Wrist Stabilising Exercise Versus Hand Orthotic Intervention for Persons with Hypermobility - A Randomised Clinical Trial.
Lindholm Susanne, Claesson Lisbeth
PMID 39469898WHAT IT FOUND
Wrist stabilising exercises, plus hand anatomy and ergonomic advice, did not outperform a hand orthosis, plus the same advice, for activity, hand function or pain in hypermobility.
Neither showed clear advantage after 12 weeks.
Key findings
01There was no statistically significant difference between the wrist exercise group and the hand orthosis group after 12 weeks for activity ability, hand function, grip strength, pain, paraesthesia or health-related quality of life.
02Mean Disabilities of Arm, Shoulder, and Hand scores were 46.4 in the exercise group and 45.8 in the orthosis group at baseline, and 43.0 and 40.7 after 12 weeks, with no significant between-group difference.
03At 12 weeks, 20 participants in the exercise group and 17 in the orthosis group had missing data, and 40% of diaries were not submitted.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
169 people were enrolled, but 116 remained at 12 weeks, and missing data were 20 in the exercise group and 17 in the control group. 40% of training diaries were not submitted, so self-reported adherence was incomplete. Both groups received the same hand anatomy information and ergonomic advice, so the effect of exercise alone or orthosis alone cannot be separated. The sample was almost entirely women (95 to 97%), Swedish-speaking, and recruited from a journal system rather than consecutively. The outcome measures were not specifically tested for people with hypermobility spectrum disorders or hypermobile Ehlers-Danlos syndrome. The authors report large variation, so the size of any difference is uncertain. Hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome were treated as synonymous, and 13 Ehlers-Danlos variants share the same diagnosis code. Some participants may have previously received, or used, a hand orthosis during the exercise intervention.
Declared interests
Funding came from the Southeast Region Healthcare FORSS grant FORSS-420511 and Region Kalmar County.
The easy way to misread this
Do not conclude that wrist stabilising exercise or a hand orthosis does not help. The trial found no significant difference between them, but both groups also received hand anatomy information and ergonomic advice, many diaries were missing, and the authors report large variation that made the size of any difference uncertain.