| dc.description.abstract | ABSTRACT
Aim: This study compares the effect of a combination of an exercise program and splinting with splinting alone on pain and activities in daily life (ADL) in patients osteoarthritis (OA) of the thumb base joint (CMC-1). Furthermore, this study investigates predictors for outcomes on pain and ADL in order to optimize healthcare for individual patients with CMC-1 OA.
Methods: A prospective cohort study was conducted in eleven outpatient clinics for hand surgery and hand therapy in the Netherlands. A combination of an exercise program and splinting was compared with splinting alone using propensity score matching (PSM). Primary outcomes included pain and ADL at three months, measured with a Visual Analogue Scale (VAS) and the Michigan Hand outcomes Questionnaire (MHQ). Linear mixed model analysis was used to study between-group differences and multiple regression analysis on baseline characteristics for the total exercise program group was used in order to identify predictors for outcome.
Results: In total, 107 participants were included, of which 44 were matched using PSM. A larger decrease in VAS pain during physical load was found in the exercise program group (35 points) compared to the splint group (19.5 points, p=0.012). Outcomes on the MHQ score showed no clinically relevant differences. Treatment of the dominant side, higher flexion of the first metacarpophalangeal joint, higher age and type of work with heavy physical labor predicted outcomes on pain or ADL for the total exercise program group (N=85).
Conclusion: Superior results were found for the exercise program group when compared to the splint group, indicating positive effects of an exercise program. Furthermore, several predictors for outcomes on splinting combined with an exercise program were identified. Future research should study exercise programs and predictors of outcome in a larger sample and a more standardized setting.
Clinical Relevance: Applying exercise programs in clinical practice appears to be beneficial for individual patients with CMC-1 OA.
Dutch Trial Register Trial ID: NTR5627. | |
