Mobilisation or immobilisation-based treatments for first carpometacarpal joint osteoarthritis: A systematic review and meta-analysis with subgroup analyses

Abstract

Introduction Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this review was to establish whether either intervention reduced pain and improved pinch strength in people with first CMCJ OA in the short term and assess whether one intervention is superior to the other. Method This was a systematic review and meta-analysis. Seven databases were searched until May 2021. Only RCTs were included. The Cochrane Risk of Bias Tool and the Grade of Recommendations Assessment, Development and Evaluation system were utilised to rate the evidence. Random-effects meta-analysis with subgroup analyses were used. Results Eight studies were included with a total of 417 participants. Mobilisation treatments included manual therapy with or without exercise while immobilisation interventions utilised thumb splinting with several different designs. Very low-quality and low-quality evidence showed that mobilisation led to statistically but not clinically significant improvements in pain (standardised mean difference (SMD) = 0.53; 95% confidence interval (CI) = 0.03 to 1; I2 = 60%; p = 0.06) and pinch strength (SMD = 0.35; 95% CI = 0.03 to 0.7; I2 = 12%; p = 0.3) compared to placebo. Very low-quality and low-quality evidence showed no effect on pain and pinch strength compared to a control or no intervention. Subgroup analyses revealed no difference between interventions. Discussion Neither mobilisation nor immobilisation alone led to clinically important improvements in pain or pinch strength in the short term in people with symptomatic first CMCJ OA. Neither therapeutic strategy appeared to be superior.

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

“…Con-sidering the objectives of the present review, a direct overall comparison between our results with the systematic reviews that do not contain an active component is difficult. Nevertheless, our findings are in agreement with two previous systematic reviews and meta-analyses that suggested low and very low certainty of evidence for the superiority of unimodal or multimodal physiotherapy interventions including exercises in thumb CMCJ OA in pain and function in the short term [5,41]. However, the results of these reviews should be interpreted with caution because both studies included only three RCTs that evaluated the use of exercises in thumb CMCJ OA.…”

The effectiveness of exercises in patients with thumb carpometacarpal osteoarthritis: a study protocol for a systematic review and meta-analysis

“…be interpreted with caution because functional outcomes were not included. 26 Another systematic review has advocated the superiority of unimodal or multimodal physiotherapy interventions including exercises in CMC OA; however, their literature search was conducted seven years ago and several recently published studies have not been considered. 6 Also, comparisons between physiotherapy with or without exercises against different types of injections remains inconclusive.…”