***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function . METHODS Thirty-six patients with definite rheumatoid arthritis participated in the r and omized , controlled , cross-over design study of 3 commercial wrist extensor orthoses . Dominant-h and dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted . Functional impact was assessed using a written question naire . RESULTS All 3 commercial orthoses reduced grip strength when first donned . After a 1-week adjustment period , one orthosis , the Smith and Nephew Roylan D-Ring ( Roylan ) , afforded splinted grip strength equal to that of the nonsplinted grip strength . The other 2 orthoses continued to reduce grip strength , and afforded splinted grip strength significantly below that of the Roylan . The Roylan was deemed comfortable by more subjects than the other orthoses . CONCLUSIONS The belief that commercial orthotic use increases grip strength , either immediately or after 1 week , is not supported by this study 's data . Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength BACKGROUND It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis ( RA ) for the UK were published . Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA , especially in women . OBJECTIVES To estimate the age- and sex-specific point prevalence of RA ( defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment ) . The estimate was made in the primary care setting in Norfolk , UK . METHODS A stratified r and om sample was drawn from seven age and gender b and s. The 7050 individuals selected were mailed a screening question naire . Positive responders were invited to attend for a clinical examination . The sample was matched against the names in the Norfolk Arthritis Register ( NOAR ) , a register of incident cases of inflammatory polyarthritis which has been in existence since 1990 . RESULTS The overall response rate was 82 % . Sixty-six cases of RA were identified . Extrapolated to the population of the UK , the overall minimum prevalence of RA is 1.16 % in women and 0.44 % in men . A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission . In addition , some cases who failed to attend for examination had significant disability . These prevalence figures are therefore an underestimate . CONCLUSIONS The prevalence of RA in women , but not in men , in the UK may have fallen since the 1950s OBJECTIVE To investigate the efficacy of wrist working splints after a period of splinting in patients with rheumatoid arthritis ( RA ) . METHODS We performed a 4-week r and omized controlled trial among 33 RA patients with wrist arthritis . Patients were r and omly allocated to the splinting group ( n = 17 ) or the control group ( n = 16 ) . Patients in the splinting group received a prefabricated wrist working splint and were instructed to use this splint as much as possible during the day . The primary outcome measure was average wrist pain during the past week , measured using a visual analog scale ( VAS ) . Secondary outcome measures were grip strength and functional ability . The latter was measured using the Disabilities of the Arm , Shoulder , and H and question naire and the short version of the Sequential Occupational Dexterity Assessment . Measurements were performed at baseline and after 4 weeks . Performance tests were performed without splint . Differences in change scores between the splinting and the control group were analyzed using analysis of covariance . To indicate the magnitude of the treatment effects , effect sizes were calculated . RESULTS A large and highly significant treatment effect on wrist pain was found . VAS pain scores decreased by 32 % in the splinting group and increased by 17 % in the control group . Small and nonsignificant treatment effects were found with regard to nonsplinted grip strength and functional ability . CONCLUSION Prefabricated wrist working splints are highly effective in reducing wrist pain after 4 weeks of splint wearing in RA patients with wrist arthritis Objective . To describe the usage of functional wrist orthoses and to identify factors contributing to usage in patients with rheumatoid arthritis ( RA ) . Methods . A multicentre , cross-sectional study , including a r and om selection of patients with RA visiting outpatient clinics . A total of 240/362 eligible patients ( 66 % ) completed question naires , a semi-structured interview and a clinical assessment . Usage was registered according to eight categories ranging from ‘ always ’ to ‘ never ’ . Factors potentially associated with usage included demographic variables , the presence of wrist and h and complaints , general disease characteristics , mental and physical functioning , coping strategies and satisfaction with functional wrist orthoses . Logistic regression analyses were used to determine which factors were associated with the usage of wrist splints . Results . One hundred twenty-eight patients ( 53 % ) possessed functional wrist orthoses , whereas 74/128 ( 58 % ) were actually using them . Patients used them mainly during house keeping and cycling/driving . Main reasons for using the orthoses were relief of pain and joint protection , and main reasons for not using them were no need and problems with ease of use . Factors significantly associated with usage included the presence of wrist and h and complaints , worse physical functioning and greater satisfaction with comfort of the wrist orthoses . Conclusion . About half of patients with RA possessed functional wrist orthoses , with 58 % of them actually being used . Apart from local complaints and general functional ability , satisfaction with comfort of the functional wrist orthoses appears to be an important factor for their usage . These results point at the need for additional research regarding modifiable factors associated with compliance , such as comfort and ease of use OBJECTIVE To examine the efficacy of wrist orthoses on pain , motion , and function of the wrist . METHODS Consecutive patients were r and omized to a treatment group using wrist orthoses  or to a control group using no wrist orthoses  , in a prospect i ve , controlled , 6-month study . RESULTS Changes in wrist joint variables and general disease activity variables were not statistically different between the orthosis group ( n = 36 ) and the control group ( n = 33 ) . Patients in the orthosis group had 25 % and 12 % improvements in grip strength and pinch grip and 50 % reduction in pain while using the wrist orthosis . CONCLUSION Use of wrist orthoses improves function and reduces pain , but has no effects after 6 months , compared to a control group , on measures of local or general disease activity OBJECTIVE To compare the short-term utility and clinical effectiveness of the