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

Wouters, Robbert M.; Tsehaie, Jonathan; Slijper, Harm P.; Hovius, Steven E.R.; Feitz, Reinier; Selles, Ruud W.

doi:10.1016/j.apmr.2018.11.010

Cited by 27 publications

(32 citation statements)

References 43 publications

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“…In our country, specialties of PRM, rheumatology (both internal medicine and PRM), pain medicine, and hand surgery (orthopedics/plastic surgery) are mainly interested in hand OA. Non-pharmacological options such as education, exercises, splinting, and paraffin, [13][14][15]21 or pharmacological interventions such as topical and systemic non-steroidal anti-inflammatory drugs (NSAIDs), local injections, and surgical procedures 11,12,36 should be considered in the management of hand OA.…”

Section: Overarching Principlesmentioning

confidence: 99%

“…Education is an effective and safe nonpharmacological intervention, particularly when combined with other modalities such as splinting and exercises. [13][14][15] Recommendation 2: Exercise should be considered for all patients to enhance function and muscle strength in addition to reducing pain.…”

Section: Recommendationsmentioning

confidence: 99%

“…Therefore, the 2018 EULAR hand OA update management recommendation guideline has been presented with the latest studies in the literature. 12 After this guideline, many studies have been published about the treatment of hand OA, including combined non-pharmacological interventions such as education, exercise, splinting, and paraffin bath therapy, [13][14][15] intra-articular injections, 16 biologic disease modifying anti-rheumatic drugs (DMARDs), [17][18][19] and surgery. 20 Furthermore, two systematic reviews about splinting and surgery in thumb base OA have also been published recently.…”

mentioning

confidence: 99%

“…Hand exercises are effective with small effect size, 38 and it has been reported that they are more effective when combined with other non-pharmacological treatment modalities such as education, splinting, ergonomics, or paraffin bath. [13][14][15] Recommendation 3: Patients with thumb base OA should be considered for use of splints in order to alleviate symptoms. Long duration of use is encouraged.…”

mentioning

confidence: 99%

“…Thumb splints are effective on pain and function in medium-term (3-12 months) with low level of evidence 21 and generally combined with non-pharmacological treatments. 15 Recommendation 4: Topical treatment is preferred over systematic treatment due to safety concerns. Topical NSAIDs are the first choice of treatment.…”

mentioning

confidence: 99%

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The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations

Ayhan

Sunar

Umay³

et al. 2020

Arch Rheumatol

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Objectives: This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature. Materials and methods: The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed. Results: Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11 th recommendation about paraffin bath was added. Conclusion: The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.

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Section: Overarching Principlesmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations

Ayhan

Sunar

Umay³

et al. 2020

Arch Rheumatol

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Konservative Therapieverfahren zur Behandlung der symptomatischen Daumensattelgelenksarthrose

et al. 2021

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Ergebnisse: Intraartikuläre Injektionen haben eher kurzfristige positive Effekte mit nicht zu unterschätzendem Infektionsrisiko. Radiotherapie scheint eine effiziente Behandlung zu sein, die jedoch bisher wenig erforscht wurde. Physiotherapie und Schienenbehandlung versprechen eine längerfristige Besserung der klinischen Symptomatik und der Handfunktion. Schlussfolgerung: Die Rhizarthrose ist ein häufiges Krankheitsbild, welches bei Beschwerden adäquat diagnostiziert und behandelt werden sollte. Ein multimodales Therapieschema mit Vermeidung repetitiver intraartikulärer Injektionen scheint die besten Langzeiterfolge zu liefern. Schlüsselwörter Intraartikuläre Injektionen • Schienentherapie • Konservativ • Physiotherapie • Rhizarthrose a b c Abb. 3 8 Individuell hergestellter Daumenbrace mit Einschluss des Daumengrundgelenks. a, b, c Die Anlage erfolgt in 30°P almarabduktion im Daumensattelgelenk und 15°Flexion im Daumengrundgelenk. Die Bewegung im Handgelenk bleibt (Mit freundl. Genehmigung, © BG Klinik Ludwigshafen, alle Rechte vorbehalten) a b c Abb. 4 8 Hilfsmittel für den Alltag. a Der CMCBrace (Fa. Basko, Hamburg, Deutschland) stabilisiert das Daumensattelgelenk und positioniert den Mittelhandknochen des Daumens; b verdickter Stift; c Griffverdickung Besteck. (Mit freundl. Genehmigung, © BG Klinik Ludwigshafen, alle Rechte vorbehalten) a b Abb. 5 8 Der Therapeut fixiert mit der einen Hand das Os trapezium und mit der anderen Hand den ersten Mittelhandknochen. Das Ziel ist es, durch Traktionstechniken (a) und Roll-Gleit-Mobilisation die Gelenkführung zur verbessern und die Gelenkkapsel zu stabilisieren (b) . (Mit freundl. Genehmigung, © BG Klinik Ludwigshafen, alle Rechte vorbehalten)

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Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study

Wouters¹,

Slijper²,

Lopez³

et al. 2020

Archives of Physical Medicine and Rehabilitation

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Objective: To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. Design: Prospective cohort study. Setting: A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. Participants: A consecutive sample of patients with symptomatic CMC-1 instability (NZ431). Intervention: Nonsurgical treatment including exercise therapy and an orthosis. Main Outcome Measures: Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). Results: VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001). No difference was present at 3 months for MHQ total score, but the subscales activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI, 1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively (P<.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared with baseline (P<.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients who eventually converted to surgery (P<.001). Conclusions: In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.

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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

Cited by 27 publications

References 43 publications

The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations

The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations

Konservative Therapieverfahren zur Behandlung der symptomatischen Daumensattelgelenksarthrose

Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study

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