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Campos-Villegas C, Pérez-Alenda S, Carrasco JJ, Igual-Camacho C, Tomás-Miguel JM, Cortés-Amador S. Effectiveness of proprioceptive neuromuscular facilitation therapy and strength training among post-menopausal women with thumb carpometacarpal osteoarthritis. A randomized trial. J Hand Ther 2024; 37:172-183. [PMID: 35948454 DOI: 10.1016/j.jht.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life. PURPOSE Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength. STUDY DESIGN Superiority randomized clinical trial. METHODS 42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks). RESULTS Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P<.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P<.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P<.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P = .003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P = .024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P = .003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P = .049; d = 0.62). These improvements were maintained at follow-up. CONCLUSIONS The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength.
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Affiliation(s)
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Celedonia Igual-Camacho
- Group of Physiotherapy in the Ageing Process, Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Sara Cortés-Amador
- UBIC research group, Department of Physiotherapy, University of Valencia, Valencia, Spain
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Sánchez-Montoya LJ, Sánchez DP, Ordoñez-Mora LT. Proprioceptive rehabilitation strategies in posttraumatic wrist injuries. Scoping review. Colomb Med (Cali) 2023; 54:e3005709. [PMID: 39211804 PMCID: PMC11360815 DOI: 10.25100/cm.v54i4.5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/24/2023] [Accepted: 12/16/2023] [Indexed: 09/04/2024] Open
Abstract
Background The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality. Objective To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries. Methods A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated. Results After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates. Conclusion Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.
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Affiliation(s)
- Lida J Sánchez-Montoya
- Universidad Santiago de Cali, Facultad de Salud, Programa de Fisioterapia, Cali Colombia
| | - Diana P Sánchez
- Universidad Santiago de Cali, Facultad de Salud, Programa de Fisioterapia, Cali Colombia
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Cruz-Gambero L, Tuljak AL, Garcia Orza S, Villafañe JH, Cantero-Téllez R. Effectiveness of proprioception training in functional recovery of thumb osteoarthritis. Single, multicenter, non-blind randomized clinical trial. REUMATOLOGIA CLINICA 2023; 19:417-422. [PMID: 37202242 DOI: 10.1016/j.reumae.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/02/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Osteoarthritis at the base of the thumb (CMC-1 OA) is a pathology that mainly affects postmenopausal women. The main symptoms including pain, decreased hand-thumb strength and fine motor capacity. Although a proprioceptive deficit has already been demonstrated in people with CMC-1 OA, there is insufficient evidence regarding the effects of proprioceptive training. The main objective of this study is to determine the effectiveness of proprioceptive training in functional recovery. MATERIALS AND METHODS A total of 57 patients were included in the study, 29 in the control group and 28 in the experimental group. Both groups underwent the same basic intervention programme, but the experimental group included a proprioceptive training protocol. Variables of the study were pain (VAS), perception of occupational performance (COMP), sense position (SP) and force sensation (FS). RESULTS Statistically significant improvement was observed in the experimental group in pain (p < .05) and occupational performance (p < .001) after 3 months of treatment. No statistical differences were found in sense position (SP) or sensation of force (FS). DISCUSSION AND CONCLUSIONS The results concord with previous studies focussing on proprioception training. The incorporation of a proprioceptive exercise protocol reduces pain and significantly improves occupational performance.
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Affiliation(s)
- Leire Cruz-Gambero
- Unidad de Mano, Centro de Rehabilitación Tecan, Málaga, Spain; Departamento de Fisioterapia, Facultad Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | - Alejandra Lucía Tuljak
- Universidad Católica de Córdoba, Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | - Santiago Garcia Orza
- Hospital Comarcal de la Axarquía, Vélez, Málaga, Spain; HandresearchTeam, Instituto de investigación IBIMA, Málaga, Spain
| | | | - Raquel Cantero-Téllez
- Departamento de Fisioterapia, Facultad Ciencias de la Salud, Universidad de Málaga, Málaga, Spain; HandresearchTeam, Instituto de investigación IBIMA, Málaga, Spain.
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Cheuquelaf-Galaz C, Antúnez-Riveros MA, Lastra-Millán A, Canals A, Aguilera-Godoy A, Núñez-Cortés R. Exercise-based intervention as a nonsurgical treatment for patients with carpal instability: A case series. J Hand Ther 2023:S0894-1130(23)00123-0. [PMID: 37777444 DOI: 10.1016/j.jht.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. PURPOSE This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. STUDY DESIGN This was a case series study. METHODS This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. RESULTS A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P < .001; d = 2.9) and visual analog scale (P < .001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. CONCLUSIONS Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol.
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Affiliation(s)
- Cristian Cheuquelaf-Galaz
- Servicio de Kinesiología, Hospital Clínico Universidad de Chile, Santiago, Chile; Servicio de Kinesiología, Clínica Santa María, Santiago, Chile
| | | | | | - Andrea Canals
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
| | | | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
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Cantero-Tellez R, Naughton N, Algar LA, Medina-Porqueres I, Cruz-Gambero L, Valdes KA. Proprioceptive Neuromuscular Facilitation Protocol for Thumb Osteoarthritis: A Pilot Study. Hand (N Y) 2023; 18:111S-118S. [PMID: 33955250 PMCID: PMC10052626 DOI: 10.1177/1558944721990785] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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O'Brien V, Johnson J, Pisano K, Enke A. Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis. J Hand Ther 2022; 35:388-399. [PMID: 35985937 DOI: 10.1016/j.jht.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Expert opinion INTRODUCTION: Thumb carpometacarpal joint (CMC) osteoarthritis is a common condition seen in the hand therapy clinic. Prevalence is generally higher in females, and the percentage rises for post-menopausal females. Patients typically present with pain and functional difficulties. Conservative management is recommended before a surgical consult. Evidence is mounting that a dynamic stability modeled approach has a significant effect on pain and improving function. PURPOSE The purpose of this paper is two-fold: first, to present the history and development of a dynamic stabilization model for treatment of the patient with thumb CMC osteoarthritis (OA), and second, to provide expert clinical commentary and recommendations for the treatment of thumb CMC OA in light of the best available evidence. METHODS Expert clinical commentary is based on an extensive review of relevant literature. RESULTS The current literature and expert opinion supports an evidence-informed multimodal intervention: modalities, pain relief techniques, manual release, joint mobilizations as deemed necessary, neuromuscular re-education through proprioceptive exercises, and education in joint protection principles. CONCLUSION A rationale for a dynamic stabilization approach is presented. The unique anatomy of the thumb deserves finely tuned care based on high quality research. To advance our knowledge and clinical skills we must not become stagnant, but continue to generate high level evidence. The standard for future thumb CMC OA studies should be well-defined intervention parameters, consistent documentation, and the use of appropriate patient-rated outcome measures.
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Affiliation(s)
- Virginia O'Brien
- Department of Rehabilitation and Orthopedics, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
| | | | - Katie Pisano
- Hand and Upper Body Rehabilitation Center, Erie, PA, USA
| | - Ashley Enke
- M Health Fairview Hand Therapy, Minneapolis, MN, USA
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