Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

Robbert M Wouters*, Jonathan Tsehaie, the Hand-Wrist Study Group, Harm P Slijper, Steven E R Hovius, Reinier Feitz, Ruud W Selles

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Scopus)

Abstract

OBJECTIVE: To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.

DESIGN: Prospective cohort study with propensity score matching.

SETTING: Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands.

PARTICIPANTS: A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes.

INTERVENTIONS: Exercises and orthotics versus orthotics alone.

MAIN OUTCOME MEASURES: Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100).

RESULTS: A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).

CONCLUSIONS: Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.

Original languageEnglish
Pages (from-to)1050-1060
Number of pages11
JournalArchives of Physical Medicine and Rehabilitation
Volume100
Issue number6
DOIs
Publication statusPublished - Jun 2019

Bibliographical note

Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Research programs

  • EMC OR-01

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