Anne Wajon

No difference between two splint and exercise regimens for people with osteoarthritis of the thumb: A randomised controlled trial

The purpose of this study was to compare the effects of two 6-week splint and exercise regimens for patients with trapeziometacarpal osteoarthritis. Forty participants were enrolled in a randomised, controlled clinical trial. The experimental group received a newly designed thumb strap splint and an abduction exercise regimen, whereas the control group received current clinical practice consisting of a short opponens splint and a pinch exercise regimen. Outcome measures included pain (VAS at rest in cm), strength (tip pinch in kg), and hand function (Sollerman Test of Hand Function scored out of 80), measured by a blinded assessor at Weeks 0, 2, and 6. By Week 6 there was no significant difference in the extent of mean improvement between the groups in: pain, 0.5 cm (95% CI -1.1 to 2.1); strength, 0.1 kg (95% CI -0.8 to 0.9); or hand function, 0.7 points (95% CI -3.6 to 5.0). While both groups improved, neither regimen is superior to the other in patients with trapeziometacarpal osteoarthritis.

Prevalence of Thumb Pain in Physical Therapists Practicing Spinal Manipulative Therapy

Thumb pain is a common complaint of physical therapists. The purpose of this study was to investigate the prevalence, presentation, and techniques associated with aggravation of thumb pain in physical therapists practicing spinal manipulative therapy and the management strategies used to deal with pain. A survey was sent to members of Musculoskeletal Physiotherapy Australia. Data were collected from subjects who had completed postgraduate study in manipulative physical therapy. Of the 155 subjects who responded, 83% complained of pain in their thumbs aggravated by performing manipulative therapy techniques in the preceding year (2000). The most common presentation of pain included mild pain (3.8/10) at the metacarpophalangeal joint, with multiple, short-lived episodes. Techniques most commonly responsible for aggravation of symptoms were unilateral (87%) and central posteroanterior glides (85%). Most subjects (74%) changed their choice of treatment technique to alleviate symptoms. Suggestions are made about the safe alignment of the thumb during performance of spinal manipulative therapy techniques.

No difference between two types of exercise after proximal phalangeal fracture fixation: a randomised trial.

QUESTION Are 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained in an orthosis (constrained exercises) more effective than traditional finger exercises with the metacarpophalangeal joint unconstrained (unconstrained exercises) after open reduction and internal fixation of a proximal phalangeal fracture in terms of impairment, activity limitation and participation restriction at 6 and 12 weeks? DESIGN Randomised, parallel-group trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. PARTICIPANTS Sixty-six participants within 1 week of open reduction and internal fixation of proximal phalangeal fractures. INTERVENTION The experimental group carried out 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained, whilst the control group carried out finger exercises with the metacarpophalangeal joint unconstrained, as part of a comprehensive rehabilitation program. OUTCOME MEASURES The primary outcomes were: active proximal interphalangeal joint extension of the injured finger, total active range of motion, and strength. Secondary outcomes were: pain, difficulty with specific hand activity and difficulty with usual hand activity. A blinded assessor measured outcomes at Weeks 1, 6 and 12. RESULTS By Week 6, there were no significant between-group differences in improvement for: active proximal interphalangeal joint extension (MD 2 deg, 95% CI -3 to 7); total active finger range of motion (MD 0 deg, 95% CI -21 to 22); strength (MD -2kg, 95% CI -8 to 4); pain (MD 1/50, 95% CI -3 to 5); difficulty with specific hand activity (MD 2/60, 95% CI -3 to 8); or difficulty with usual hand activity (MD 0/40, 95% CI -4 to 3). By Week 12, there were also no significant between-group differences in any outcome. CONCLUSIONS Constrained and unconstrained exercises has similar effects after open reduction and internal fixation of proximal phalangeal fracture. REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12610000294055).

