Highlights
- •Randomized trial of efficacy of dynamic stability program for the base of the thumb
- •Standard conservative therapy vs standard therapy plus dynamic stability exercises
- •Small improvement in pain and QuickDASH scores for dynamic stability group
- •Significant reduction in pain and improved QuickDASH scores within each group.
Abstract
Study Design
Randomized control trial.
Introduction
Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and
disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis
and instruction in joint protection, adaptive equipment, and pain relieving modalities.
The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb
CMC.
Purpose of the Study
To investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing
pain and disability in thumb CMC OA compared to SCT alone.
Methods
The study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home
pain management instructions, joint protection strategies with adaptive equipment,
and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions
for adductor stretching and opponens and first dorsal interosseous strengthening in
addition to SCT. Our primary outcome measure was the numerical rating scale (NRS)
with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder
and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome
measurements were assessed at first visit, 6 weeks, and 6 months.
Results
There was no statistical difference between the 2 groups for NRS and QuickDASH at
6 weeks (P = .28 and P = .36, respectively) or 6 months (P = .52 and P = .97, respectively). However, there was a statistically significant decrease in NRS
and QuickDASH scores at 6 weeks and 6 months within both groups.
Conclusions
Both SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb
CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH
scores at 6-week or 6-month follow-up.
Keywords
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JHT Read for Credit
Quiz: # 861
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 was
- a.retrospective cohort
- b.RCTs
- c.case study
- d.qualitative
- a.
- # 2.The nature of the HE was
- a.soft tissue mobilization
- b.ROM improvement
- c.PNF + MFR
- d.strengthening the muscles stabilizing the CMC
- a.
- # 3.The primary outcome measure was
- a.the standard DASH
- b.a 100 point VAS
- c.NRS
- d.pinch strength
- a.
- # 4.Analyses were performed based on the
- a.ranked sum concept
- b.intention-to-treat principle
- c.maximum effort test
- d.Occam's Razor theory
- a.
- # 5.Neither program demonstrated superiority over the other
- a.true
- b.false
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: June 23, 2021
Accepted:
June 18,
2021
Received in revised form:
June 15,
2021
Received:
April 15,
2020
Footnotes
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Mayo Clinic does not endorse specific products or services included in this article.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
