Patients perceptions on the use of prefabricated wrist-hand orthoses in the management of rheumatoid arthritis

Rheumatoid arthritis (RA) affects over 400,000 people in the UK [1]. The wrist and hand are commonly affected in the early stages of RA, with most hand deformities occurring during the first year of the disease [2]. Prefabricated functional wrist-hand orthoses (WHOs) with a volar bar are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. Studies have previously investigated the efficacy of these orthoses, with many reporting on the benefits and limitations of these devices but rarely on compliance. It is the aim of the present work to report on patients’ perceptions on the use of these WHOs. A six month user survey was conducted in the UK to seek and evaluate the opinions of patients with RA who had been prescribed commercially available prefabricated WHOs. A questionnaire was developed and participants were invited to both rate and comment on their experience of orthosis provision and of wearing the orthosis. Analysis of the results demonstrated that patients recognise clear benefits associated with WHO use. However many users are still dissatisfied with service provision and their orthoses, identifying many limitations to the functionality of the devices and factors which impact significantly on wear time and overall compliance. While there are some positive outcomes reported in the literature and recognised benefits from users in wearing these devices, if patients are to derive optimal benefit from the use of prefabricated WHOs, the factors which underpin orthotic use must be addressed. If the functionality of wrist-hand orthoses and factors affecting user compliance are both addressed, there is the potential to achieve additional gains in the outcome measures and positively impact on quality of life