Efficacy of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis: protocol for a randomised, controlled trial (COMBO)

Introduction Management of thumb base osteoarthritis (OA) using a combination of therapies is common in clinical practice; however, evidence for the efficacy of this approach is lacking. The aim of this study is to determine the effect of a combination of conservative therapies for the treatment of thumb base OA compared with an education control group. Methods and analysis This is a randomised, controlled, single-centre, two-arm superiority trial with 1:1 allocation ratio; with assessor and statistician blinded. Participants are blinded to the trials hypothesis and to the interventions received by the opposite group. A total of 204 participants will be recruited from the community and randomised using a computer-generated schedule. The intervention group will receive education for joint protection and OA, a splint for the base of the thumb, hand exercises and topical diclofenac sodium 1% gel over 6 weeks. The control group will receive education for joint protection and OA alone. Main inclusion criteria are pain ≥40 mm (Visual Analogue Scale, 0–100) at the base of the thumb, impairment in hand function ≥6 (Functional Index for Hand Osteoarthritis, 0–30) and radiographic thumb base OA (Kellgren Lawrence grade ≥2). Participants currently receiving any of the intervention components will be excluded. Outcomes will be measured at 2, 6 and 12 weeks. The primary outcome is change in pain and hand function from baseline to 6 weeks. Other outcomes include changes in grip and pinch strength, quality of life, presence of joint swelling and tenderness, duration of joint stiffness, patients global assessment and use of rescue medication. Analysis will be performed according to the intention-to-treat principle. Adverse events will be monitored throughout the study. Ethics and dissemination This protocol is approved by the local ethics committee (HREC/15/HAWKE/479). Dissemination will occur through presentations at international conferences and publication in peer-reviewed journals. Trial registration number ACTRN12616000353493; Pre-results.

Pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures in the finger: a prospective longitudinal study

The purpose of this study was to determine the pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures. A prospective longitudinal study of 66 patients who started rehabilitation within 1 week of fixation was undertaken. Measures of the level of impairment (range of motion, pain, strength), activity limitation (hand use) and return to work were collected at Weeks 1, 6, 12 and 26 after operation. Before starting rehabilitation, although pain was minimal, the range of motion was severely restricted and there was considerable restriction in ability to work. Most of the recovery in range of motion, pain, strength, hand use and work participation occurred by Week 6, with smaller gains by Week 12 and Week 26. Level of evidence: III

ASSOCIATION BETWEEN JOINT LAXITY AND DISEASE SEVERITY IN TRAPEZIOMETACARPAL OSTEOARTHRITIS

Maternal drug use is not new but over the last few decades, the number of mothers using drugs of addiction has escalated to epidemic levels. These drugs are both legal (e.g. prescription medication) and illegal (e.g. heroin) and all will cross the placental barrier into the developing infant. The most immediate and obvious consequence of intra‐uterine drug exposure is newborn withdrawal or the Neonatal Abstinence Syndrome (NAS) which is now, with prompt recognition and treatment, an uncommon cause of neonatal death. Thousands (if not millions) of adults most likely would have had a history of passive drug exposure during gestation and the outcomes of these people are unknown. Most are physically healthy and do not need extra medical attention but the effects of prenatal drug exposure may be subtle and extensive. Drug‐use disorders are accompanied by a myriad of other adverse problems, including poverty, mental and physical health problems and inadequate parenting ability that may compound the negative effects of drugs. Emerging data suggest that vulnerability to health and neurocognitive issues are pervasive and long‐lasting as are lifestyle issues. This review will address current evidence in this area and highlight the knowledge gaps that must be addressed in order to optimise the outcomes for this vulnerable and marginalised but rapidly expanding population of adults.

Long-term use of a splint at night reduces pain and disability in people with osteoarthritis at the base of the thumb

