PMID- 35811182
OWN - NLM
STAT- Publisher
LR  - 20231019
IS  - 1545-004X (Electronic)
IS  - 0894-1130 (Linking)
VI  - 36
IP  - 3
DP  - 2023 Jul-Sep
TI  - Effect of a stabilization exercise program versus standard treatment for thumb 
      carpometacarpal osteoarthritis: A randomized trial.
PG  - 546-559
LID - S0894-1130(22)00040-0 [pii]
LID - 10.1016/j.jht.2022.03.009 [doi]
AB  - STUDY DESIGN: Randomized, interventional trial with 1 year follow-up. 
      INTRODUCTION: Though recommended, evidence is lacking to support specific 
      exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for 
      cases of osteoarthritis (OA). PURPOSE OF THE STUDY: To determine in a 
      naturalistic setting, whether standard treatment plus a home exercise program 
      (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick 
      Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other 
      patient-centered (pain, function) and clinical outcomes (range of motion, 
      strength). METHODS: A total of 190 patients from a hand therapy practice in 
      northwestern PA were enrolled by informed consent and randomized into ST or 
      ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary 
      occupations most common (36%). ST group received orthotic interventions, 
      modalities, joint protection education and adaptive equipment recommendations, 
      while the ST+HEP group received a home exercise program in addition to ST for 
      6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip 
      strength, pinch strength, range of motion (ROM), qDASH, Patient Specific 
      Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could 
      change groups if desired. Efficacy data analysis included both parametric and 
      non-parametric tests. The threshold for statistical significance was 0.05 and 
      adjusted for multiple comparisons. RESULTS: Repeated measures ANOVA failed to 
      show a statistically significant difference in strength and ROM assessments 
      between treatment groups over the 12 month follow-up (P >/= .398). Differences 
      between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced 
      improvement over time in most patient-focused assessments (P </= .011), including 
      improvements exceeding reported clinically important differences in pain with 
      activity and PSFS scores. Scores for these measures were similar at each 
      follow-up period (P >/= .080) in each group. The presence of CTS exerted no effect 
      on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS 
      scores initially. Of those enrolled, 48% of subjects completed the study. 
      CONCLUSIONS: The addition of a high-frequency home exercise program did not 
      improve clinical or patient-centered outcomes more so than standard care in our 
      sample however, study limitations are numerous. Both groups had decreased pain 
      with activity and improved PSFS scores, meeting the established minimally 
      clinically important difference (MCID) of each at 6 and 12 months. Adherence with 
      the home program was poor and/or unknown.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Pisano, Katie
AU  - Pisano K
AD  - Hand and Upper Body Rehabilitation Center, Erie, PA, USA. Electronic address: 
      k8pisano@gmail.com.
FAU - Wolfe, Terri
AU  - Wolfe T
AD  - Hand and Upper Body Rehabilitation Center, Erie, PA, USA.
FAU - Lubahn, John
AU  - Lubahn J
AD  - Hand, Microsurgery and Reconstructive Orthopaedics LLP, Erie, PA, USA.
FAU - Cooney, Timothy
AU  - Cooney T
AD  - UPMC Hamot, Erie, PA, USA.
LA  - eng
PT  - Journal Article
DEP - 20220708
PL  - United States
TA  - J Hand Ther
JT  - Journal of hand therapy : official journal of the American Society of Hand 
      Therapists
JID - 8806591
SB  - IM
OTO - NOTNLM
OT  - Basal joint arthritis (BJA)
OT  - Carpometacarpal osteoarthritis (CMC OA)
OT  - Dynamic stabilization
OT  - Hand osteoarthritis
OT  - Thumb arthritis
OT  - Trapeziometacarpal osteoarthritis (TMC OA)
EDAT- 2022/07/11 06:00
MHDA- 2022/07/11 06:00
CRDT- 2022/07/10 22:04
PHST- 2021/01/27 00:00 [received]
PHST- 2022/01/24 00:00 [revised]
PHST- 2022/03/27 00:00 [accepted]
PHST- 2022/07/11 06:00 [pubmed]
PHST- 2022/07/11 06:00 [medline]
PHST- 2022/07/10 22:04 [entrez]
AID - S0894-1130(22)00040-0 [pii]
AID - 10.1016/j.jht.2022.03.009 [doi]
PST - ppublish
SO  - J Hand Ther. 2023 Jul-Sep;36(3):546-559. doi: 10.1016/j.jht.2022.03.009. Epub 
      2022 Jul 8.