Highlights
- •Less pain and disability after hand therapy with a dynamic stabilization approach
- •Clients with unilateral thumb pain improved more than those with bilateral pain
- •Persons in early radiographic stages had more functional gains than late stages
- •Persons with higher pain levels improved more than those with lower pain levels
Abstract
Study Design
Retrospective case series.
Introduction
Literature trends indicate that thumb dynamic stabilization may benefit clients with
thumb carpometacarpal (CMC) joint pain and arthritis. There is minimal research investigating
whether client characteristics predict responsiveness to hand therapy for thumb dynamic
stabilization.
Purpose of the Study
1) To investigate how adults with thumb CMC joint pain responded to a hand therapy
dynamic stabilization modeled intervention. 2) To determine if various client factors
influenced responsiveness and to what extent.
Methods
An electronic medical record search identified adults treated from August 2009 through
December 2015 for thumb CMC joint pain. Radiographs were retrospectively staged. Outcome
measures were 1) Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) total
disability score and 2) Numerical Pain Rating Scale (NPRS). Paired t-tests were performed to compare pre and post treatment measures. Multivariate analyses
were used to investigate predictive factors.
Results
A total of 249 charts were analyzed. Large overall significant effects were noted
for disability score (QuickDASH P <.001, X = 12.1, Cohen's d = 0.9). The average improvement of 2.1 (SD = 2.6) points exceeded the minimal clinically important difference (MCID) of 1.7
points on the NPRS pain scale. Significant predictors of QuickDASH Scores were radiographic
staging, bilateral hand involvement and initial pain ratings. Significant predictors
for change in pain scores (meeting or exceeding the minimal clinically important difference
for the NPRS) were bilateral thumb involvement and initial “pain at worst” rating.
Conclusion
After completing hand therapy with a dynamic stabilization approach, clients had less
pain and disability. Those who had unilateral thumb pain, or those who started with
higher pain levels were most likely to have clinically meaningful improvements in
pain. Clients in early CMC osteoarthritis (OA) stages responded better than those
in later stages, indicating that early referral to therapy is important.
Keywords
Abbreviations:
MCID (minimal clinically important difference), NPRS (Numerical Pain Rating Scale), CMC (carpometacarpal), MP (metacarpophalangeal), AdP (adductor pollicis), OP (opponens pollicis), 1st DI (1st dorsal interosseous), EPB (extensor pollicis brevis), AE (adaptive equipment), JPE (joint protection education), IP (interphalangeal), APB (abductor pollicis brevis), APL (abductor pollicis longus)To read this article in full you will need to make a payment
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JHT Read for Credit
Quiz: # 869
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.qualitative
- b.RCTs
- c.case study
- d.case series
- a.
- # 2.Improvement scores
- a.were significantly better using the NPRS than the QuickDASH
- b.were not significant
- c.met the criteria for MCID
- d.exceeded all author expectations
- a.
- # 3.Data were gathered from
- a.chart reviews
- b.patient interviews
- c.therapist interviews
- d.videography of therapy sessions
- a.
- # 4.The clinical techniques of dynamic stabilizing were
- a.alluded to, but not described in sufficient detail to allow clinical application
- b.well described in order to be followed by readers of the article
- c.based on the concepts of Mennell and Cyriax
- d.based on the concepts of Colditz et al
- a.
- # 5.The authors advocate for early hand therapy intervention
- a.false
- b.true
- 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: August 01, 2022
Accepted:
June 20,
2022
Received in revised form:
June 3,
2022
Received:
January 21,
2022
Footnotes
Conflicts of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Funding: This research was supported by the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health's National Center for Advancing Translational Sciences. This research was approved by the University of Minnesota Institutional Review Board (study number 1702M07481).
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