Exercise therapy in addition to an orthosis reduces pain more than an orthosis alone in patients with thumb base osteoarthritis: a propensity score matching study

Publication date: Available online 11 December 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): R.M. Wouters, J. Tsehaie, H.P. Slijper, S.E.R. Hovius, R. Feitz, Hand-Wrist Study Group, R.W. Selles

Abstract

Objective

To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with thumb base (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.

Design

Prospective cohort study with propensity score matching

Setting

Data collection took place in thirteen outpatient clinics for hand surgery and hand therapy in the Netherlands.

Participants

A consecutive, population-based sample of 173 patients with CMC-1 OA was included in this study of which 84 were matched on baseline demographics and baseline primary outcomes.

Interventions

Exercises and orthotics versus orthotics alone.

Main Outcome Measure(s)

Primary outcomes included pain and hand function at three months, measured using Visual Analogue Scales (0-100, VAS) and the Michigan Hand outcomes Questionnaire (0-100, MHQ).

Results

A larger decrease in VAS pain at rest (11.1 points difference, 95% Confidence interval(CI): 1.9, 20.3, p=0.002) and during physical load (22.7 points difference, 95% CI: 13.6, 31.0, p<0.001,) was found in the exercise + orthotic group compared to the orthotic group. Additionally, larger improvement was found for the MHQ subscales pain, work performance, aesthetics and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scapho-trapezio-trapezoid OA, VAS pain at rest, heavy physical labor and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).

Conclusions

Conservative treatment for patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.

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