commercial-made Futuro wrist orthosis with a newly developed , custom-made ThermoLyn wrist orthosis . METHODS Using a r and omized cross-over trial , 10 patients with rheumatoid arthritis used each of the two orthoses for two weeks . Outcome measures were patients ' judgments with respect to different statements about utility and clinical assessment s including pain and swelling of the wrist and finger joints , range of motion of the wrist , and grip strength . At the end of the study the patients were asked which of the two orthoses they preferred and why . RESULTS Patients tended to favor the Futuro wrist orthosis with respect to pain relief and to h and ling the orthosis . The visual analog scale score of the appearance of the ThermoLyn wrist orthosis was a little higher than that of the Futuro wrist orthosis , but the difference was not statistically significant . Clinical parameters such as pain in the wrist , swelling of the wrist and finger joints , and movements of the wrist showed that the Futuro orthosis tended to be more effective than the ThermoLyn orthosis . None of the differences reached statistical significance . At the end of the study , 5 patients preferred the Futuro and 5 patients the ThermoLyn wrist orthosis . Arguments in favor of the ThermoLyn orthosis were better hygiene , stability , and no need to remove the orthosis during dirty and wet conditions . Arguments in favor of the Futuro orthosis were greater suppleness and freedom of movement . CONCLUSIONS The ready-made fabric Futuro wrist orthosis appears to be as good as the more expensive individually made synthetic ThermoLyn wrist orthosis with respect to short-term utility and clinical effectiveness . The conditions under which the orthosis will be worn will help to decide which orthosis is the best for the patient . In the event that the patient wants to use the orthosis in wet and dirty conditions , the ThermoLyn wrist orthosis is a good alternative to the Futuro wrist orthosis OBJECTIVE To determine the effect of a wrist orthosis on work performance , h and dexterity , and pain during task performance , 40 individuals with rheumatoid arthritis were studied using a 2 period , crossover design . METHODS Each patient was fitted with a Futuro wrist orthosis . Dexterity was measured with and without the orthosis using the Jebsen H and Function Test . Work performance was assessed using 2 tasks ( one simulating the use of shears , the other the use of a screwdriver ) on a work simulator . All tasks were performed both with and without the orthosis , with the order of orthosis versus no orthosis r and omly assigned . Pain before and after performing tasks was assessed using a 10 cm horizontal visual analog scale . RESULTS While on the screwdriver task work performance was less with the orthosis ( p = 0.0002 ) ; on the shears task there was no significant difference in work performance with and without the orthosis . The average pain after performing both tasks was significantly less with the orthosis on . A 2 factor analysis of variance model with repeated measures suggested that taking into account the reduced work performance during splint wear , pain was still significantly reduced with splint wear . The average time to complete all 7 tasks on the Jebsen H and Function Test was longer when the subjects wore the splint compared to when they did not ( 62.0 vs 57.6 s , respectively ; p = 0.0086 ) . CONCLUSION The results suggest that the effect of splint wear on work performance is highly task specific , and thus the ergonomic dem and s of the individual 's daily life must be considered if a splint is to provide maximal effectiveness OBJECTIVE In individuals with rheumatoid arthritis ( RA ) , to identify the influence of  wrist splint wear  on pain , work performance , endurance , perceived task difficulty , and perceived splint benefit while performing various upper limb tasks . METHODS This crossover study included 30 individuals with wrist involvement .  Pain , work performance , endurance , and perceived task difficulty were assessed with the splint on and off . Using a work simulator , participants performed 14 tasks , 10 assessing work performance and 4 assessing endurance . A visual analog scale ( VAS ) was used to rate pain , task difficulty , and perceived splint benefit . RESULTS With the splint on , pain was significantly lower in 5 tasks , as was perceived difficulty in task performance . Work performance did not differ significantly with the splint on versus off . While mean endurance scores were always better with the splint on , differences reached significance on only one task . The task with greatest overall perceived splint benefit was " chopping with a knife . " CONCLUSION Results revealed that for most tasks , there was generally a positive effect of splint use on h and function ; however , perceived splint benefit was marginal . For most tasks splint use improved or did not change pain levels , did not interfere with work performance , increased or maintained endurance , and did not increase perceived task difficulty . The findings suggest that wrist splint prescription is not a simple process ; clinicians and clients need to work together to determine the daily wear pattern that maximizes benefit and minimizes inconvenience according to the client 's individual needs OBJECTIVE To investigate the effect of 3 commercial wrist orthoses on finger dexterity and h and function of patients with rheumatoid arthritis ( RA ) . METHODS Forty-two patients with definite RA participated in the cross-over study comparing 3 styles of commercial wrist orthoses .  Finger dexterity and h and function of the dominant h and were assessed while splinted and unsplinted , at the initial session and after 1 week of intermittent orthosis use .  Finger dexterity was assessed using two subtests from the Purdue Pegboard Test ( Purdue ) and h and function was assessed using the Jebsen-Taylor H and Function Test ( Jebsen-Taylor ) . RESULTS Both finger dexterity and h and function were reduced by splinting ; men and women were affected similarly . There was no difference in finger dexterity or h and function afforded by the 3 orthoses . Results on both the Purdue and Jebsen-Taylor tests showed a significant learning effect across time . CONCLUSIONS The 3 commercial wrist orthoses studied reduce dexterity similarly and significantly . When commercial wrist orthoses are to be used during tasks that require maximum dexterity , this reduction should be weighed against the known benefits of splinting This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA 
    Output:
    
CONCLUSIONS Working wrist splints  reduce pain and improve grip in rheumatoid arthritis .
The effect of splints on function is not yet clear