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

Published:October 19, 2016DOI:https://doi.org/10.1016/j.jht.2016.07.007

      Abstract

      Study Design

      Cross-sectional descriptive study.

      Introduction

      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.

      Methods

      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.

      Results

      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).

      Conclusion

      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.

      Keywords

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      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 JHTReadforCredit.com. There is only one best answer for each question.
      • #1.
        The study design is
        • a.
          RCTs
        • 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.
          surgery
        • 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.
          ASHT
        • b.
          EULAR
        • c.
          AOTA
        • d.
          IFSHT
      • #5.
        The authors were unable to identify the one most effective orthosis
        • a.
          true
        • b.
          false
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.