exercises. Currently, there is no cure for h-OA and individuals with symptomatic h-OA need strategies and approaches on how to maintain their active daily living and functioning.

Joint protection programs were primarily developed for people with Rheumatoid Arthritis (RA) and had been reported to be beneficial [3Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a task force of the EULAR standing committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(3): 377-88.http://www.ncbi.nlm.nih.gov/pubmed/17046965[http://dx.doi.org/10.1136/ard.2006.062091] [PMID: 17046965] ]. Joint protection includes self-management strategies to alleviate pain, reduce inflammation and reduce the risk of deformities [4Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clin Rehabil 1998; 12(1): 81-7.[http://dx.doi.org/10.1177/026921559801200111] [PMID: 9549029] ]. Also, joint protection has been developed as an approach to improve the performance of daily tasks by enhancing the control perceptions and improve the psychological status of the patient [5Hammond A, Lincoln N, Sutcliffe L. A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis. Patient Educ Couns 1999; 37(1): 19-32.[http://dx.doi.org/10.1016/S0738-3991(98)00093-7] [PMID: 10640116] ]. Joint protection is considered a multimodal intervention that aims to alter working methods by using proper body mechanics and by using assistive devices. It is often integrated with stretching and hand exercises [54Hammond A. Joint protection: Enabling change in musculoskeletal conditions.International handbook of occupational therapy interventions 2015; 607-18.]. Individuals with RA can play an essential role in the management of their disease progression, but this requires their involvement. The American College of Rheumatology in 2012 guidelines [6Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64(4): 465-74.[http://dx.doi.org/10.1002/acr.21596] [PMID: 22563589] ] suggested the use of joint protection for the management of h-OA however, no definite recommendations have been made so far. The European League Against Rheumatism (EULAR) evidence-based recommendations [3Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a task force of the EULAR standing committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(3): 377-88.http://www.ncbi.nlm.nih.gov/pubmed/17046965[http://dx.doi.org/10.1136/ard.2006.062091] [PMID: 17046965] ] reported that the joint protection programs is a well-established approach for the management of RA but whether this method can be generalized to h-OA remains unclear. A scoping review of joint protection programs will be a narrative synthesis that aims to map the basic principles of joint protection and identify the primary sources of the current scientific evidence.

2. PURPOSE OF THE STUDY

The purpose of this scoping review is to gather, synthesize and critically examine the scope of joint protection principles for the management of h-OA and guide future research on joint protection programs for the future management of h-OA. The following questions were generated:

  1. What are the main sources of scientific evidence of the current joint protection programs?
  2. What are the main outcome measures that are used for joint protection?
  3. What are the current approaches of the joint protection programs?
  4. What is available in “Grey Literature” for joint protection programs?

3. METHODS

This study followed the steps of reporting guidelines by Arksey and O’ Malley’s [7Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: A large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol 2013; 13(1): 48.http:// www.pubmedcentral. nih.gov/ articlerender. fcgi?artid= 3614526& tool=pmcentrez &rendertype= abstract.[http://dx.doi.org/10.1186/1471-2288-13-48] [PMID: 23522333] ]. The steps were as follows: identifying the research question [1Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258] ], identifying relevant studies [2Moe RH, Iversen MD. Active approach to hand osteoarthritis. Rheumatology (Oxford) 2016; 55(3): 389-90.[PMID: 26615028] ], study selection [1Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258] ], charting the data [4Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clin Rehabil 1998; 12(1): 81-7.[http://dx.doi.org/10.1177/026921559801200111] [PMID: 9549029] ] and synthesizing, summarizing and reporting the results [7Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: A large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol 2013; 13(1): 48.http:// www.pubmedcentral. nih.gov/ articlerender. fcgi?artid= 3614526& tool=pmcentrez &rendertype= abstract.[http://dx.doi.org/10.1186/1471-2288-13-48] [PMID: 23522333] ].

3.1. Study Identification

The first author (PB) performed the literature search in 4 databases (PubMed, EMBASE, Google SCHOLAR and CINHAL) from January 1990 to February 2017. A combination of search terms was used such as hand osteoarthritis or/and rheumatoid arthritis, joint protection and/or hand exercises and/or self-management strategies. A Grey literature was also conducted through the Google web search engine. The grey literature was investigated through google manual searches in the first 10 pages of results. Also, relevant articles from the scientific databases and the grey literature were selected from the title and entered into a word database file.

3.2. Study Selection

The title and the abstract from all the articles and the grey literature were independently screened by 2 investigators (PB) and (GN) and discrepancies were resolved by discussion with a 3rd investigator (JM). We included all articles and handbooks (grey literature) that contained information about joint protection programs for people with hand osteoarthritis and/or rheumatoid arthritis. Studies, where the primary language was not in English, were excluded from the review process. Also, studies and grey literature that focused exclusively on assistive devices or orthotic devices or hand exercises were excluded from our review. Articles with the same data presentation were prioritized as the ones that have the most details, and the others were eliminated. A flow diagram of the search results and selection process is shown in Fig. (1).

Fig. (1)
Selection of articles and grey literature for scoping review.


