Orthotic use for CMC osteoarthritis: Variations among different health professionals in Brazil

Published:October 19, 2016DOI:


      Study Design

      Cross-sectional descriptive study.


      Osteoarthritis (OA) is the most prevalent musculoskeletal disease in the adult and older adult populations. The use of orthoses to stabilize the thumb's articular complex is one of the most common conservative management strategies. Despite substantial research about this topic, there is insufficient evidence about the optimal use of orthoses to inform clinical practice, contributing to practice variations within and across health professionals.

      Purpose of the Study

      To identify the prescription patterns, design preferences, and barriers for the use of orthotic devices among Brazilian health care professionals involved in the treatment of patients with OA of the basal thumb joint.


      An electronic questionnaire was sent to occupational therapists, physiotherapists, and rheumatologists across Brazil through professional association mailing lists. Survey included questions about orthosis design, materials, and barriers to the use of orthotic interventions. Respondents indicated their use based on photographs of 25 orthoses models that were selected through bibliographic review and expert consultation. Descriptive statistics, the chi-square test for independence, and the Fisher exact test were used to compare differences among orthotic prescription preferences, barriers, and challenges observed amidst the 3 participants' professional classes.


      There was no consensus about orthotic prescription among 275 professionals who answered the survey. About 69% of participants reported the use of multiple orthosis during treatment of patients with thumb OA. Results suggest significant variations in the number of joints included and stabilization strategies adopted, with a preference for orthotics made in rigid materials and involving the wrist, carpometacarpal, and metacarpophalangeal joints (P < .001). The lack of knowledge about orthotic options, institutional regulations, and policies were the major barriers reported by respondents (P < .01).


      A plentiful variety of different orthoses designs were observed in this study, and the prescriptions made by 3 professional classes showed differences regarding types of stabilization, joint involvement, and positioning. Despite the existence of clinical trials suggesting benefits for specific custom-made design models, our results indicated widespread clinical variation in practices and preferences.

