Table 2

Efficacy of main non-pharmacological interventions for hand osteoarthritis from randomised controlled trials/clinical controlled trials

Intervention	Control	Outcome	Participants (studies), n	Duration	Quality of evidence	Effect estimate (95%CI)	References; comments
Exercise
Hand exercise	No exercise	Pain	381 (5)	12 weeks	GRADE: low	SMD −0.27 (−0.47 to −0.07)*	6; Cochrane review
		Function	369 (4)	12 weeks	GRADE: low	SMD −0.28 (−0.58 to 0.02)*	Idem
		OARSI-OMERACT responder	305 (3)	12 weeks	Not reported	RR 2.8 (1.4 to 5.6)*	Idem
		Grip strength	362 (5)	12 weeks	Not reported	SMD 0.34 (−0.01 to 0.69)*	Idem
Joint protection
Joint protection	No joint protection	Pain	257 (1)	26 weeks	RoB: high	MD −0.79 (−1.7 to 0.12) on AUSCAN pain scale (range 0–20)*	7; adjusted for age, gender, social class,centre, disease duration
		Function	257 (1)	26 weeks	RoB: high	MD −0.6 (−1.9 to 1.1) on AUSCAN function scale (range 0–36)*	Idem
		OARSI-OMERACT responder	257 (1)	26 weeks	RoB: high	OR 2.1 (1.1 to 4.0)*	Idem
		Grip strength	257 (1)	26 weeks	RoB: high	MD −0.47 (−1.9 to 0.94) kg†	Idem
Splints
Thumb splint	Usual care or no intervention	Pain	221 (4)	4–8 weeks	RoB: high	MD −2.9 (−12.2 to 6.5) on 100 mm VAS*	9–12
		Pain	137 (2)	13–52 weeks	RoB: high	MD −17.4 (−25.6 to −9.2) on 100 mm VAS*	10 12
		Function	144 (3)	4 weeks	RoB: high	SMD 0.24 (−0.11 to 0.60)†	8 9 12; effect estimate based on two trials (n=126)9 12
		Function	112 (1)	52 weeks	RoB: high	MD −6.3 (−10.9 to −1.7) on Cochin hand function scale (range 0–90)*	12
		Grip strength	95 (2)	6–8 weeks	RoB: high	SMD 0.39 (−0.35 to 1.1)*	10 11
		Grip strength	40 (1)	13 weeks	RoB: high	MD 0.8 (−3.1 to 4.7) kg*	10
Long thumb splint (MCP+CMC joint)	Short thumb splint (only CMC joint)	Pain	185 (3)	2–12 weeks	RoB: high	MD −0.85 (−5.1 to 3.4) on 100 mm VAS*	13–15; Wajon: results after splint period used for pooling
Long thumb splint (MCP+CMC joint)	Short thumb splint (only CMC joint)	Function	146 (2)	9–12 weeks	RoB: high	MD 1.7 (−0.94 to 4.3)†	13 14
DIP splint	No intervention	Pain	26 (1)	12 weeks	RoB: high	Median difference 0.5 (range −7 to 3.5, p=0.53) on 10 cm VAS*	21; outcome: average pain
DIP splint	No intervention	Function	26 (1)	12 weeks	RoB: high	No between-group difference	21; no raw data presented
Assistive devices
Assistive device	Information provision	Pain	70 (1)	12 weeks	RoB: high	MD 0.4 (−9.8 to 10.6) on 100 mm VAS†	22; adjusted for baseline
Assistive device	Information provision	Function	70 (1)	12 weeks	RoB: high	MD −0.3 (−0.6 to 0.01) on AUSCAN function scale (range 1–5)*	22; adjusted for baseline, COPM scores (primary outcome) also significant improvements*
Combination programme
Combination programme: education, joint protection, exercise	Education alone	Pain	321 (3)	12 weeks	RoB: high	MD 0.40 (−0.50 to 1.3) on AUSCAN pain scale (range 0–20)†	7 25 26; effect estimate based on one trial (n=151),26adjusted for baseline
		Function	321 (3)	12 weeks	RoB: high	MD 0.49 (−1.0 to 2.0) on AUSCAN function scale (range 0–36)*	7 25 26; effect estimate based on one trial (n=151),26adjusted for baseline
		OARSI-OMERACT responder	281 (2)	12 weeks	RoB: high	OR 0.82 (0.42 to 1.6)†	7 26; effect estimate based on one trial (n=151)26
		Grip strength	321 (3)	12 weeks	RoB: high	SMD −0.21 (−0.49 to 0.08)†	7 25 26; effect estimate based on two trials (n=186)25 26
Quality of evidence:	GRADE: very low/low RoB: high	GRADE: moderate RoB: unclear	GRADE: high RoB: low		Effect estimate:	No effect	Between-group difference

*In favour of the intervention group.
†In favour of the control group.
AUSCAN, Australian/Canadian Hand Osteoarthritis Index; CMC, first carpometacarpal; COPM, Canadian Occupational Performance Measure; DIP, distal interphalangeal joint; idem, same as above; MCP, metacarpophalangeal joint; MD, mean difference; OA, osteoarthritis; RoB, risk of bias; RR, risk ratio; SMD, standardised mean difference; VAS, visual analogue scale.