3.3. Data Charting

Data were extracted from the first author (PB) from the included studies. Data information included Author(s) name or source, year of publication, type of research, study population, age, outcome measures, joint protection approaches, and by whom it was provided, and if authors made any recommendations.

3.4. Analyzing, Synthesizing and Reporting the Results

Description of the study design, the population that was examined and by whom the joint protection was delivered. The reported summarized findings are presented in a summary (Table 1). To answer our research questions, we categorized each type of study by level of evidence. Current joint protection approaches/principles and outcome measures are listed and reported in separate Tables 2 and 3. Grey literature was reported in a different category (Tables 4 and 6).

Table 1
Characteristics of the included studies.


Table 2
Study outcome measures that were reported.


Table 3
Joint protection Principles/Approaches that were reported from the included studies.


4. RESULTS

Our search found 8,788 citations. After duplication 231 articles were deemed relevant from the title and abstract. Review of abstracts identified 111 articles and were assessed for a full-text review. In total, 40 articles were eligible for inclusion in the scoping review (Fig. 1). The most common reason that studies were excluded was that either they did not test joint protection on hand or they talked about patient education in general and not for joint protection. Approximately 72% of the included articles reported Rheumatoid Arthritis (RA) as a patient population and only 20% reported patients with hand Osteoarthritis (h-OA). A small portion of studies (8%) included both populations for joint protection programs. The average age of the included population was ranging from 48.95 to 67.2 years old. In terms of sex, more than 75% of the included sample size were females across the studies.

5. STUDY DESCRIPTION

The majority of the articles which consisted of 70% of the included articles were [19Dilek B, Gözüm M, Şahin E, Baydar M, Ergör G, El Ö, et al. Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled Trial. [Internet]. Vol. 94, Archives of Physical Medicine & Rehabilitation. Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey: W B Saunders; 2013 Apr. Available from: http:// search.ebscohost.com/ login.aspx? direct=true& db=cin20& AN=104258900 &site=ehost-live.]: randomized controlled trials [8Williams MA, Williamson EM, Heine PJ, Nichols V, Glover MJ, Dritsaki M, et al. Strengthening and stretching for rheumatoid arthritis of the hand (SARAH). A randomised controlled trial and economic evaluation. Health Technol Assess (Rockv) 2015; 19(42): 1-222. Available from: http:// search.ebscohost. com/login. aspx?direct= true&db =cin20&AN =109707566 &site=ehost-live.-25Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil 2004; 18(5): 520-8.[http://dx.doi.org/10.1191/0269215504cr766oa] [PMID: 15293486] ], [6Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64(4): 465-74.[http://dx.doi.org/10.1002/acr.21596] [PMID: 22563589] ] systematic reviews [26Siegel P, Tencza M, Apodaca B, Poole JL. Effectiveness of occupational therapy interventions for adults with rheumatoid arthritis: A systematic review. Am J Occup Ther 2017; 71(1): 7101180050p1-.-31Steultjens EMJ, Dekker J, Bouter LM, van Schaardenburg D, van Kuyk MAH, van den Ende CHM. Occupational therapy for rheumatoid arthritis. Cochrane Database Syst Rev 2004; (1): CD003114.[PMID: 14974005] ] and [3Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a task force of the EULAR standing committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(3): 377-88.http://www.ncbi.nlm.nih.gov/pubmed/17046965[http://dx.doi.org/10.1136/ard.2006.062091] [PMID: 17046965] ] overviews of reviews [32Ekelman BA, Hooker L, Davis A, et al. Occupational therapy interventions for adults with rheumatoid arthritis: An appraisal of the evidence. Occup Ther Heal care 2014 Oct; 28(4): 347-61.[http://dx.doi.org/10.3109/07380577.2014.919687] -34Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: An overview of systematic reviews. Phys Ther 2007; 87(12): 1697-715.https:// academic.oup.com/ ptj/ article-lookup/ doi/10.2522/ptj.20070039[http://dx.doi.org/10.2522/ptj.20070039] [PMID: 17906290] ]. The rest of the studies were a critical review of the literature [35Beasley J. Osteoarthritis and rheumatoid arthritis: conservative therapeutic management. J Hand Ther 2012; 25(2): 163-71.[http://dx.doi.org/10.1016/j.jht.2011.11.001] [PMID: 22326361] -37Hammond A. Rehabilitation in rheumatoid arthritis: A critical review. Musculoskelet Care 2004; 2(3): 135-51.http:// www.ncbi.nlm.nih. gov/pubmed/17041978[http://dx.doi.org/10.1002/msc.66] [PMID: 17041978] ], cohort studies [38Boustedt C, Nordenskiöld U, Lundgren Nilsson A, et al. Effects of a hand-joint protection programme with an addition of splinting and exercise: One year follow-up. Clin Rheumatol 2009; 28(7): 793-9.[http://dx.doi.org/10.1007/s10067-009-1150-y] [PMID: 19294479] , 39Hammond A, Lincoln N. The effect of a joint protection education programme for people with rheumatoid arthritis. Clin Rehabil 1999; 13(5): 392-400.http:// search. ebscohost .com/login. aspx?direct= true&db= cin20&AN= 107089864&site= ehost-live.[http://dx.doi.org/10.1191/026921599667005364] [PMID: 10498346] ], surveys [40Veitiene D, Tamulaitiene M. Comparison of self-management methods for osteoarthritis and rheumatoid arthritis. J Rehabil Med 2005; 37(1): 58-60.[http://dx.doi.org/10.1080/16501970410032669] [PMID: 15788334] , 41Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clin Rehabil 1998; 12(1): 81-7.[http://dx.doi.org/10.1177/026921559801200111] [PMID: 9549029] ], mixed methods studies [42Niedermann K, Hammond A, Forster A, de Bie R. Perceived benefits and barriers to joint protection among people with rheumatoid arthritis and occupational therapists. A mixed methods study. Musculoskelet Care 2010; 8(3): 143-56. [eng].[http://dx.doi.org/10.1002/msc.177] [PMID: 20803632] ], pilot [43Hammond A. Evaluating joint protection education for people with rheumatoid arthritis 1994.] and cross-sectional studies [44McGee C, Mathiowetz V. Evaluation of hand forces during a joint-protection strategy for women with hand osteoarthritis. Vol. 71, American Journal of Occupational Therapy. Assistant Professor, Programs in Occupational Therapy and Rehabilitation Science, University of Minnesota, Minneapolis: American Occupational Therapy Association; 2017 Jan. Available from: http:// search. ebscohost.com/ login.aspx? direct=true%7B& %7Ddb=cin20% 7B&%7DAN =120052984%7B &%7Dsite =ehost-live.]. The characteristics of the included studies are summarized in Table 1.

