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Karanasios S, Mertyri D, Karydis F, Gioftsos G. Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Healthcare (Basel) 2024; 12:823. [PMID: 38667585 PMCID: PMC11049805 DOI: 10.3390/healthcare12080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: -21.91; 95% confidence interval [CI]: -36.59, -7.24; p = 0.003) and wrist disability (MD: -8.1, 95% CI: -4.6, -11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: -0.76; 95% CI: -1.30, -0.21; p = 0.007) and short-term (SMD: -0.93; 95% CI: -1.86, -0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: -0.94; 95% CI: -1.68, -0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 122 43 Aigaleo, Greece;
- Hellenic OMT eDu, 116 31 Athens, Greece; (D.M.); (F.K.)
| | | | - Fotis Karydis
- Hellenic OMT eDu, 116 31 Athens, Greece; (D.M.); (F.K.)
| | - George Gioftsos
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 122 43 Aigaleo, Greece;
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Valdes KA, Rider JV. Test-retest reliability of joint position sense in the carpometacarpal joint among healthy adults. J Hand Ther 2024; 37:238-242. [PMID: 37775433 DOI: 10.1016/j.jht.2023.08.014] [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: 08/07/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Accurate proprioception in the thumb carpometacarpal (CMC) joint is necessary during activities such as performing fine manipulative tasks, such as coin handling, opening doors, using keys, and pressing control buttons. PURPOSE The primary aim of the present study was to examine the test-retest reliability of CMC joint position sense (JPS) in healthy subjects. The secondary aim was to determine the most reliable JPS testing position for the thumb CMC joint. STUDY DESIGN This was a cross-sectional study of a convenience sample of healthy adults. METHODS Three thumb positions (20°, 30°, and 40° of thumb abduction) were measured twice on the same day by a single rater using a universal goniometer. The absolute error in degrees between each position and reposition was calculated. The intraclass correlation coefficient (2,1) was calculated for relative reliability. The standard error of the measurement was calculated. RESULTS Sixty-four healthy adults (mean age 27.8 years, standard deviation = 8.7) were assessed. The intraclass correlation coefficients were poor (-0.08 to 0.22), and the standard error of the measurement was 1.4° for all positions. CONCLUSIONS The joint position reproduction test for JPS using goniometry demonstrated poor test-retest reliability and acceptable measurement error in healthy adults.
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Affiliation(s)
- Kristin A Valdes
- Touro University Nevada, School of Occupational Therapy, Henderson, NV, USA.
| | - John V Rider
- Touro University Nevada, School of Occupational Therapy, Henderson, NV, USA
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Seo HG, Yun SJ, Farrens A, Johnson C, Reinkensmeyer DJ. A Systematic Review of the Learning Dynamics of Proprioception Training: Specificity, Acquisition, Retention, and Transfer. Neurorehabil Neural Repair 2023; 37:744-757. [PMID: 37864458 PMCID: PMC10847967 DOI: 10.1177/15459683231207354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE We aimed to identify key aspects of the learning dynamics of proprioception training including: 1) specificity to the training type, 2) acquisition of proprioceptive skills, 3) retention of learning effects, and 4) transfer to different proprioceptive skills. METHODS We performed a systematic literature search using the database (MEDLINE, EMBASE, Cochrane Library, and PEDro). The inclusion criteria required adult participants who underwent any training program that could enhance proprioceptive function, and at least 1 quantitative assessment of proprioception before and after the intervention. We analyzed within-group changes to quantify the effectiveness of an intervention. RESULTS In total, 106 studies with 343 participant-outcome groups were included. Proprioception-specific training resulted in large effect sizes with a mean improvement of 23.4 to 42.6%, nonspecific training resulted in medium effect sizes with 12.3 to 22% improvement, and no training resulted in small effect sizes with 5.0 to 8.9% improvement. Single-session training exhibited significant proprioceptive improvement immediately (10 studies). For training interventions with a midway evaluation (4 studies), trained groups improved by approximately 70% of their final value at the midway point. Proprioceptive improvements were largely maintained at a delayed follow-up of at least 1 week (12 studies). Finally, improvements in 1 assessment were significantly correlated with improvements in another assessment (10 studies). CONCLUSIONS Proprioceptive learning appears to exhibit several features similar to motor learning, including specificity to the training type, 2 time constant learning curves, good retention, and improvements that are correlated between different assessments, suggesting a possible, common mechanism for the transfer of training.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Andria Farrens
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
| | - Christopher Johnson
- Department of Biomedical Engineering, University of California at Irvine, California, USA
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
- Department of Biomedical Engineering, University of California at Irvine, California, USA
- Department of Anatomy and Neurobiology, University of California at Irvine, California, USA
- Department of Physical Medicine and Rehabilitation, University of California at Irvine, California, USA
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Algar L, Naughton N, Ivy C, Loomis K, McGee C, Strouse S, Fedorczyk J. Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists. J Hand Ther 2023; 36:982-999. [PMID: 37798185 DOI: 10.1016/j.jht.2023.08.008] [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: 06/02/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. PURPOSE This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. STUDY DESIGN This was a consensus paper via the modified Delphi approach. METHODS A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist's research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. RESULTS The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient's unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. CONCLUSIONS The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.
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Affiliation(s)
- Lori Algar
- Orthopaedic Specialty Group PC, Fairfield, CT, USA
| | | | - Cynthia Ivy
- Northern Arizona University, Phoenix, AZ, USA
| | - Katherine Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Corey McGee
- Programs in Occupational Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Strouse
- Center of Hand, Upper Limb & Health Perfromance, Leigh Valley Health Network, Pottsville, PA, USA
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Cantero-Téllez R, Algar LA, Valdes KA, Naughton N. Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial. J Hand Ther 2022; 35:358-366. [PMID: 36008246 DOI: 10.1016/j.jht.2022.06.009] [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: 02/23/2021] [Revised: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized Control Trial. INTRODUCTION Thumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population. PURPOSE OF THE STUDY To establish the effectiveness of a proprioceptive training program as a complementary therapy for patients with thumb CMC joint OA. METHODS Standard conservative thumb CMC joint OA treatments were received by both the control (n = 26) and experimental groups (n = 26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included severity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). RESULTS Fifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. DISCUSSION Experimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between-group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. CONCLUSION Proprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.
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Affiliation(s)
| | - Lori A Algar
- Outpatient Hand Therapy, Orthopaedic Specialty Group PC, Fairfield, CT, USA
| | - Kristin A Valdes
- Occupational Therapy Department, Touro University, Henderson NV 89014, USA
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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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The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063592. [PMID: 35329279 PMCID: PMC8955750 DOI: 10.3390/ijerph19063592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/15/2022]
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.
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