Systematic review of non-surgical therapies for osteoarthritis of the hand: an update

Lue, Sabrina; Koppikar, Sahil; Shaikh, Kamran; Mahendira, Dharini; Towheed, Tanveer

doi:10.1016/j.joca.2017.05.016

Cited by 42 publications

(31 citation statements)

References 96 publications

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“…This largely biases the findings of the review towards a European context, which may consequently influence its generalizability to other geographical locations. The present reviewers therefore report that perhaps the findings of this systematic review may not Interestingly, we observed from the literature, that our assumptions were consistent with a recent systematic review [40] that reported that despite the marked improvement in the overall design and conduct of RCTs, further large RCTs with more robust methodological approaches specific to hand OA are needed to make clinically relevant conclusions about the efficacy of the diverse treatment options available.…”

Section: Summary Of Evidencesupporting

confidence: 80%

“…The above findings are consistent with previous evidence [27], which reported that physiotherapy interventions lacked detailed information regarding the mode of delivery, intensity, frequency and duration. To identify the cause of this gap, we appraised some of the key "underpinning research evidence" [11,40,41,42] of the guidelines included in our systematic review. From this appraisal, we found that whilst some of the underpinning research evidence described the content of exercises which was not reported by the guidelines, majority provided limited or no content for guideline developers to report on subsequently.…”

Section: Summary Of Evidencementioning

confidence: 99%

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Exercises for hand osteoarthritis: a systematic review of clinical practice guidelines and consensus recommendations

Sankah

Stokes

Adams

2019

Physical Therapy Reviews

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Background: Individuals with hand osteoarthritis (OA) often experience hand pain, joint stiffness and reduced grip strength, which affect performance of everyday functional tasks. There is a need to evaluate evidence-based rehabilitation strategies that aim to lessen the burden and improve the quality of life of people living with hand OA. Objectives: Our objectives were to: (1) identify guidelines and consensus recommendations on hand OA management to ascertain whether hand exercises are recommended as part of best practice; (2) identify the type and dosage of exercises recommended regarding frequency, intensity and duration and (3) provide a summary of exercise recommendations for the management of hand OA. Methods: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and was registered on Prospero (CRD42018086440). Seven published databases and 20 grey literature sources were searched (January 1997-January2019). Quality assessment was conducted with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument and, using a narrative approach, evidence was synthesized based on the levels of evidence and strength of recommendations. Results: Eight guidelines and consensus recommendations were identified and included. Evidence from seven guidelines was rated between fair to high quality. Five out of seven guidelines recommended exercises for the management of hand OA. Limited information on exercise dosage (frequency, intensity and duration) was reported. Three strong and two weak recommendations for using different hand exercises were proposed in this systematic review. Conclusion: Available guidelines and consensus recommendations on hand OA recommend exercises as part of current best practice for hand OA management. There is strong evidence to support the recommendation of strengthening, stretching and joint mobility exercises for the management of the hand OA. These recommended exercises, however, lacked specific details regarding the type and dosage (frequency, intensity and time) for optimal uptake, which therefore need to be established through research.

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Section: Summary Of Evidencesupporting

confidence: 80%

Section: Summary Of Evidencementioning

confidence: 99%

Exercises for hand osteoarthritis: a systematic review of clinical practice guidelines and consensus recommendations

Sankah

Stokes

Adams

2019

Physical Therapy Reviews

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“…A wide range of OA serum or plasma biomarkers have been investigated in hand OA, which can provide insight into disease development. These biomarkers include various inflammatory markers, such as Creactive protein and adipokines, and markers of cartilage or bone homeostasis, such as type II collagen 149,150 . In one small sub-study of 18 patients from a 2016 hand OA clinical trial, serum IL-1 levels were associated with loss of hand function and radiological erosions 151 .…”

mentioning

confidence: 99%

Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

et al. 2018

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Osteoarthritis (OA) is a highly prevalent condition and the hand is the most commonly affected site. Patients with hand OA frequently report symptoms of pain, functional limitations, and frustration in undertaking everyday activities. The condition presents clinically with changes to the bone, ligaments, cartilage and synovial tissue, which can be observed using radiography, ultrasonography or MRI. Hand OA is a heterogeneous disorder and is considered to be multifactorial in aetiology. This review provides an overview of the epidemiology, presentation and burden of hand OA, including an update on hand OA imaging (including the development of novel techniques), disease mechanisms and management. In particular, areas for which new evidence has substantially changed the way we understand, consider and treat hand OA are highlighted. For example, genetic studies, clinical trials and careful prospective imaging studies from the past 5 years are beginning to provide insights into the pathogenesis of hand OA that might uncover new therapeutic targets in disease.

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“…Treatments commonly used prior to surgery include injections (cortisone, hyaluronate), analgesics, patient education in joint protection, strengthening exercises, assistive devices, and orthotics [21,22]. Few randomized clinical trials on conservative treatment of OAT have been published [22][23][24][25][26][27]. There is increasing evidence favoring multimodal manual treatment to reduce pain and ameliorate function in OAT patients [26,[28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Study of Medical Ultrasound for Rhizarthrosis (SUR): study protocol for a randomized controlled single-center pilot-trial

Böck

Eisenschenk

Lorenzen

et al. 2020

Trials

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Background: Rhizarthrosis (trapeziometacarpal osteoarthritis) is the second most common site of osteoarthritis in the hand affecting 10-30% of adults over the age of 50. Up to four times as many women as men have rhizarthrosis. Clinical symptoms include functional disability of the thumb, pain, joint swelling, and reduced strength. The first carpometacarpal joint is pivotal in the opposition of the thumb and allows a high degree in flexibility to humans. Current therapies focus mainly on surgical strategies, which should be considered in advanced, therapy-resistant stages to relieve pain and improve function. However, conservative treatment methods are urgently required in presurgical stages. The efficacy of conservative treatment options for rhizarthrosis, which are intended to preserve function, joint integrity and to relieve pain, has not been adequately studied. In the clinical study protocol presented here, we investigate the efficacy of multimodal hand therapy versus therapeutic ultrasound versus combination therapy with both hand therapy and therapeutic ultrasound. Methods: This study is a single-center, randomized, controlled, parallel-group pilot trial. One hundred fifty patients with rhizarthrosis and current disease activity will be randomized to one of three conservative interventions over 6 months. Interventions are (1) multimodal hand therapy (2) therapeutic ultrasound, and (3) combination therapy with both hand therapy and ultrasound therapy. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score after 6 months. Secondary endpoints are changes in pain, quality of life, disability progression, and changes of hand function. Safety will also be assessed. Discussion: Clinical data suggest that multimodal hand therapy may improve functionality and reduce pain in rhizarthrosis. Clinical data regarding therapeutic ultrasound are not available. Clinical evidence is lacking. This study is the first clinical study investigating the effects of multimodal hand therapy in direct comparison to therapeutic ultrasound and to a combination therapy with both hand therapy and ultrasound therapy for rhizarthrosis.

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Systematic review of non-surgical therapies for osteoarthritis of the hand: an update

Cited by 42 publications

References 96 publications

Exercises for hand osteoarthritis: a systematic review of clinical practice guidelines and consensus recommendations

Exercises for hand osteoarthritis: a systematic review of clinical practice guidelines and consensus recommendations

Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

Study of Medical Ultrasound for Rhizarthrosis (SUR): study protocol for a randomized controlled single-center pilot-trial

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