Table 4
Special Considerations for Joint protection principles for the hand from Physiopedia (Grey Literature online material on joint protection).


Table 5
OASIS-Vancouver Coastal Health. Hand Osteoarthritis - Protecting Your Hands (Grey Literature online material on joint protection).


Table 6
East Sussex Healthcare NHS. Joint protection techniques for hands (claiming source Arthritis Research UK, www.arthritisresearchuk.org.) (Grey Literature).


6. OUTCOME MEASURES

The outcome measures that were used in the included studies are summarized in Table 2. Pain was the most evaluated outcome measure and it was evaluated with Visual Analog Scale (VAS) or by pain subscale of Health Assessment Questionnaire (HAQ) or by Numeric Pain Rating Scale (NRS) and by Michigan Hand Questionnaire. Self-report measures for psychological domains were evaluated with the Arthritis Self-Efficacy Scale (ASES), Hospital Anxiety and Depression Scale (HADS), Arthritis Helplessness Index (AHI) and Sense of Coherence (SoC). Disease-specific activity outcome measures were evaluated with the Disease Activity Score 28 (DAS28), Rheumatoid Arthritis Disease Activity Index (RADAI), Arthritis Impact Measurement Scale (AIMS2). Quality of life was assessed with EUROHIS-QOL 8 and health status with SF-12 and EQ-5D-3L. Functional ability was evaluated with HAQ, Dreiser Functional Index (DFI), Australian Canadian Osteoarthritis Index (AUSCAN), and Functional Index for Hand Osteoarthritis (FIHOA). The adherence of joint protection programs was measured with the Joint Protection Behaviour Assessment (JPBA), and joint deformity was assessed with Hand Joint Alignment and Motion Scale. Efficacy was measured with general self-efficacy scale and with global change. Disability was assessed with HAQ and with Disabilities of the Arm, Shoulder, and Hand (DASH). Performance-based tests were performed to assess grip and pinch strength as well as hand dexterity. Clinician based-outcomes included wrist range of motion and finger range of motion.

7. JOINT PROTECTION APPROACHES

In half of the studies, it was not clear who was primarily involved in delivering the joint protection program. Only two studies reported that the joint protection was provided by medical staff (nurse or physician) and by a research assistant. Joint protection and energy conservation were administered mostly with two methods such as an educational-behavioral approach or as an approach that was focused on personal goals and available resources. The average time of a standardized joint protection education lasted from 1.5 to 3.25 hours approximately over two sessions. The usual content of the joint protection education was to educate the participants about the disease and how the joints are affected by h-OA or RA. The education sessions included information about the joint protection principles with short time demonstrations (15 to 30 minutes) of hand joint protection approaches usually for household activities. At the end of the joint protection education, there was a discussion about patients' needs and problems that were mostly supported by a leaflet. The joint protection tasks are summarized in detail in Table 3. Assistive devices were not reported in the vast majority of the studies.