      Level of Evidence

      Not applicable.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Therapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Turkiewicz A.
        • Petersson I.F.
        • Bjork J.
        • et al.
        Current and future impact of osteoarthritis on health care: a population-based study with projections to year 2032.
        Osteoarthritis Cartilage. 2014; 22: 1826-1832
        • Bijlsma J.W.
        • Berenbaum F.
        • Lafeber F.P.
        Osteoarthritis: an update with relevance for clinical practice.
        Lancet. 2011; 377: 2115-2126
        • Wilder F.V.
        • Barrett J.P.
        • Farina E.J.
        Joint-specific prevalence of osteoarthritis of the hand.
        Osteoarthritis Cartilage. 2006; 14: 953-957
        • Dahaghin S.
        • Bierma-Zeinstra S.M.
        • Ginai A.Z.
        • Pols H.A.
        • Hazes J.M.
        • Koes B.W.
        Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study).
        Ann Rheum Dis. 2005; 64: 682-687
        • Abraham A.M.
        • Pearce M.S.
        • Mann K.D.
        • Francis R.M.
        • Birrell F.
        Population prevalence of ultrasound features of osteoarthritis in the hand, knee and hip at age 63 years: the Newcastle thousand families birth cohort.
        BMC Musculoskelet Disord. 2014; 15: 162
        • Beasley J.
        Therapist's examination and conservative management of arthritis of the upper extremity.
        in: Rehabilitation of the Hand and Upper Extremity. Vol. 2. Elsevier Mosby, Philadelphia, PA2011: 1330-1343
        • Hochberg M.C.
        • Altman R.D.
        • April K.T.
        • et al.
        American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.
        Arthritis Care Res (Hoboken). 2012; 64: 465-474
        • O'Brien V.H.
        • McGaha J.L.
        Current practice patterns in conservative thumb CMC joint care: survey results.
        J Hand Ther. 2014; 27: 14-22
        • Spaans A.J.
        • van Minnen L.P.
        • Kon M.
        • Schuurman A.H.
        • Schreuders A.R.
        • Vermeulen G.M.
        Conservative treatment of thumb base osteoarthritis: a systematic review.
        J Hand Surg Am. 2015; 40: 16-21.e1-e6
        • Malcus-Johnson P.
        • Carlqvist C.
        • Sturesson A.L.
        • Eberhardt K.
        Occupational therapy during the first 10 years of rheumatoid arthritis.
        Scand J Occup Ther. 2005; 12: 128-135
        • Sillem H.
        • Backman C.L.
        • Miller W.C.
        • Li L.C.
        Comparison of two carpometacarpal stabilizing splints for individuals with thumb osteoarthritis.
        J Hand Ther. 2011; 24 (quiz 126; discussion 227-230): 216-225
        • Kjeken I.
        • Smedslund G.
        • Moe R.H.
        • Slatkowsky-Christensen B.
        • Uhlig T.
        • Hagen K.B.
        Systematic review of design and effects of splints and exercise programs in hand osteoarthritis.
        Arthritis Care Res (Hoboken). 2011; 63: 834-848
        • Neumann D.A.
        • Bielefeld T.
        The carpometacarpal joint of the thumb: stability, deformity, and therapeutic intervention.
        J Orthop Sports Phys Ther. 2003; 33: 386-399
        • Weiss S.
        • LaStayo P.
        • Mills A.
        • Bramlet D.
        Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment.
        J Hand Ther. 2000; 13: 218-226
        • Boustedt C.
        • Nordenskiold U.
        • Lundgren Nilsson A.
        Effects of a hand-joint protection programme with an addition of splinting and exercise: one year follow-up.
        Clin Rheumatol. 2009; 28: 793-799
        • Bani M.A.
        • Arazpour M.
        • Hutchins S.W.
        • Layeghi F.
        • Bahramizadeh M.
        • Mardani M.A.
        A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: an orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis.
        Prosthet Orthot Int. 2014; 38: 79-82
        • Bani M.A.
        • Arazpour M.
        • Kashani R.V.
        • Mousavi M.E.
        • Hutchins S.W.
        Comparison of custom-made and prefabricated neoprene splinting in patients with the first carpometacarpal joint osteoarthritis.
        Disabil Rehabil Assist Technol. 2013; 8: 232-237
        • Bani M.A.
        • Arazpour M.
        • Kashani R.V.
        • Mousavi M.E.
        • Maleki M.
        • Hutchins S.W.
        The effect of custom-made splints in patients with the first carpometacarpal joint osteoarthritis.
        Prosthet Orthot Int. 2013; 37: 139-144
        • Gomes Carreira A.C.
        • Jones A.
        • Natour J.
        Assessment of the effectiveness of a functional splint for osteoarthritis of the trapeziometacarpal joint on the dominant hand: a randomized controlled study.
        J Rehabil Med. 2010; 42: 469-474
        • Hermann M.
        • Nilsen T.
        • Eriksen C.S.
        • Slatkowsky-Christensen B.
        • Haugen I.K.
        • Kjeken I.
        Effects of a soft prefabricated thumb orthosis in carpometacarpal osteoarthritis.
        Scand J Occup Ther. 2014; 21: 31-39
        • Rannou F.
        • Dimet J.
        • Boutron I.
        • et al.
        Splint for base-of-thumb osteoarthritis: a randomized trial.
        Ann Intern Med. 2009; 150: 661-669
        • Poole J.U.
        • Pellegrini Jr., V.D.
        Arthritis of the thumb basal joint complex.
        J Hand Ther. 2000; 13: 91-107
        • Colditz J.C.
        The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.
        J Hand Ther. 2000; 13: 228-235
        • Kjeken I.
        • Darre S.
        • Smedslund G.
        • Hagen K.B.
        • Nossum R.
        Effect of assistive technology in hand osteoarthritis: a randomised controlled trial.
        Ann Rheum Dis. 2011; 70: 1447-1452
        • Maddali-Bongi S.
        • Del Rosso A.
        • Galluccio F.
        • Sigismondi F.
        • Matucci-Cerinic M.
        Is an intervention with a custom-made splint and an educational program useful on pain in patients with trapeziometacarpal joint osteoarthritis in a daily clinical setting?.
        Int J Rheum Dis. 2016; 19: 773-780
        • Wajon A.
        • Ada L.
        No difference between two splint and exercise regimens for people with osteoarthritis of the thumb: a randomised controlled trial.
        Aust J Physiother. 2005; 51: 245-249
        • Egan M.Y.
