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Characterizing response to a dynamic stability modeled approach for thumb carpometacarpal joint pain: A retrospective study

Published:August 01, 2022DOI:https://doi.org/10.1016/j.jht.2022.06.010

      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)
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