July 26, 2022

Home Exercise Program vs Standard Treatment in Thumb Carpometacarpal Osteoarthritis

Sheila Jacobs

Previous studies have shown that the thumb carpometacarpal joint receives some of its stability from dynamic stabilizing structure via muscles such as the opponens pollicis, abductors pollicis, and first dorsal interosseous. Credit: Getty Images

The addition of a high-frequency home exercise program to standard treatment for patients with carpometacarpal osteoarthritis (CMC OA) did not improve clinical or patient-reported outcomes compared with standard care alone, although the adherence to exercise was poor and/or unknown. Results of the study were published in Journal of Hand Surgery.

A randomized, interventional trial with a 1-year follow-up was conducted among patients from a hand therapy practice in northwestern Pennsylvania. The researchers sought to establish, in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) was more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder, and Hand (qDASH) scores. Other outcomes included grip strength, pinch strength, range of motion (ROM), Patient-Specific Functional Scale (PSFS), and pain ratings. Although exercise is recommended, evidence is lacking to support the use of specific exercises to stabilize and strengthen the CMC joint in those with OA.

A total of 190 patients with confirmed CMC OA were recruited from the Hand and Upper Body Rehabilitation Center in Erie, Pennsylvania. Patients with unilateral or bilateral CMC OA were included, along with those who had received corticosteroid injections, orally administered steroids, other medications to treat OA symptoms, and/or prior therapeutic interventions for OA. Patients with such concomitant pathologic diagnoses as carpal tunnel syndrome (CTS) and trigger finger were included as well. Overall, 78% of the patients were women and 36% had sedentary occupations. Study patients were aged 34 to 88 years, with a mean age of 60±9.2 years.

They were randomized to 1 of 2 treatment groups: the ST arm (n=94) or ST+HEP arm (n=96; ST plus 6- to 12-month, high-frequency [2 to 3 times per day] stretching and/or stabilizing and/or strengthening home exercise program that targeted the thumb musculature). The ST arm comprised heat modalities, joint protection education, adaptive equipment training, and orthoses. Follow-up took place at 3 months, 6 months, and 12 months. At 6 months, all patients could change treatment group if desired.

Results of the study showed that repeated measures analysis of variance (ANOVA) failed to demonstrate a statistically significant difference in strength and ROM evaluations between the 2 groups during the 12-month follow-up (P ≥.398). In fact, none of the differences between the groups were greater than 13%. Patients in the ST arm and the ST+HEP arm demonstrated improvements over time in most patient-focused evaluations (P ≤.011), which included improvements that exceeded reported clinically important differences in pain with activity and PSFS scores. In each of the study arms, scores for these measures were similar at each follow-up period (P ≥.080). The presence of CTS had no impact on outcomes. Initially, longer treatment time was weakly associated with poorer qDASH and PSFS scores.

Overall, 48% of enrolled patients completed the study. Patients in both of the groups experienced reduced pain with activity and improved PSFS scores, fulfilling the established minimally clinically important difference of each at 6 months and at 12 months. Adherence to the home exercise program was poor and/or unknown.

Limitations of the study included the fact that the efficacy analysis that was used to determine treatment effects was not based on complete data and did not involve imputation. Accessor blinding was not performed because of the limited number of available staff; thus, participants were unable to be blinded to the intervention received.

The study authors concluded that future research should focus on larger, multicenter studies designed to examine whether there are “specific and individualized exercises and/or directions and/or loads and/or doses that are the most beneficial in cases of CMC OA, as well as to account for the 3:1 ratio of female:male disease occurrence.”