Proprioceptive Neuromuscular Facilitation Protocol for Thumb Osteoarthritis: A Pilot Study

Abstract

Background Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint often presents with joint instability and proprioceptive deficits. Proprioception has been found to play an important role in the rehabilitative process. The purpose of this study was to evaluate the effectiveness of a proprioceptive training program on pain and function in individuals with early-stage thumb Carpometacarpal joint OA. Methods A double-blind experimental trial using a 2-group pretest/posttest design was used in this pilot study. Participants had a diagnosis of grade I and II thumb CMC joint OA in their dominant hand and a pain rating of >4/10 on Visual Analogue Scale. Participants received either standard treatment (control group) or standard treatment plus a proprioceptive training program (experimental group). Outcome measures were lateral pinch strength, pain intensity during activities, and proprioceptive response via joint position sense (JPS) testing. Results Twelve individuals (average age of 66.25 years) participated. Both groups had a statistically significant decrease in pain and increase in lateral pinch strength, all occurring with a large effect size but no statistically significant difference between groups. The experimental group experienced a large effect size for JPS testing, whereas the control group experienced a trivial effect size, and there was a statistically significant difference between groups for JPS testing. Conclusions Individuals who completed the proprioceptive training program in this study had an improvement in proprioceptive functioning. This program shows potential for routine inclusion in hand therapy for thumb CMC joint OA; however, additional high-level studies with larger sample sizes are required.

The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial

“…The MCID for JPS for CMC OA has not been established. These results confirm those obtained in the pilot study carried out by Cantero-Tellez et al [ 34 ]. However, the improvement in JPS testing may be due in part to the learning that occurred with repetition of the positioning exercises during the intervention, rather than an improvement in JPS.…”

“…There is no high-level evidence defining the best techniques or exercises for proprioceptive rehabilitation for thumb CMC joint OA. The thumb exercise program used in this experiment was based on a previous study [ 34 ].…”

Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial

“…The change in pain scores from this study differed from prior investigations 36 as our effect size for pain reduction was considered large, however the between-group comparison was not statistically significant. 23 The pain score findings from this study should be considered relevant based on other investigations.…”

“…For this reason, the current study used several outcome measures including the COPM, a measure of selfperception and occupational performance, which has been recently validated for individuals with thumb CMC joint OA. 23 , 40 The results of the aforementioned study 36 concur with our study findings, both clinically and statistically significant changes in participant pain and function over time., However, in the current study the COPM score made greater increases from 2.28 at baseline to 6.44 at 12 weeks compared to the findings of Cantero-Tellez et al study. 36 The findings of our study suggest that proprioceptive intervention along with traditional treatment may be an effective intervention for improving sensorimotor impairment.…”

“…12 There is high quality evidence that hand therapy treatment can improve pain and function for individuals with thumb CMCJ OA 27 , 28 and prior investigations have demonstrated that proprioceptive training improves symptoms in individuals with other types of OA. 29 Despite the recent growing body of evidence regarding the usefulness of thumb proprioception, [27][28][29] a specific exercise protocol has not been described. High level evidence regarding the role of proprioception in CMCJ OA and the potential role of its training for disease prevention or treatment remains unclear.…”