Outcomes | Illustrative Comparative Risks* (95% CI) | Relative Effect (95% CI) | No. Study Participants | Quality of the Evidence (GRADE) | Comments | |
---|---|---|---|---|---|---|
Assumed risk No exercise | Corresponding risk Hand exercise | |||||
Hand pain: self-report questionnaires. Scale from 0 to 10 (0 represents no pain). Followup: median 3 mos | Mean hand pain in the control groups:3.9 points1 | Mean hand pain in the intervention group: 0.5 points lower (0.1–0.9 points lower) | 381 (5 studies) | ⊕ ⊕ ⊖ ⊖low2,3 | SMD −0.27 (−0.47 to −0.07). Absolute reduction in pain 5% (1%–9%) on a 0–10 scale. Relative change 13% (3%–22%). NNTB: 9 (5–32) | |
Hand function: self-report questionnaires. Scale from 0 to 36 (0 represents no physical disability). Followup: median 3 mos | Mean hand function in the control groups: 14.5 points4 | Mean hand function in the intervention groups: 2.2 points lower (0.2 points higher to 4.6 points lower) | 369 (4 studies) | ⊕ ⊕ ⊖ ⊖low2,3 | SMD −0.28 (−0.58 to 0.02). Absolute improvement in hand function 6% (0.4% worsening to 13% improvement). Relative change 15% (1% worsening to 32% improvement). NNTB: 9 (5–52) | |
Radiographic joint structure changes: not measured. | Not measured | Not measured | Not estimable | 0 (0) | Not applicable | Radiographic joint changes were not measured. |
Quality of life: self-report questionnaires. Scale from 0 to 100 (100 represents maximum quality of life). Followup: mean 3 mos | Mean quality of life in the control groups: 50.4 points5 | Mean quality of life in the intervention group was 0.3 points higher (3.5 points lower to 4.1 points higher) | 113 (1 study) | ⊕ ⊖ ⊖ ⊖very low2,6 | MD 0.30 (−3.72 to 4.32). Absolute improvement in quality of life 0.3% (4% worsening to 4% improvement). Relative change in quality of life 0.6% (7% worsening to 8% improvement). | |
Finger joint stiffness: self-reported questionnaires. Scale from 0 to 10 (0 represents no stiffness). Followup: mean 3 mos | Mean finger joint stiffness in the control groups: 4.5 points7 | Mean finger joint stiffness in the intervention groups: 0.7 points lower (0.3–1.0 points lower) | 368 (4 studies) | ⊕ ⊕ ⊖ ⊖low2,3 | SMD −0.36 (−0.58 to −0.15). Absolute reduction in finger joint stiffness 7% (3%–10%). Relative change 14% (6%–23%). NNTB: 7 (4–15) | |
Adverse events: followup 3–6 mos | 0 per 1000 | 32 per 10008 | RR 4.55 (0.53–39.31) | 309 (3 studies) | ⊕ ⊖ ⊖ ⊖very low2,6 | Absolute risk difference: 2% more events (2% fewer to 5% more). Relative difference: 355% (47% decrease to 3831% increase) |
Withdrawal due to adverse events: followup 3–6 months | 0 per 1000 | 13 per 10009 | RR 2.88 (0.30–27.18) | 309 (3 studies) | ⊕ ⊖ ⊖ ⊖very low2,6 | Absolute risk difference: 1% more events (2% fewer to 3% more). Relative difference: 188% (70% decrease to 2618% increase) |
↵* The basis for the assumed risk (e.g., the median control group risk across studies) is given below. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). GRADE Working Group levels of evidence: high quality — further research is very unlikely to change our confidence in the estimate of effect; moderate quality — further research is likely to have an important effect on our confidence in the estimate of effect and may change the estimate; low quality — further research is very likely to have an important effect on our confidence in the estimate of effect and is likely to change the estimate; very low quality — we are very uncertain about the estimate.
↵1 Control group baseline hand pain mean (SD) 3.9 (1.8) from Østerås 2014.
↵2 Downgraded because of risk of detection bias on self-reported outcomes (lack of blinding of participants).
↵3 Downgraded because of imprecision (few participants, wide CI).
↵4 Control group baseline hand function mean (SD) 14.5 (8.0) from Dziedzic 2015.
↵5 Control group baseline quality of life mean (SD) 50.4 (10.3) from Dziedzic 2015.
↵6 Downgraded 2 levels for imprecision owing to very few participants and CI crossing 0.
↵7 Control group baseline finger joint stiffness mean (SD) 4.5 (1.8) from Østerås 2014.
↵8 The few adverse events (n = 4) included increased finger joint inflammation and increased hand or shoulder/neck pain.
↵9 Adverse events leading to withdrawal included high and sustained hand pain (n = 1) or shoulder/neck pain (n = 1). RR: risk ratio; SMD: standardized mean difference; NNTB: number needed to treat for an additional beneficial outcome.