A self-managed exercise therapy program for wrist osteoarthritis: study protocol for a randomized controlled trial

Abstract

Background Post-traumatic wrist osteoarthritis (OA) may eventually lead to pain, muscular weakness, and stiffness of the wrist, which can affect the function of the entire upper limb and cause reduced quality of life. Although there is strong evidence that all patients with OA should be offered adequate education and exercises as a first-line treatment, an effective self-management program, including structured education and therapeutic exercises, has not yet been introduced for individuals with wrist OA. The purpose of this study is to describe a self-managed exercise therapy program with joint protective strategies to improve neuromuscular control and to investigate if this exercise therapy program is more effective in reducing pain and improving function, compared to a training program with range of motion exercises, for individuals with wrist OA. Methods This is a study protocol that describes a single-blinded randomized controlled trial (RCT) in patients with symptomatic and radiographically confirmed wrist OA with two treatment arms. The participants will randomly be assigned either to a neuromuscular exercise therapy program or to a training program with range of motion exercises only. Participants in both groups will receive a wrist orthosis and structured education on wrist anatomy, pathophysiology, and joint protective self-management strategies. The programs consist of home exercises that will be performed twice a day for 12 weeks. The Patient-Rated Wrist Evaluation (PRWE) is the primary outcome measure of pain and function. Wrist Range of Motion (ROM), grip strength, the Numeric Pain Rating scale (NPRS), Disabilities of the Arm, Shoulder, and Hand (DASH), the General Self-Efficacy Scale (GSES), Global Rating of Change (GROC) and conversion to surgery are the secondary measures of outcome. Assessments will be performed at baseline and at 3, 6, and 12 months after baseline by a blinded assessor. Discussion The results from this study can add new knowledge about the effectiveness of a self-managed exercise therapy program on pain and function for individuals with wrist OA. If this self-management program proves to be efficient, it can redefine current treatment strategies and may be implemented in wrist OA treatment protocols. Trial registration: ClinicalTrials.gov, NCT05367817. Retrospectively registered on 27 April 2022. https://clinicaltrials.gov.