8. GREY LITERATURE

Our grey literature search identified several online sources that are [1Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258] ]: non-profit organizations (e.g. National Agricultural Safety Database (NASD), East Sussex Healthcare NHS, OASIS-Vancouver Coastal Health. Hand Osteoarthritis) [68Hammond A. Rehabilitation in rheumatoid arthritis: A critical review. Musculoskelet Care 2004; 2(3): 135-51.http:// www.ncbi. nlm.nih. gov/ pubmed/ 17041978[http://dx.doi.org/10.1002/msc.66] [PMID: 17041978] ] [2Moe RH, Iversen MD. Active approach to hand osteoarthritis. Rheumatology (Oxford) 2016; 55(3): 389-90.[PMID: 26615028] ] educational e-learning communities (e.g. Physiopedia) [69Stamm TA, Machold KP, Smolen JS, et al. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Arthritis Rheum 2002; 47(1): 44-9.[http://dx.doi.org/10.1002/art1.10246] [PMID: 11932877] ] that have available online material for joint protection for people with hand arthritis and [3Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a task force of the EULAR standing committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(3): 377-88.http://www.ncbi.nlm.nih.gov/pubmed/17046965[http://dx.doi.org/10.1136/ard.2006.062091] [PMID: 17046965] ] Thesis from post-graduate and doctoral studies. General joint protection principles for hand consideration included: avoid tight grasp, avoid pressure on back of knuckles, use both hands when possible, avoid repetitive hand activities, avoid stress to tip or pad of thumb, avoid to pressure against the radial side of each finger thumb side, avoid prolonged period of holding hands in the same position, use more prominent joints to complete a task, plan ahead, use orthotic devices to protect your joints and respect pain., and further details are summarized in Tables 4-7.

Table 7
Energy conservation and joint protection from National Agricultural Safety Database (NASD) Grey Literature online material on joint protection.


9. DISCUSSION

This study aimed to summarize the extent of the evidence for joint protection principles for the management of RA / h-OA and identified randomized controlled trials, systematic reviews and overviews of reviews as the primary sources of scientific evidence for the current joint protection programs. Pain, function, psychological domains, adherence, quality of life and health-status were the main outcomes that were administered. More specifically, pain levels were mainly examined by Visual Analog Scale, Health Assessment Questionnaire, Numeric Rating Scale and self-reported psychological domains Arthritis Self-Efficacy Scale, Health Anxiety and Depression Scale, Arthritis Helplessness Index and Self of Coherence. Function was mostly examined by Australian Canadian Osteoarthritis index (AUSCAN), Michigan Hand Questionnaire (MHQ) and Health Assessment Questionnaire (HAQ). While the occupational therapist was primarily responsible for the delivery of joint protection, in half of the included studies, it was unclear who was mainly involved in delivering the joint protection program. Also, the current joint protection programs primarily focused on tasks associated with home care and kitchen, and the review of the grey literature yielded principles such as avoiding tight grips, awareness of pain, limiting prolonged periods of holding and use of larger joints.

This scoping study did not evaluate the effectiveness of Joint protection programs but identified 18 RCTs that can be synthesized to investigate their effectiveness. The two most recent systematic reviews (26,27) provided recommendations from 8 RCTs in total leading to the exclusion of 10 additional trials. Therefore, an update of the most recent evidence is highly recommended.

Joint protection as a multimodal intervention includes the following components [1Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258] ] altering working methods [2Moe RH, Iversen MD. Active approach to hand osteoarthritis. Rheumatology (Oxford) 2016; 55(3): 389-90.[PMID: 26615028] ], use of proper joint and body mechanics through applying ergonomic principles [3Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a task force of the EULAR standing committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(3): 377-88.http://www.ncbi.nlm.nih.gov/pubmed/17046965[http://dx.doi.org/10.1136/ard.2006.062091] [PMID: 17046965] ], use of assistive devices, and [4Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clin Rehabil 1998; 12(1): 81-7.[http://dx.doi.org/10.1177/026921559801200111] [PMID: 9549029] ] modifying functional performance and environments [54Hammond A. Joint protection: Enabling change in musculoskeletal conditions.International handbook of occupational therapy interventions 2015; 607-18.]. It is often integrated with fatigue management, working splints and flexibility and strengthening exercises [54Hammond A. Joint protection: Enabling change in musculoskeletal conditions.International handbook of occupational therapy interventions 2015; 607-18.]. We were unable to extract all the components mentioned above of joint protection because either there was a lack of reporting or either the joint protection intervention was not fully implemented. Joint protection programs may include specific principles and techniques such as avoiding tight grips or use of larger joints or utilize particular exercises or energy conservation methods. Therefore, it is crucial to ensure comprehensive reporting of all the components of such programs when used in clinical studies. In this review, we were unable to extract specific information on what exactly included in joint protection programs from most of the clinical studies because the information was not available.

Future research needs to focus on clear and concise reporting of different principles included in joint protection programs utilized in clinical studies and ensure adequate representation of men and women. It is crucial to assess the effectiveness of such joint protection programs in large-scaled well-designed randomized controlled trials by incorporating all the components of joint protection and not only parts of joint protection.

The strengths of this review are that we summarized all the reported joint protection principles in peer-reviewed and grey literature. We highlighted the main outcome measures that were used in most of the studies to help future clinical studies to select the most commonly used self-report outcome measures and performance-based tests. We identified a lack of clarity and lack of detailed description on the components of joint protection that were tested. Finally, we indicated that many RCTs (n=10) have been published that have not been considered in a recent evidence synthesis.

