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.

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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.

Arch Phys Med Rehabil. 2018 Dec 10;:

Authors: Wouters RM, Tsehaie J, Slijper HP, Hovius SER, Feitz R, Hand-Wrist Study Group, Selles RW

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.

PMID: 30543802 [PubMed - as supplied by publisher]

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