Predicting outcome after hand orthosis and hand therapy for thumb carpometacarpal osteoarthritis; a prospective study

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jonathan Tsehaie, Kim R. Spekreijse, Robbert M. Wouters, Reinier Feitz, Steven Hovius, Harm Slijper, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objective

1 to identify predictive factors for outcome after splinting and hand therapy for CMC OA and to identify predictive factors for conversion to surgical treatment, and 2) to determine how many patients that have not improved in outcome within six weeks after start of treatment will eventually improve after three months.

Design

Observational prospective multi-center cohort study.

Setting

& participants: Between 2011 and 2014, 809 patients with CMC OA received splinting and weekly hand therapy for three months.

Intervention

Not applicable

Main outcome measures

Satisfaction and pain were measured with a visual analog

scale and function with the Michigan Hand Questionnaire at baseline, six weeks and three months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after three months and for conversion to surgery.

Results

Multivariable regression model explained 34-42% of the variance in outcome (p<0.001) with baseline satisfaction, pain and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically-relevant improvement in pain and function after six weeks, 73-83% also had no clinically-relevant improvement after three months.

Conclusion

This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after six weeks of therapy, when levels of improvement are still mainly unsatisfactory.

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