Despite the authors’ efforts to follow rigorous guidelines from Arksey and O’Malley (7), this scoping study is subjected to several limitations. A thorough literature search was performed; however, we may have missed research articles that were under development during the study period. Also, a search of the grey literature was conducted through google search web engine, but we have decided to stop after the first ten pages of google web. Therefore, online material that addresses joint protection strategies may have been missed during the search process.

CONCLUSION

This review synthesized and critically examined the scope of joint protection programs for management of h-OA and found that RCTs, systematic reviews and overviews of reviews constituted two-thirds of the current body of literature. Furthermore, it identified a lack of clarity regarding the specific elements of joint protection programs used in studies.

KEY MESSAGES

  • An occupational therapist mainly delivers joint protection.
  • Pain levels (VAS, HAQ, NRS), self-reported psychological domains (ASES, HADS, AHI, SoC) and function levels (AUSCAN, HAQ, MHQ) were identified as the main outcomes that were administered.
  • Lack of detailed reporting for the components of joint protection programs.

FUNDING STATEMENT

This work was supported by an operating grant from The Arthritis Society of Canada and by the Canadian Institutes of Health Research (CIHR) with funding reference number (FRN: 201710GSD-402354-282879).

CONSENT FOR PUBLICATION

Not applicable.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGMENTS

PB was supported by the Canadian Institutes of Health Research (CIHR). GN was supported by Transdisciplinary Bone and Joint Award. JM was supported by a Canadian Institutes of Health Research Chair in Gender, Work and Health and the Dr. James Roth Chair in Musculoskeletal Measurement and Knowledge Translation.

