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

Abstract

A randomized controlled trial of forty-five females over 18 years of age with diagnosis of thumb basal osteoarthritis in their dominant hand and with a minimum pain rating of 4/10 on the Visual Analogue Scale (VAS) during activities of daily living (ADLs) were recruited from March to June 2021. The group receiving proprioception training was compared to routine conservative physiotherapy treatment. The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis. Primary outcome was joint position sense (JPS) for the assessment of CMC proprioception and secondary outcomes were Visual Analogue Scale (VAS) and Canadian Occupational Performance Measure (COPM) for the assessment of patient satisfaction and the Quick-DASH which assessed upper limb function. A block randomization was carried out for the control group (n = 22) and experimental group (n = 23). Participants and evaluator were blinded to the group assignment. Proprioception training produced a statistically significant reduction in pain post intervention, but this reduction was small (d = 0.1) at the 3-month follow-up. JPS accuracy demonstrated statistically significant differences between the groups (p = 0.001) post-intervention and at the 3-month follow-up (p < 0.003). Statistically significant differences between means were found in both the Quick-Dash and COPM post intervention (both, p < 0.001), as well as at the 3-month follow-up (both, p < 0.001). There was a significant time factor for the reduction of pain intensity over time but effect sizes between groups was small at the 3-month follow-up period. Proprioceptive training improves thumb JPS accuracy; however, it does not contribute to a reduction in pain intensity in the long term. The inclusion of a proprioceptive program may be beneficial for improving individuals with thumb CMC OA sensorimotor performance. The study was registered at ClinicalTrials.gov NCT04738201. No funding was provided for this study.

Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…Subsequent screening of titles and abstracts resulted in 29 eligible publications for full-text assessment. Fifteen studies did not satisfy the inclusion criteria and fourteen RCTs were finally included [19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The flow chart of the study selection is presented in Figure 1.…”

“…The diagnosis of thumb CMCJ OA was confirmed using the radiographic Eaton-Littler Classification or the Modified Kellgren-Lawrence grade scale (grades 0-4, 0 = no OA) [33,34]. Three studies included patients with CMCJ OA grade 1 to 4 [26,29,32], four studies with grade 1 to 3 [20,22,23,27], three studies with grade 3 or 4 [23,27,28], two studies with grade 2 to 4 [30,31], two studies with grade 1 or 2 [21,28] and one study with grade 3 [24]. A detailed description of the study characteristics and main results are shown in Table 1.…”

“…Exercise as an intervention was used alone or in combination with a multimodal physiotherapy programme [20][21][22][26][27][28][29][30] and orthotic devices [20,22,23,[25][26][27]32]. Eight trials evaluated the use of exercises against a multimodal therapeutic programme [20][21][22][23]26,27,30,31], another exercise programme [19,24], no treatment [29,32], joint protection alone [25] or corticosteroid injections [28]. Exercise-based therapy programmes were used for between 2 and 12 weeks.…”

“…Exercise-based therapy programmes were used for between 2 and 12 weeks. Nine of the eligible trials evaluated the use of proprioceptive exercise programmes [19][20][21][22][23][24][25][26][27]. Three of the eligible trials evaluated the use of mobility and strengthening exercises while two trials focused on the use of neurodynamic exercises (Table 1).…”

“…Nine RCTs [20][21][22][23][24][25]27,30,31] compared proprioceptive exercises with standard therapy for thumb CMCJ OA. The outcomes were assessed at very short-, short-, mid-and longterm follow-up times.…”