Biomechanical assessment of grasping postures in individuals with rheumatoid arthritis when holding adaptive silverware.

Introduction: Utensils with built-up handles are often recommended to minimize the required finger joint angles for functional grasping to reduce pain and help individuals with Rheumatoid Arthritis (RA) overcome participation barriers. However, there is a paucity of data describing the impact of built-up handles on range of motion (ROM) requirements of the hand. Therefore, the purpose of this study was to evaluate how built-up handles of varying thickness affect hand ROM in individuals with RA. Methods: Thirty-five individuals with RA were instructed to grasp a standard handle spoon, a 1.00 inch, and a 1.50 inch built-up handle spoon and perform a simulated eating task. Electrogoniometers were used to measure the finger joint angles of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints for digits 2-5. Results: In general, there were significant decreases in finger joint flexion as handle diameters increased. Twenty-nine of the thirty-five individuals selected the 1.50 inch handle to take home with the remainder choosing the 1.00 inch. Discussion: This study is the first to provide quantitative data to support the notion that the grasping postures required when using built-up handled spoons utilizes reduced finger joint angles for individuals with RA when compared to a standard handle spoon which could help providers when assessing patient needs and when designing hand orthoses. We recommend practitioners provide built-up handled utensils where possible, or educate people with RA on where to buy or how to make adaptive utensils, to assist the independence of individuals with RA. Conclusion: This paper supports the appropriate prescription and use of adaptive silverware by healthcare providers in the promotion of independence for individuals with RA.