Shorter versus longer immobilization after surgery for thumb carpometacarpal osteoarthritis: a propensity score matched study

Publication date: Available online 23 April 2019

Source: Archives of Physical Medicine and Rehabilitation

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

Abstract

Objective

To investigate if shorter immobilization is non-inferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis.

Design

Prospective cohort study with propensity score matching (PSM).

Setting

Data collection took place in sixteen outpatient clinics for hand surgery and hand therapy.

Participants

131 participants with shorter immobilization and 131 participants with longer immobilization.

Intervention

Shorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14 days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks postoperatively) after Weilby procedure for CMC-1 osteoarthritis. PSM was used to control for confounders.

Main outcome measures

Outcomes were pain measured with a Visual Analogue Scale (VAS) and hand function measured with the Michigan Hand outcomes Questionnaire (MHQ) at three and twelve months. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment and return to work.

Results

No significant differences were found in VAS pain (effect size 0.03, 95% C.I. -0.21-0.27) or the MHQ (effect size 0.01, 95% C.I. -0.23-0.25) between the groups at three months or at twelve months. Furthermore, no differences were found in complication rate or in other secondary outcomes.

Conclusions

In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal compared to longer immobilization for outcomes on pain, hand function and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following CMC-1 arthroplasty.

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