REFERENCES

[1] Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The framingham study. Am J Epidemiol 2002; 156(11): 1021-7.[http://dx.doi.org/10.1093/aje/kwf141] [PMID: 12446258]
[2] Moe RH, Iversen MD. Active approach to hand osteoarthritis. Rheumatology (Oxford) 2016; 55(3): 389-90.[PMID: 26615028]
[3] Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a task force of the EULAR standing committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(3): 377-88.http://www.ncbi.nlm.nih.gov/pubmed/17046965[http://dx.doi.org/10.1136/ard.2006.062091] [PMID: 17046965]
[4] Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clin Rehabil 1998; 12(1): 81-7.[http://dx.doi.org/10.1177/026921559801200111] [PMID: 9549029]
[5] Hammond A, Lincoln N, Sutcliffe L. A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis. Patient Educ Couns 1999; 37(1): 19-32.[http://dx.doi.org/10.1016/S0738-3991(98)00093-7] [PMID: 10640116]
[6] Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64(4): 465-74.[http://dx.doi.org/10.1002/acr.21596] [PMID: 22563589]
[7] Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: A large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol 2013; 13(1): 48.http:// www.pubmedcentral. nih.gov/ articlerender. fcgi?artid= 3614526& tool=pmcentrez &rendertype= abstract.[http://dx.doi.org/10.1186/1471-2288-13-48] [PMID: 23522333]
[8] Williams MA, Williamson EM, Heine PJ, Nichols V, Glover MJ, Dritsaki M, et al. Strengthening and stretching for rheumatoid arthritis of the hand (SARAH). A randomised controlled trial and economic evaluation. Health Technol Assess (Rockv) 2015; 19(42): 1-222. Available from: http:// search.ebscohost. com/login. aspx?direct= true&db =cin20&AN =109707566 &site=ehost-live.
[9] Oppong R, Jowett S, Nicholls E, et al. Joint protection and hand exercises for hand osteoarthritis: An economic evaluation comparing methods for the analysis of factorial trials. Rheumatology (Oxford) 2015; 54(5): 876-83.[http://dx.doi.org/10.1093/rheumatology/keu389] [PMID: 25339642]
[10] Stamm TA, Machold KP, Smolen JS, et al. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Arthritis Rheum 2002; 47(1): 44-9.[http://dx.doi.org/10.1002/art1.10246] [PMID: 11932877]
[11] Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40(9): 1044-51.http://www.ncbi.nlm.nih.gov/pubmed/11561117[http://dx.doi.org/10.1093/rheumatology/40.9.1044] [PMID: 11561117]
[12] Hammond A, Lincoln N, Sutcliffe L. A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis. Patient Educ Couns 1999; 37(1): 19-32.[http://dx.doi.org/10.1016/S0738-3991(98)00093-7] [PMID: 10640116]
[13] Lindroth Y, Brattström M, Bellman I, et al. A problem-based education program for patients with rheumatoid arthritis: Evaluation after three and twelve months. Arthritis Care Res 1997; 10(5): 325-32.[http://dx.doi.org/10.1002/art.1790100507] [PMID: 9362599]
[14] Neuberger GB, Vogel K, Black SO P. Romoting self-care in clients with arthritis 1993.
[15] Lindroth Y, Bauman A, Brooks PM, Priestley D. A 5-year follow-up of a controlled trial of an arthritis education programme. Br J Rheumatol 1995; 34(7): 647-52.[http://dx.doi.org/10.1093/rheumatology/34.7.647] [PMID: 7670785]
[16] Giraudet-Le Quintrec J-S, Mayoux-Benhamou A, Ravaud P, et al. Effect of a collective educational program for patients with rheumatoid arthritis: A prospective 12-month randomized controlled trial. J Rheumatol 2007; 34(8): 1684-91.http:// www.ncbi. nlm. nih.gov/ pubmed/ 17610321[PMID: 17610321]
[17] Scholten C, Brodowicz T, Graninger W, et al. Persistent functional and social benefit 5 years after a multidisciplinary arthritis training program. Arch Phys Med Rehabil 1999; 80(10): 1282-7.[http://dx.doi.org/10.1016/S0003-9993(99)90030-8] [PMID: 10527088]
[18] Dziedzic K, Nicholls E, Hill S, et al. Self-management approaches for osteoarthritis in the hand: A 2×2 factorial randomised trial. Ann Rheum Dis 2015; 74(1): 108-18.[http://dx.doi.org/10.1136/annrheumdis-2013-203938] [PMID: 24107979]
[19] Dilek B, Gözüm M, Şahin E, Baydar M, Ergör G, El Ö, et al. Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled Trial. [Internet]. Vol. 94, Archives of Physical Medicine & Rehabilitation. Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey: W B Saunders; 2013 Apr. Available from: http:// search.ebscohost.com/ login.aspx? direct=true& db=cin20& AN=104258900 &site=ehost-live.
[20] Niedermann K, Buchi S, Ciurea A, et al. Six and 12 months’ effects of individual joint protection education in people with rheumatoid arthritis: A randomized controlled trial. Scand J Occup Ther 2012; 19(4): 360-9.http://www.ncbi.nlm.nih.gov/pubmed/21936735[http://dx.doi.org/10.3109/11038128.2011.611820] [PMID: 21936735]
[21] Niedermann K, de Bie RA, Kubli R, et al. Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial. Patient Educ Couns 2011; 82(1): 42-8.[http://dx.doi.org/10.1016/j.pec.2010.02.014] [PMID: 20451345]
[22] Hammond A, Bryan J, Hardy A. Effects of a modular behavioural arthritis education programme: A pragmatic parallel-group randomized controlled trial. Rheumatology (Oxford) 2008; 47(11): 1712-8.[http://dx.doi.org/10.1093/rheumatology/ken380] [PMID: 18815153]
[23] Masiero S, Boniolo A, Wassermann L, Machiedo H, Volante D, Punzi L. Effects of an educational-behavioral joint protection program on people with moderate to severe rheumatoid arthritis: A randomized controlled trial. Clin Rheumatol 2007; 26(12): 2043-50.[http://dx.doi.org/10.1007/s10067-007-0615-0] [PMID: 17404783]