        • Brousseau L.
        Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence.
        Am J Occup Ther. 2007; 61: 70-78
        • Kloppenburg M.
        Hand osteoarthritis—nonpharmacological and pharmacological treatments.
        Nat Rev Rheumatol. 2014; 10: 242-251
        • Bertozzi L.
        • Valdes K.
        • Vanti C.
        • Negrini S.
        • Pillastrini P.
        • Villafane J.H.
        Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.
        Disabil Rehabil. 2015; 37: 1-19
        • Zhang W.
        • Doherty M.
        • Leeb B.F.
        • et al.
        EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).
        Ann Rheum Dis. 2007; 66: 377-388
        • Morris C.
        • Newdick H.
        • Johnson A.
        Variations in the orthotic management of cerebral palsy.
        Child Care Health Dev. 2002; 28: 139-147
        • Sneed R.C.
        • May W.L.
        • Stencel C.
        Policy versus practice: comparison of prescribing therapy and durable medical equipment in medical and educational settings.
        Pediatrics. 2004; 114: e612-e625
        • Hill S.
        • Dziedzic K.S.
        • Nio Ong B.
        Patients' perceptions of the treatment and management of hand osteoarthritis: a focus group enquiry.
        Disabil Rehabil. 2011; 33: 1866-1872
        • Buurke J.H.
        • Grady J.H.
        • de Vries J.
        • Baten C.T.
        Usability of thenar eminence orthoses: report of a comparative study.
        Clin Rehabil. 1999; 13: 288-294
        • American Society of Hand Therapists
        A Splint Classification System.
        American Society of Hand Therapists, Chicago, IL1992
        • Ford M.
        • McKee P.
        • Szilagyi M.
        A hybrid thermoplastic and neoprene thumb metacarpophalangeal joint orthosis.
        J Hand Ther. 2004; 17: 64-68
        • Trujillo L.G.
        • Amini D.
        Creating a custom fabricated neoprene orthosis for optimal thumb positioning.
        J Hand Ther. 2013; 26 (quiz 368): 365-368
        • Weiss S.
        • Lastayo P.
        • Mills A.
        • Bramlet D.
        Splinting the degenerative basal joint: custom-made or prefabricated neoprene?.
        J Hand Ther. 2004; 17: 401-406
        • McKee P.
        • Rivard A.
        Orthoses as enablers of occupation: client-centred splinting for better outcomes.
        Can J Occup Ther. 2004; 71: 306-314
        • Butler K.
        • Svens B.
        A functional thumb metacarpal extension blocking splint.
        J Hand Ther. 2005; 18: 375-377
        • Wajon A.
        Clinical splinting successes: the thumb “strap splint” for dynamic instability of the trapeziometacarpal joint.
        J Hand Ther. 2000; 13: 236-237
        • Beasley J.
        Therapist's evaluation and conservative management of arthritis of the upper extremity.
        in: Skirven T.M. Osterman A.L. Fedorczyk J.M. Amadio A.C. Rehabilitation of the Hand and Upper Extremity. Vol 2. 6th ed. Elsevier Mosby, St. Louis2011: 1330-1343
        • Cohen J.W.
        Statistical Power Analysis for the Behavioral Sciences.
        2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Beasley J.
        Osteoarthritis and rheumatoid arthritis: conservative therapeutic management.
        J Hand Ther. 2012; 25 (quiz 172): 163-171
        • Hamann N.
        • Heidemann J.
        • Heinrich K.
        • et al.
        Stabilization effectiveness and functionality of different thumb orthoses in female patients with first carpometacarpal joint osteoarthritis.
        Clin Biomech (Bristol, Avon). 2014; 29: 1170-1176
        • Basford J.R.
        • Johnson S.J.
        Form may be as important as function in orthotic acceptance: a case report.
        Arch Phys Med Rehabil. 2002; 83: 433-435
        • Borg J.
        • Ostergren P.O.
        Users' perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers.
        Disabil Rehabil Assist Technol. 2015; 10: 301-308
        • Rios A.
        • Miguel Cruz A.
        • Guarin M.R.
        • Caycedo Villarraga P.S.
        What factors are associated with the provision of assistive technologies: the Bogota D.C. case.
        Disabil Rehabil Assist Technol. 2014; 9: 432-444
        • Simoens S.
        • Guillaume P.
        • Moldenaers I.
        • et al.
        International comparison of orthotic brace prices.
        Eur J Health Econ. 2009; 10: 149-155
        • Caro C.C.
        • Faria P.S.
        • Bombarda T.B.
        • Ferrigno I.S.V.
        • Palhares M.S.
        Orthotics, prosthesis and mobility aids (OPM) dispensation in the Regional Health Department of the 3rd Region.
        Cadernos de Terapia Ocupacional da UFSCar. 2014; 22: 521-529
        • Simoens S.
        • Debruyne H.
        • Moldenaers I.
        • et al.
        Do tariffs and prices correspond with costs? A case study of orthotic braces.
        J Med Econ. 2008; 11: 245-254
        • McDonald H.N.
        • Dietrich T.
        • Townsend A.
        • Li L.C.
        • Cox S.
        • Backman C.L.
        Exploring occupational disruption among women after onset of rheumatoid arthritis.
        Arthritis Care Res (Hoboken). 2012; 64: 197-205
        • Lim A.Y.
        • Doherty M.
        What of guidelines for osteoarthritis?.
        Int J Rheum Dis. 2011; 14: 136-144

      JHT Read for Credit

      Quiz: #441

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The study design is
        • a.
        • b.
          cross sectional descriptive
        • c.
          case series
        • d.
          case study
      • #2.
        According to the authors _________________ is the most common intervention for thumb CMC arthritis
        • a.
          joint protection
        • b.
        • c.
          cast immobilization
        • d.
          static orthotic immobilization
      • #3.
        Data was collected using
        • a.
          chart reviews
        • b.
          patient interviews
        • c.
          an electronic questionnaire
        • d.
          a meta analysis
      • #4.
        The authors site only one guideline with specific instructions. It is attributed to the
        • a.
        • b.
        • c.
        • d.
      • #5.
        The authors were unable to identify the one most effective orthosis
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.