Immobilization and Hand Therapy After Carpometacarpal Arthroplasty: A Systematic Review

Barrett, Patrick C.; Hackley, Darren T.; Samuel, Linsen T.; Apel, Peter J.

doi:10.1016/j.jhsg.2022.05.011

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…T herapy after thumb CMC arthroplasty remains controversial 22 . Nonetheless, IPT is still quite common 6 .…”

Section: Discussionmentioning

confidence: 99%

“…T herapy after thumb CMC arthroplasty remains controversial 22 . Nonetheless, IPT is still quite common 6 . Experienced surgeons, having witnessed successful patient outcomes with therapy, may be hesitant to stop prescribing it for fear of negative results.…”

Section: Discussionmentioning

confidence: 99%

“…The slow adoption of VOT may be due to concern regarding the loss of meaningful patient-clinician interaction, challenges in monitoring compliance, and the technological barriers that it may impose 21 . Specifically, for thumb CMC arthroplasty, 2.5% of hand surgeons reported using only a handout, video, or other patientdirected method 6 . Systematic reviews on postoperative care following thumb CMC arthroplasty have found no trials testing a VOT program 2,22 .…”

mentioning

confidence: 99%

“…Specifically, for thumb CMC arthroplasty, 2.5% of hand surgeons reported using only a handout, video, or other patientdirected method 6 . Systematic reviews on postoperative care following thumb CMC arthroplasty have found no trials testing a VOT program 2,22 . Palm et al, in a pilot study involving 30 patients undergoing thumb CMC arthroplasty, assessed the feasibility and effectiveness of synchronous telerehabilitation after arthroplasty and compared it with IPT 5 .…”

mentioning

confidence: 99%

“…Thumb carpometacarpal (CMC) arthroplasty is a common procedure, with an estimated 40,000 to 100,000 such procedures being performed annually in the United States 1 . Although the benefits of postoperative therapy are uncertain 2-5 , in-person therapy (IPT) for the hand is common, with a recent survey demonstrating that >80% of hand surgeons prescribe it 6 . While supervised IPT may help to enhance postoperative hand function for daily activities 7-9 , it can be burdensome to complete, especially for patients in rural or remote areas 10 .…”

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confidence: 99%

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Provision of a Home-Based Video-Assisted Therapy Program Is Noninferior to In-Person Hand Therapy After Thumb Carpometacarpal Arthroplasty

Barrett,

Hackley,

Yu-Shan

et al. 2024

Journal of Bone and Joint Surgery

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Background: In-person hand therapy is commonly prescribed for rehabilitation after thumb carpometacarpal (CMC) arthroplasty but may be burdensome to patients because of the need to travel to appointments. Asynchronous, video-assisted home therapy is a method of care in which videos containing instructions and exercises are provided to the patient, without the need for in-person or telemedicine visits. The purpose of the present study was to evaluate the effectiveness of providing video-only therapy (VOT) as compared with scheduled in-person therapy (IPT) after thumb CMC arthroplasty. Methods: We performed a single-site, prospective, randomized controlled trial of patients undergoing primary thumb CMC arthroplasty without an implant. The study included 50 women and 8 men, with a mean age of 61 years (range, 41 to 83 years). Of these, 96.6% were White, 3.4% were Black, and 13.8% were of Hispanic ethnicity. The primary outcome measure was the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) score. Subjects in the VOT group were provided with 3 videos of home exercises to perform. Subjects in the control group received standardized IPT with a hand therapist. Improvements in the PROMIS UE score from preoperatively to 12 weeks and 1 year postoperatively were compared. Results: Fifty-eight subjects (29 control, 29 experimental) were included in the analysis at the 12-week time point, and 54 (27 control, 27 experimental) were included in the analysis at the 1-year time point. VOT was noninferior to IPT for the PROMIS UE score at 12 weeks and 1 year postoperatively, with a difference of mean improvement (VOT − IPT) of 1.5 (95% confidence interval [CI], −3.6 to 6.6) and 2.2 (95% CI, −3.0 to 7.3), respectively, both of which were below the minimal clinically important difference (4.1). Patients in the VOT group potentially saved on average 201.3 miles in travel. Conclusions: VOT was noninferior to IPT for upper extremity function after thumb CMC arthroplasty. Time saved in commutes was considerable for those who did not attend IPT. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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“…T herapy after thumb CMC arthroplasty remains controversial 22 . Nonetheless, IPT is still quite common 6 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%