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Background: The aim of this study was to investigate to what extent psychological factors are related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint. Methods: We included patients (n ¼ 255) at the start of non-invasive treatment for osteoarthritis of the first carpometacarpal joint who completed the Michigan Hand Outcome Questionnaire. Psychological distress, pain catastrophizing behavior and illness perception was measured. X-rays were scored on presence of scaphotrapeziotrapezoid osteoarthritis. We used hierarchical linear regression analysis to determine to what extent pain levels could be explained by patient characteristics, X-ray scores, and psychological factors. Results: Patient characteristics and X-ray scores accounted for only 6% of the variation in pre-treatment pain levels. After adding the psychological factors to our model, 47% of the variance could be explained. Conclusions: Our results show that psychological factors are more strongly related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint than patient characteristics and X-ray scores, which implies the important role of these factors in the reporting of symptoms. More research is needed to determine whether psychological factors will also affect treatment outcomes for patients treated non-invasively for osteoarthritis of the first carpometacarpal joint. ä IMPLICATIONS FOR REHABILITATION Pain is the most important complaint for patients with osteoarthritis of the first carpometacarpal joint. Psychological factors are strongly associated with pain levels prior to treatment. Pain catastrophizing behavior appears to be a promising target for complementary treatment in patients with osteoarthritis of the first carpometacarpal joint.

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Purpose Initial treatment for symptomatic carpometacarpal (CMC) osteoarthritis (OA) of the thumb is usually nonsurgical. However, evidence on the effect of a hand orthosis and hand therapy for mid-and long-term results is limited, and it is unknown how many patients undergo additional surgical treatment. Therefore, the aim of this study is to describe the outcome of a hand orthosis and hand therapy for CMC OA in a large cohort study, and to evaluate the conversion rate to surgical treatment.Methods In this multicenter, prospective cohort study, patients treated with a hand orthosis and hand therapy for primary CMC OA between 2011 and 2014 were included. Pain (visual analog scale) and function (Michigan Hand Questionnaire) were measured at baseline, 6 weeks, 3 months, and at 12 months after the start of treatment. All patients converted to surgery were recorded between 2012 and 2016. Outcome was compared with baseline, and post hoc comparisons were made between patients who were not converted to surgery and patients who were converted to surgery after initially receiving a hand orthosis and hand therapy. Lastly, subgroup analysis was performed based on baseline pain levels.Results After a mean follow-up of 2.2 AE 0.9 years, 15% of all patients were surgically treated. In the group that was not converted to surgery, pain (visual analog scale) significantly improved from 49 AE 20 at baseline to 36 AE 24 at 12 months. The Michigan Hand Questionnaire score was essentially unchanged from 65 AE 15 at baseline to 69 AE 10 at 12 months. Post hoc testing showed that improvement in pain was only significant between baseline and 6 weeks, and thereafter stabilized until 1 year after the start of treatment. The group that converted to surgery did not show any improvement in pain and function at follow-up.Conclusions In this cohort of patients with thumb CMC OA who underwent hand therapy including an orthosis, 15% of the patients underwent additional surgical treatment. The patients (85%) who did not undergo surgery improved in pain and function, although only improvements in pain were significant and clinically relevant. Most improvement was seen in the first 6 weeks and stabilized till 1 year after the start of treatment.