Highlights
- •Standard therapy for CMC osteoarthritis with and without a stabilization home exercise program decreases pain and improves function over the course of a year.
- •Individuals with CMC osteoarthritis may benefit from individualized stabilization, stretching and strengthening exercises.
- •The role of exercise including optimal exercise selection and dosage is still under investigation.
ABSTRACT
Study Design
Randomized, interventional trial with 1 year follow-up.
Introduction
Though recommended, evidence is lacking to support specific exercises to stabilize
and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA).
Purpose of the Study
To determine in a naturalistic setting, whether standard treatment plus a home exercise
program (ST+HEP) is more effective than standard treatment (ST) alone in improving
Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other
patient-centered (pain, function) and clinical outcomes (range of motion, strength).
Methods
A total of 190 patients from a hand therapy practice in northwestern PA were enrolled
by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years,
most were female (78%) with sedentary occupations most common (36%). ST group received
orthotic interventions, modalities, joint protection education and adaptive equipment
recommendations, while the ST+HEP group received a home exercise program in addition
to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included
grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional
Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups
if desired. Efficacy data analysis included both parametric and non-parametric tests.
The threshold for statistical significance was 0.05 and adjusted for multiple comparisons.
Results
Repeated measures ANOVA failed to show a statistically significant difference in strength
and ROM assessments between treatment groups over the 12 month follow-up (P ≥ .398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups
evidenced improvement over time in most patient-focused assessments (P ≤ .011), including improvements exceeding reported clinically important differences
in pain with activity and PSFS scores. Scores for these measures were similar at each
follow-up period (P ≥ .080) in each group. The presence of CTS exerted no effect on outcomes; longer
treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those
enrolled, 48% of subjects completed the study.
Conclusions
The addition of a high-frequency home exercise program did not improve clinical or
patient-centered outcomes more so than standard care in our sample however, study
limitations are numerous. Both groups had decreased pain with activity and improved
PSFS scores, meeting the established minimally clinically important difference (MCID)
of each at 6 and 12 months. Adherence with the home program was poor and/or unknown.
Keywords
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Article info
Publication history
Published online: July 07, 2022
Accepted:
March 27,
2022
Received in revised form:
January 24,
2022
Received:
January 27,
2021
Publication stage
In Press Corrected ProofFootnotes
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
