Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial

• Published in: Journal of hand therapy 2022-07, Vol.35 (3), p.435-446
• Main Authors: McVeigh, Kimberly H., Kannas, Stephanie N., Ivy, Cynthia C., Garner, Hillary W., Barnes, Carolyn S., Heckman, Michael G., Brushaber, Danielle E., Murray, Peter M.
• Format: Article
• Language: English
• Subjects: Arm; Arthritis; Carpometacarpal joint; Carpometacarpal Joints; Disabilities; Dynamic stability; Dynamic stabilization; Exercise Therapy; Fingers & toes; Grip strength; Hand; Hand (anatomy); Humans; Joints (anatomy); Muscles; Occupational therapy; Orthoses; Osteoarthritis; Osteoarthritis - therapy; Pain; Patients; Physical therapists; Physical therapy; Prospective Studies; Range of motion; Statistical analysis; Therapy; Thumb; Treatment Outcome
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2021.06.002

•Randomized trial of efficacy of dynamic stability program for the base of the thumb•Standard conservative therapy vs standard therapy plus dynamic stability exercises•Small improvement in pain and QuickDASH scores for dynamic stability group•Significant reduction in pain and improved QuickDASH scores within each group. Randomized control trial. Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis and instruction in joint protection, adaptive equipment, and pain relieving modalities. The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb CMC. To investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing pain and disability in thumb CMC OA compared to SCT alone. The study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home pain management instructions, joint protection strategies with adaptive equipment, and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions for adductor stretching and opponens and first dorsal interosseous strengthening in addition to SCT. Our primary outcome measure was the numerical rating scale (NRS) with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome measurements were assessed at first visit, 6 weeks, and 6 months. There was no statistical difference between the 2 groups for NRS and QuickDASH at 6 weeks (P = .28 and P = .36, respectively) or 6 months (P = .52 and P = .97, respectively). However, there was a statistically significant decrease in NRS and QuickDASH scores at 6 weeks and 6 months within both groups. Both SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH scores at 6-week or 6-month follow-up.