Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial

Pisano, Katie; Wolfe, Terri L.; Lubahn, John D.; Cooney, Timothy E.

doi:10.1016/j.jht.2022.03.009

Cited by 6 publications

(7 citation statements)

References 39 publications

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“…Subsequent screening of titles and abstracts resulted in 29 eligible publications for full-text assessment. Fifteen studies did not satisfy the inclusion criteria and fourteen RCTs were finally included [19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The flow chart of the study selection is presented in Figure 1.…”

Section: Studies Selectionmentioning

confidence: 99%

“…The diagnosis of thumb CMCJ OA was confirmed using the radiographic Eaton-Littler Classification or the Modified Kellgren-Lawrence grade scale (grades 0-4, 0 = no OA) [33,34]. Three studies included patients with CMCJ OA grade 1 to 4 [26,29,32], four studies with grade 1 to 3 [20,22,23,27], three studies with grade 3 or 4 [23,27,28], two studies with grade 2 to 4 [30,31], two studies with grade 1 or 2 [21,28] and one study with grade 3 [24]. A detailed description of the study characteristics and main results are shown in Table 1.…”

Section: Participantsmentioning

confidence: 99%

“…Exercise as an intervention was used alone or in combination with a multimodal physiotherapy programme [20][21][22][26][27][28][29][30] and orthotic devices [20,22,23,[25][26][27]32]. Eight trials evaluated the use of exercises against a multimodal therapeutic programme [20][21][22][23]26,27,30,31], another exercise programme [19,24], no treatment [29,32], joint protection alone [25] or corticosteroid injections [28]. Exercise-based therapy programmes were used for between 2 and 12 weeks.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Exercise-based therapy programmes were used for between 2 and 12 weeks. Nine of the eligible trials evaluated the use of proprioceptive exercise programmes [19][20][21][22][23][24][25][26][27]. Three of the eligible trials evaluated the use of mobility and strengthening exercises while two trials focused on the use of neurodynamic exercises (Table 1).…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Nine RCTs [20][21][22][23][24][25]27,30,31] compared proprioceptive exercises with standard therapy for thumb CMCJ OA. The outcomes were assessed at very short-, short-, mid-and longterm follow-up times.…”

Section: Proprioceptive Exercises Compared With Standard Treatmentmentioning

confidence: 99%

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Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Karanasios,

Mertyri,

Karydis

et al. 2024

Healthcare

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Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: −21.91; 95% confidence interval [CI]: −36.59, −7.24; p = 0.003) and wrist disability (MD: −8.1, 95% CI: −4.6, −11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: −0.76; 95% CI: −1.30, −0.21; p = 0.007) and short-term (SMD: −0.93; 95% CI: −1.86, −0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: −0.94; 95% CI: −1.68, −0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.

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Section: Studies Selectionmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Description Of the Studiesmentioning

confidence: 99%

Section: Description Of the Studiesmentioning

confidence: 99%

Section: Proprioceptive Exercises Compared With Standard Treatmentmentioning

confidence: 99%

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Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Karanasios,

Mertyri,

Karydis

et al. 2024

Healthcare

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Osteoarthritis Year In Review 2024: Rehabilitation and outcomes

Lawford,

Bennell,

Haber

et al. 2024

Osteoarthritis and Cartilage

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What Are the Most Clinically Effective Nonoperative Interventions for Thumb Carpometacarpal Osteoarthritis? An Up-to-date Systematic Review and Network Meta-analysis

Thakker,

Ramchandani,

Divall

et al. 2024

Clin Orthop Relat Res

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Background Thumb carpometacarpal osteoarthritis (CMC-1 OA) is a common and debilitating condition, particularly among older adults and women. With the aging population, the prevalence of CMC-1 OA is expected to rise, emphasizing the need to find effective nonoperative strategies. So far, for determining the most effective nonoperative interventions in CMC-1 OA, two network meta-analyses (NMAs) have been published. However, these NMAs were limited to specific intervention types: one comparing multiple splints and the other comparing different intraarticular injections. Therefore, an NMA that compared all nonoperative intervention types is urgently needed. Questions/purposes This study aimed to assess and compare the effectiveness of available nonoperative interventions (both nonpharmacologic and pharmacologic) for CMC-1 OA to establish which nonoperative options are more effective than control in terms of (1) pain, (2) function, and (3) grip strength. Methods We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) NMA guidelines (PROSPERO: CRD2021272247) and conducted a comprehensive search across Medline, Embase, CENTRAL, and CINAHL up to March 2023. We included randomized controlled trials (RCTs) and quasi-RCTs evaluating nonoperative interventions for symptomatic CMC-1 OA, excluding inflammatory or posttraumatic arthritis. Studies comparing ≥ 2 interventions or against a control, focusing on pain reduction, functional improvement, and grip strength, were selected. We assessed methodologic quality using the modified Coleman Methodology Score, including only studies scoring > 70. Risk of bias was evaluated with the Risk of Bias 2.0 tool, and evidence quality with Confidence in Network Meta-Analysis (CINeMA). Of 29 screened studies, 22 (21 RCTs and one quasi-RCT) were included, involving 1631 women and 331 men. We analyzed eight different nonoperative interventions, including splints, hand exercises, injections, and multimodal treatment (≥ 2 nonpharmacologic interventions or nonpharmacologic with a pharmacologic intervention). Six studies had a low risk of bias, eight had a high risk, and the remainder were moderate. We extracted mean and SD scores, and NMA and pairwise analyses were performed at short- (≤ 3 months) and medium-term (> 3 to ≤ 12 months) time points. Standardized mean differences were re-expressed into common units for interpretation, which were the VAS (range 0 to 10) for pain, the DASH test (range to 100) for function, and pounds for grip strength. Clinical recommendations were considered strong if the mean differences exceeded the minimum clinically important difference—1.4 points for VAS, 10 points for DASH, and 14 pounds for grip strength—and were supported by moderate or high confidence in the evidence, as assessed using CINeMA methodology. Results Our NMA (based on moderate or high confidence) showed a clinically important reduction in pain at the short-term time point for multimodal treatment and hand exercises versus control (mean difference VAS score -5.3 [95% confidence interval (CI) -7.6 to -3.0] and -5.0 [95% CI -8.5 to -1.5]). At the medium-term time point, only the rigid carpometacarpal-metacarpophalangeal (CMC-MCP) splint was superior to control (mean difference VAS score -1.9 [95% CI -3.1 to -0.6]) and demonstrated clinical importance. For function, only the rigid CMC-MCP splint demonstrated a clinically important improvement at the medium-term time point versus control (mean difference DASH score -11 [95% CI -21 to -1]). Hand exercises resulted in a clinically important improvement in short-term grip strength versus control (mean difference 21 pounds [95% CI 11 to 31]). Conclusion This systematic review and NMA show that multimodal treatment and hand exercises reduce short-term pain and improve grip strength, while a rigid CMC-MCP splint enhances medium-term function. Future research should evaluate long-term efficacy. Level of Evidence Level I, therapeutic study.

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Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial

Cited by 6 publications

References 39 publications

Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Osteoarthritis Year In Review 2024: Rehabilitation and outcomes

What Are the Most Clinically Effective Nonoperative Interventions for Thumb Carpometacarpal Osteoarthritis? An Up-to-date Systematic Review and Network Meta-analysis

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