[24] O’Brien VH, Giveans MR. Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: A retrospective study. J Hand Ther 2013; 26(1): 44-51. [Internet].[http://dx.doi.org/10.1016/j.jht.2012.10.005] [PMID: 23177671]
[25] Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil 2004; 18(5): 520-8.[http://dx.doi.org/10.1191/0269215504cr766oa] [PMID: 15293486]
[26] Siegel P, Tencza M, Apodaca B, Poole JL. Effectiveness of occupational therapy interventions for adults with rheumatoid arthritis: A systematic review. Am J Occup Ther 2017; 71(1): 7101180050p1-.
[27] Carandang K, Pyatak EA, Vigen CLP. Systematic review of educational interventions for rheumatoid arthritis. Am J Occup Ther 2016; 70(6): 7006290020p1-.[http://dx.doi.org/10.5014/ajot.2016.021386]
[28] Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders ART, Vermeulen GM. Conservative treatment of thumb base osteoarthritis: A systematic review. J Hand Surg Am 2015; 40(1): 16-21.e1, 6.[http://dx.doi.org/10.1016/j.jhsa.2014.08.047] [PMID: 25534834]
[29] Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther 2010; 23(4): 334-50.[http://dx.doi.org/10.1016/j.jht.2010.05.001] [PMID: 20615662]
[30] Eemj S, Jj D, Lm B, Dd S, Mamah K, Den V, et al. Cochrane Database of Systematic Reviews Occupational therapy for rheumatoid arthritis (Review). www.cochranelibrary.com. 2008;(1).
[31] Steultjens EMJ, Dekker J, Bouter LM, van Schaardenburg D, van Kuyk MAH, van den Ende CHM. Occupational therapy for rheumatoid arthritis. Cochrane Database Syst Rev 2004; (1): CD003114.[PMID: 14974005]
[32] Ekelman BA, Hooker L, Davis A, et al. Occupational therapy interventions for adults with rheumatoid arthritis: An appraisal of the evidence. Occup Ther Heal care 2014 Oct; 28(4): 347-61.[http://dx.doi.org/10.3109/07380577.2014.919687]
[33] Vliet Vlieland TPM, Pattison D. Non-drug therapies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2009; 23(1): 103-16.[http://dx.doi.org/10.1016/j.berh.2008.08.004] [PMID: 19233050]
[34] Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: An overview of systematic reviews. Phys Ther 2007; 87(12): 1697-715.https:// academic.oup.com/ ptj/ article-lookup/ doi/10.2522/ptj.20070039[http://dx.doi.org/10.2522/ptj.20070039] [PMID: 17906290]
[35] Beasley J. Osteoarthritis and rheumatoid arthritis: conservative therapeutic management. J Hand Ther 2012; 25(2): 163-71.[http://dx.doi.org/10.1016/j.jht.2011.11.001] [PMID: 22326361]
[36] Swann J. Managing rheumatoid arthritis: joint protection and treatment. Br J Healthc Assist 2011; 5(2)[http://dx.doi.org/10.12968/bjha.2011.5.2.78]
[37] Hammond A. Rehabilitation in rheumatoid arthritis: A critical review. Musculoskelet Care 2004; 2(3): 135-51.http:// www.ncbi.nlm.nih. gov/pubmed/17041978[http://dx.doi.org/10.1002/msc.66] [PMID: 17041978]
[38] Boustedt C, Nordenskiöld U, Lundgren Nilsson A, et al. Effects of a hand-joint protection programme with an addition of splinting and exercise: One year follow-up. Clin Rheumatol 2009; 28(7): 793-9.[http://dx.doi.org/10.1007/s10067-009-1150-y] [PMID: 19294479]
[39] Hammond A, Lincoln N. The effect of a joint protection education programme for people with rheumatoid arthritis. Clin Rehabil 1999; 13(5): 392-400.http:// search. ebscohost .com/login. aspx?direct= true&db= cin20&AN= 107089864&site= ehost-live.[http://dx.doi.org/10.1191/026921599667005364] [PMID: 10498346]
[40] Veitiene D, Tamulaitiene M. Comparison of self-management methods for osteoarthritis and rheumatoid arthritis. J Rehabil Med 2005; 37(1): 58-60.[http://dx.doi.org/10.1080/16501970410032669] [PMID: 15788334]
[41] Hammond A. The use of self-management strategies by people with rheumatoid arthritis. Clin Rehabil 1998; 12(1): 81-7.[http://dx.doi.org/10.1177/026921559801200111] [PMID: 9549029]
[42] Niedermann K, Hammond A, Forster A, de Bie R. Perceived benefits and barriers to joint protection among people with rheumatoid arthritis and occupational therapists. A mixed methods study. Musculoskelet Care 2010; 8(3): 143-56. [eng].[http://dx.doi.org/10.1002/msc.177] [PMID: 20803632]
[43] Hammond A. Evaluating joint protection education for people with rheumatoid arthritis 1994.
[44] McGee C, Mathiowetz V. Evaluation of hand forces during a joint-protection strategy for women with hand osteoarthritis. Vol. 71, American Journal of Occupational Therapy. Assistant Professor, Programs in Occupational Therapy and Rehabilitation Science, University of Minnesota, Minneapolis: American Occupational Therapy Association; 2017 Jan. Available from: http:// search. ebscohost.com/ login.aspx? direct=true%7B& %7Ddb=cin20% 7B&%7DAN =120052984%7B &%7Dsite =ehost-live.
[45] TA S, KP M, JS S, Fischer S, Redlich K, Graninger W, et al. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Vol. 47, Arthritis & Rheumatism: Arthritis Care & Research. Department of Rheumatology, Vienna University, Waehringer Guertel 18-20, Vienna A-1090, Austria; Tanja.Stamm@akh-wien.ac.at: John Wiley & Sons, Inc.; 2002 Jul. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=106668469&site=ehost-live.
[46] Hammond A, Jeffreson P, Jones N, Gallagher J, Jones T. Clinical applicability of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Br J Occup Ther 2002; 65(9): 405-12.[http://dx.doi.org/10.1177/030802260206500903]
[47] Hammond A, Lincoln N. The effect of a joint protection education programme for people with rheumatoid arthritis. Clin Rehabil 1999; 13(5): 392-400.http:// cre.sagepub.com/ content/13/5/392.short.[http://dx.doi.org/10.1191/026921599667005364] [PMID: 10498346]