Question Does use of a splint at night improve pain and disability in people with osteoarthritis at the base of the thumb (OABT)? Design Randomised, controlled trial with concealed allocation. Setting Two tertiary hospitals in France. Participants Patients were recruited from tertiary clinics or private practices. Inclusion criteria were pain at the base of the thumb 30 mm or greater on a visual analogue scale (VAS) from 0 (no pain) to 100 mm, age 45–75 years, radiographic evidence of OABT, and either trapeziometacarpal joint enlargement or closure of the first web. Post-traumatic osteoarthritis, inflammatory and crystal arthritis, neurological conditions, trauma, surgery and collagen diseases were exclusion criteria. Randomisation of 112 participants allotted 57 to the intervention group and 55 to a control group. Interventions Both groups received usual care, at the discretion of the general practitioner or rheumatologist. In addition, a rigid splint was custom made for participants in the intervention group by an occupational therapist. It covered the base of the thumb and the thenar eminence but not the wrist. These participants were advised to wear it at night for one year, and encouraged to contact the therapist if they felt the splint needed adjustment, if pain increased while wearing the splint, or if they had adverse effects, eg, skin erosion. Outcome measures The primary outcome was the change in pain on the VAS at one month. Secondary outcome measures were disability at one month, and pain and disability at twelve months. Disability was measured with Cochin Hand Functional Scale from 0 (low disability) to 90, and on another VAS (100 mm=high perceived disability). Participants also rated their perceived global improvement and underwent clinical and radiological measures: pinch strength, pain during pinch, thumb mobility, closure of the first web, and blinded assessment of radiological progression of osteoarthritis. Results 98 (87%) participants completed the study. No significant between-group differences in any outcomes were observed at one month. At 12 months, however, the intervention group showed significantly greater reductions in pain (by 14 mm, 95% CI 5 to 23), in Cochin scores (by 6 points, 95% CI 2 to 11), and in perceived disability (by 13 mm, 95% CI 4 to 22). The groups did not significantly differ on the remaining secondary outcomes. Conclusion For patients with OABT, night splinting had no effect on pain and disability at 1 month but both improved at 12 months.

The effectiveness of physical therapies for patients with base of thumb osteoarthritis: systematic review and meta-analysis

BACKGROUND Trapeziometacarpal osteoarthritis (known as base of thumb OA) is a common condition causing pain and disability worldwide. OBJECTIVE The purpose of this review was to evaluate the effectiveness of multimodal and unimodal physical therapies for base of thumb osteoarthritis (OA) compared with usual care, placebo or sham interventions. DESIGN Systematic review and meta-analysis. METHOD We searched MEDLINE (PubMed), CINAHL, Embase, AMED, PEDro, Cochrane Database of Systematic Review, Cochrane Register of Controlled Trials (CENTRAL) from inception to May 2017. Randomized controlled trials involving adults comparing physical therapy treatment for base of thumb OA with an inactive control (placebo or sham treatment) and reported pain, strength or functional outcomes were included. Meta-analyses were performed where possible. Methodological risk of bias was assessed with the Cochrane Risk of Bias tool. RESULTS Five papers with low risk of bias were included. Meta-analyses of mean differences (MD) with 95% confidence intervals (95% CI), were calculated for between-group differences in point estimates at 4 weeks post-intervention. Multimodal and unimodal physical therapies resulted in clinically worthwhile improvements in pain intensity (MD 2.9 [95% CI 2.8 to 3.0]; MD 3.1 [95% CI 2.5 to 3.8] on a 0-10 scale, respectively). Hand function improved following unimodal treatments (MD 6.8 points [95% CI 1.7 to 11.9)] on a 0-100 scale) and after a multimodal treatment (MD 20.5 (95%CI -0.7 to 41.7). CONCLUSIONS High quality evidence shows unimodal and multimodal physical therapy treatments can result in clinically worthwhile improvements in pain and function for patients with base of thumb OA.

Time to commencement of active exercise predicts total active range of motion 6 weeks after proximal phalanx fracture fixation: A retrospective review

Introduction Whether baseline characteristics influence range of motion outcomes following proximal phalanx fracture remains unclear. The aim of this review was to investigate whether fixation type, time to commencement of active finger exercise, location of fracture or which finger is injured predict total active range of motion 6 weeks after surgical fixation. Methods A retrospective cohort of 49 patients with finger proximal phalanx fracture was analysed. Putative predictors investigated were fixation type, time to commencement of active exercise, location of fracture and injured finger. The outcome of interest was total active finger range of motion 6 weeks post-operatively. Results Multiple regression analysis found that time to commencement of active exercise was the only significant independent predictor of total active range of motion 6 weeks post-operatively. The main influence on time to commencement of active exercise was fixation type, with fractures repaired using Kirschner wire fixation associated with a delay of nearly 2 weeks, compared with fractures repaired using open reduction and internal fixation. Discussion Patients who commence active exercise early following surgical fixation of a proximal phalanx fracture may expect greater total active range of motion 6 weeks post-operatively than if exercise is delayed.