TY - JOUR
T1 - Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis
T2 - A Cohort Study
AU - Esteban Lopez, Lisa M.J.
AU - Hoogendam, Lisa
AU - Vermeulen, Guus M.
AU - Tsehaie, Jonathan
AU - Slijper, Harm P.
AU - the Hand-Wrist Study Group
AU - Selles, Ruud W.
AU - Wouters, Robbert M.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/12/6
Y1 - 2023/12/6
N2 - Background:Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at & gt;5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at & gt;5 years of follow-up and the rate of conversion to surgery.Methods:This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and & gt;5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217).Results:At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At & gt;5 years, 5% of the patients rated their satisfaction as & quot;poor,& quot; 14% as & quot;moderate,& quot; 26% as & quot;fair,& quot; 39% as & quot;good,& quot; and 16% as & quot;excellent.& quot; The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years).Conclusions:We found positive outcomes at & gt;5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable.Level of evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
AB - Background:Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at & gt;5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at & gt;5 years of follow-up and the rate of conversion to surgery.Methods:This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and & gt;5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217).Results:At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At & gt;5 years, 5% of the patients rated their satisfaction as & quot;poor,& quot; 14% as & quot;moderate,& quot; 26% as & quot;fair,& quot; 39% as & quot;good,& quot; and 16% as & quot;excellent.& quot; The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years).Conclusions:We found positive outcomes at & gt;5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable.Level of evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
UR - http://www.scopus.com/inward/record.url?scp=85179478831&partnerID=8YFLogxK
U2 - 10.2106/JBJS.22.01116
DO - 10.2106/JBJS.22.01116
M3 - Article
C2 - 37903291
AN - SCOPUS:85179478831
SN - 0021-9355
VL - 105
SP - 1837
EP - 1845
JO - Journal of Bone and Joint Surgery
JF - Journal of Bone and Joint Surgery
IS - 23
ER -