[48] Hammond A, Lincoln N. Development of the joint protection behavior assessment. Arthritis Care Res 1999; 12(3): 200-7.[http://dx.doi.org/10.1002/1529-0131(199906)12:3<200::AID-ART7>3.0.CO;2-Z] [PMID: 10513510]
[49] Lindroth Y, Brattström M, Bellman I, et al. A problem-based education program for patients with rheumatoid arthritis: Evaluation after three and twelve months. Arthritis Care Res 1997; 10(5): 325-32.[http://dx.doi.org/10.1002/art.1790100507] [PMID: 9362599]
[50] Neuberger GB, Smith KV, Black SO, Hassanein R. Promoting self-care in clients with arthritis. Arthritis Care Res 1993; 6(3): 141-8.[http://dx.doi.org/10.1002/art.1790060306] [PMID: 8130290]
[51] Hammond A, Bryan J, Hardy A. Effects of a modular behavioural arthritis education programme: A pragmatic parallel-group randomized controlled trial. Rheumatology (Oxford) 2008; 47(11): 1712-8.[http://dx.doi.org/10.1093/rheumatology/ken380] [PMID: 18815153]
[52] Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil 2004; 18(5): 520-8.[http://dx.doi.org/10.1191/0269215504cr766oa] [PMID: 15293486]
[53] Dziedzic K, Nicholls E, Hill S, et al. Self-management approaches for osteoarthritis in the hand: A 2×2 factorial randomised trial. Ann Rheum Dis 2009; 2015(74): 108-18.http://dx.doi.org/10.1136/
[54] Hammond A. Joint protection: Enabling change in musculoskeletal conditions.International handbook of occupational therapy interventions 2015; 607-18.
[55] Carandang K, Pyatak EA, Vigen CLP. Systematic review of educational interventions for rheumatoid arthritis. Am J Occup Ther 2016; 70(6): 7006290020p1-.[http://dx.doi.org/10.5014/ajot.2016.021386]
[56] Williams MA, Williamson EM, Heine PJ, et al. Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation. Health Technol Assess 2015; 19(19): 1-222.[http://dx.doi.org/10.3310/hta19190] [PMID: 25748549]
[57] Hammond A. Joint Protection: Enabling change in musculoskeletal conditions (Chapter 42) 2015.
[58] Oppong R, Jowett S, Nicholls E, et al. Cost-effectiveness of joint protection and hand exercise for hand osteoarthritis. Rheumatology Oxford Univ Press Great Clarendon ST, Oxford OX2 6DP, England 2013; 147.
[59] Ekelman BA, Hooker L, Davis A, et al. Occupational therapy interventions for adults with rheumatoid arthritis: An appraisal of the evidence. Occup Ther Heal care 2014 Oct; 28(4): 347-61.[http://dx.doi.org/10.3109/07380577.2014.919687]
[60] Beasley J. Osteoarthritis and rheumatoid arthritis: Conservative therapeutic management. J Hand Ther 2012; 25(2): 163-71.[http://dx.doi.org/10.1016/j.jht.2011.11.001] [PMID: 22326361]
[61] Niedermann K, Hammond A, Forster A, de Bie R. Perceived benefits and barriers to joint protection among people with rheumatoid arthritis and occupational therapists. A mixed methods study. Musculoskelet Care 2010; 8(3): 143-56.[http://dx.doi.org/10.1002/msc.177] [PMID: 20803632]
[62] Valdes K, Marik T. A systematic review of conservative interventions for osteoarthritis of the hand. Vol. 23, Journal of Hand Therapy. Hand Works Therapy, Sarasota, Florida.: Elsevier Inc.; 2010 Oct. Available from: http://search. ebscohost.com/ login.aspx? direct=true& db=cin20& AN=104945341& site=ehost-live
[63] Boustedt C, Nordenskiöld U, Lundgren Nilsson A. Effects of a hand-joint protection programme with an addition of splinting and exercise: One year follow-up. Clin Rheumatol 2009; 28(7): 793-9.[http://dx.doi.org/10.1007/s10067-009-1150-y] [PMID: 19294479]
[64] Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: An overview of systematic reviews. Phys Ther 2007; 87(12): 1697-715.[http://dx.doi.org/10.2522/ptj.20070039] [PMID: 17906290]
[65] O’Brien AV, Jones P, Mullis R, Mulherin D, Dziedzic K. Conservative hand therapy treatments in rheumatoid arthritis: A randomized controlled trial. Rheumatology (Oxford) 2006; 45(5): 577-83.[http://dx.doi.org/10.1093/rheumatology/kei215] [PMID: 16319099]
[66] Gossec L, Pavy S, Pham T, et al. Nonpharmacological treatments in early rheumatoid arthritis: Clinical practice guidelines based on published evidence and expert opinion. Joint Bone Spine 2006; 73(4): 396-402.[http://dx.doi.org/10.1016/j.jbspin.2006.01.008] [PMID: 16626995]
[67] Veitiene D, Tamulaitiene M. Comparison of self-management methods for osteoarthritis and rheumatoid arthritis. J Rehabil Med 2005; 37(1): 58-60.[http://dx.doi.org/10.1080/16501970410032669] [PMID: 15788334]
[68] Hammond A. Rehabilitation in rheumatoid arthritis: A critical review. Musculoskelet Care 2004; 2(3): 135-51.http:// www.ncbi. nlm.nih. gov/ pubmed/ 17041978[http://dx.doi.org/10.1002/msc.66] [PMID: 17041978]
[69] Stamm TA, Machold KP, Smolen JS, et al. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Arthritis Rheum 2002; 47(1): 44-9.[http://dx.doi.org/10.1002/art1.10246] [PMID: 11932877]
[70] Hammond A, Lincoln N. The effect of a joint protection education programme for people with rheumatoid arthritis. Clin Rehabil 1999; 13(5): 392-400.http:// search.ebscohost.com/ login.aspx?direct=true& db=cin20& AN=107089864& site=ehost-live[http://dx.doi.org/10.1191/026921599667005364] [PMID: 10498346]
[71] Hammond A. Joint protection behavior in patients with rheumatoid arthritis following an education program: A pilot study. Arthritis Care Res 1994; 7(1): 5-9.[http://dx.doi.org/10.1002/art.1790070103] [PMID: 7918727]

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