The effects of arthritis gloves on people with Rheumatoid Arthritis or Inflammatory Arthritis with hand pain: a study protocol for a multi-centre randomised controlled trial (the A-GLOVES trial)

Arthritis glove provision in rheumatoid arthritis and hand osteoarthritis: A survey of United Kingdom rheumatology occupational therapists

Introduction

Hand pain and function limitations are common in rheumatoid arthritis (RA) and hand osteoarthritis (HOA). Provision of arthritis (compression) gloves to relieve hand symptoms is increasing in occupational therapy. Research evaluating arthritis gloves dates to the 1990s, focussing on night-wear of full-length finger gloves in RA. This survey examined glove provision in contemporary clinical practice in the United Kingdom.

Methods

A survey of arthritis glove provision in RA was conducted with Royal College of Occupational Therapists Rheumatology Specialist Section members. A more detailed survey about glove provision in RA and HOA was conducted with rheumatology occupational therapists in North-West England.

Results

Response rates were good, with 60 (73%) therapists responding to the national and 24 (69%) to the regional surveys. Most therapists provided open-finger gloves (commonly IsotonerTM) to about a third of their RA and HOA patients, and to those with any arthritic condition causing significant hand pain and/or swelling. Day-wear was as common as night-wear, and patients were advised to wear these 'as and when' for hand symptom relief and support for hand function. They were advised not to wear gloves continually in the day, and regularly perform hand exercises and monitor for potential adverse effects, for example, skin discolouration. Therapists commonly provide replacement gloves as these are often used long-term.

Conclusion

Prescription of arthritis gloves has changed considerably in the last 30 years, with open-finger gloves provided to a wider range of people with arthritis, for a broader range of clinical reasons.

Does wearing arthritis gloves help with hand pain and function? A qualitative study into patients’ views and experiences

Objectives

Arthritis gloves are frequently prescribed to people with undifferentiated inflammatory (UIA) or rheumatoid arthritis (RA), to help reduce hand pain and improve function. Nested within a randomised controlled trial testing the effectiveness of arthritis gloves (Isotoner gloves versuss loose-fitting placebo gloves) in people with RA and UIA, this qualitative study aimed to explore participants’ views on the impact of wearing arthritis gloves on their hand pain and function.

Methods

Semi-structured one-to-one interviews were conducted with purposively selected participants following 12-weeks of glove wear. Participants and the interviewer were blinded to the treatment allocation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Results

Participants (intervention n = 10; control n = 9) recruited from 13 NHS hospital sites in the UK participated in the interviews. Two main themes, with sub-themes, were elicited from the data: (1) Mechanisms determining glove use: ‘As soon as your joints get a bit warmer, the pain actually eases’ (thermal qualities; glove-use in daily activities; glove-use during sleep); and (2) Ambivalence about benefits of arthritis gloves: ‘I suppose a normal pair of gloves would do the same sort of thing?’ (are they a help or hindrance?; aesthetic appeal; future use of gloves).

Conclusion

Participants had ambivalent views on the impact of both the intervention and loose-fitting placebo gloves on their hand pain and function, identifying warmth as the main benefit. Ordinary mid-finger length gloves widely accessible from high street suppliers could deliver warmth and provide perceived benefits to hand pain and function.

Clinical Trial Registration

ISRCTN, ISRCTN25892131; Registered 05/09/2016: retrospectively registered.

Compression gloves for patients with hand arthritis (C-GLOVES): A feasibility study

Introduction

Compression gloves are frequently provided to patients with hand arthritis. Evidence for effectiveness is limited. The aim of this study was to determine feasibility of recruitment, assessment and treatment procedures, in preparation for a future compression glove trial.

Methods

A non-randomised feasibility study with out-patients with either undifferentiated inflammatory arthritis, rheumatoid arthritis or hand osteoarthritis, with moderate to severe hand pain. All received Isotoner™ compression gloves provided by rheumatology occupational therapists. The main outcomes were feasibility of recruitment, assessment and treatment procedures, trial outcome selection and sample size calculation. Participants were assessed at baseline and four weeks. Assessments included: numeric rating scales (0-10) of hand pain (on activity, at rest, at night) and stiffness; hand joint swelling; finger flexion; and hand function (Grip Ability Test).

Results

Of 318 patients screened, 86/204 (42%) of inflammatory and 68/114 (60%) of hand osteoarthritis patients were eligible. Of these, 41 (48%: age: 59.10 (SD 12.54) years) and 32 (47%: age: 60.75 (SD 8.64) years) respectively, consented. All completed four-week follow-up. Assessment and treatment protocols were feasible. Hand pain on activity and at night, stiffness, joint swelling, finger flexion and hand function improved: e.g. hand pain on activity: inflammatory arthritis change = -0.95 (SD 2.26; p = 0.01); osteoarthritis -1.57 (SD 1.78; p = 0.001). Participants reported improved hand pain, stiffness and hand function as main benefits.

Conclusion

Procedures tested were feasible. The most relevant primary outcome was hand pain on activity. Future trials would need 161 participants (Inflammatory arthritis) and 151 (hand osteoarthritis).Trial registration: Clinical Trials.Gov: NCT01874067.

Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): randomised controlled trial with economic analysis

BACKGROUND

Arthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis. They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness. However, evidence for their effectiveness is limited. The aims of this study were to investigate the clinical and cost effectiveness of arthritis gloves compared to placebo gloves on hand pain, stiffness and function in people with rheumatoid arthritis and persistent hand pain.

METHODS

A parallel randomised controlled trial, in adults (≥ 18 years) with rheumatoid or undifferentiated inflammatory arthritis at 16 National Health Service sites in the UK. Patients with persistent hand pain affecting function and/or sleep were eligible. Randomisation (1:1) was stratified by recent change (or not) in medication, using permuted blocks of random sizes. Three-quarter-finger length arthritis gloves (Isotoner®: applying 23-32 mmHg pressure) (intervention) were compared to loose-fitting placebo gloves (Jobskin® classic: providing no/minimal pressure) (control). Both gloves (considered to have similar thermal qualities) were provided by occupational therapists. Patients and outcome assessors were blinded; clinicians were not. The primary outcome was dominant hand pain on activity (0-10) at 12 weeks, analysed using linear regression and intention to treat principles.

RESULTS

Two hundred six participants were randomly assigned (103 per arm) and 163 (84 intervention: 79 control) completed 12-week follow-up. Hand pain improved by 1.0 (intervention) and 1.2 (control), an adjusted mean difference of 0.10 (95% CI: - 0.47 to 0.67; p = 0.72). Adverse events were reported by 51% of intervention and 36% of control group participants; with 6 and 7% respectively, discontinuing glove wear. Provision of arthritis gloves cost £129, with no additional benefit.

CONCLUSION

The trial provides evidence of no clinically important effect of arthritis gloves on any of the trial outcomes (hand pain, function and stiffness) and arthritis gloves are not cost-effective. The clinical and cost-effectiveness results support ceasing provision of arthritis gloves in routine clinical practice.

FUNDING

National Institute for Health Research.

TRIAL REGISTRATION

ISRCTN, ISRCTN25892131 ; Registered 05/09/2016: retrospectively registered.