Therapy management of thumb carpometacarpal osteoarthritis: Exploring UK therapists’ perceptions of joint instability

Abstract

Introduction: Carpometacarpal joint osteoarthritis is a common and painful condition associated with ligament laxity, subluxation and joint instability. Therapy management includes several interventions targeting the symptoms associated with instability and subluxation. This study aimed to explore the perceptions of experienced therapists, about their understanding of joint instability in carpometacarpal joint osteoarthritis and its relationship with laxity, subluxation and strength, and the perceived effectiveness of exercise interventions. Methods: A qualitative research design, consisting of individual semi-structured interviews was conducted with nine therapists. Interviews were transcribed and analysed using a thematic analysis. Results: Three themes were identified: (a) relationships between instability and laxity-the terms laxity and instability were often used interchangeably. Instability was associated with laxity, subluxation and disease progression, and was perceived to be a problem that includes the whole thumb column; (b) clinical reasoning by stage of disease-conflicting opinions were expressed regarding instability being present in pre-arthritic lax joints, early disease or all stages of disease; (c) the role of exercise in management-there was disagreement as to whether instability could be modified by developing muscle strength, or whether treatment should be focussed on compensating for instability. Conclusion: Different perceptions of instability were reflected in wide-ranging opinions regarding the need to manage instability, and regarding the potential for altering instability. The impact of instability on function, and the concept of instability were not easily identified. A clearer definition of instability would facilitate the development and assessment of interventions for instability.

A qualitative study exploring clinicians’ views on clinical trials in thumb carpometacarpal joint osteoarthritis

“…A study by Grant 11 described the wide variety of interventions but did not explore the approach to management by therapists. Our findings resonate with Jansen et al, 9 who highlighted the importance of a ‘package of care’ in treating thumb CMCJ OA. Clinicians also described how the steroid injection should be delivered as part of a package of care and not in isolation.…”

“…Previous studies indicate the necessity of well controlled pain levels to enable or start exercises in this patient population. 9 This is consistent with what we identified that earlier use of steroid injections would help people engage with exercises better by relieving the pain. Surgery being seen as a ‘last resort’ resonates with the BSSH guidance: 20 Moreover, it reflects the ladder approach with surgery being the most invasive option with risks and complications.…”

“…Other studies in this area have included a sample size ranging from three to nine participants. 9,16 Between 2020 and 2021, BD conducted online interviews with surgeons and therapists on the Teams platform (Microsoft, USA). Despite being a surgeon, BJFD feels that he is in a position of equipoise regarding the role of surgical and non-surgical interventions in CMCJ OA, although it must be acknowledged that researchers inevitably bring their personal experiences and views into the analysis.…”

“…Other studies in this area have included a sample size ranging from three to nine participants. 9 , 16 …”

“…4 There is a limited qualitative research exploring the impact of thumb CMCJ OA. [6][7][8] A small number of qualitative studies have been carried out relating to therapists' perceptions of CMCJ OA: these studies have focused on joint instability 9 and referral process, assessment, and effectiveness of particular interventions. 10,11 There are no qualitative studies that have explored clinicians' approach to managing CMCJ OA.…”