A Systematic Review of Conservative Interventions for Osteoarthritis of the Hand

doi:10.1016/j.jht.2010.05.001

Journal of Hand Therapy

Volume 23, Issue 4, October–December 2010, Pages 334-351

https://doi.org/10.1016/j.jht.2010.05.001 Get rights and content

Abstract

Study Design

Systematic Review.

Introduction

Hand therapy interventions for patients with hand osteoarthritis (OA) can include splinting, joint protection technique instruction, paraffin, exercises, and provision of a home exercise program.

Purpose

Examine the quality of the evidence regarding the hand therapy interventions for hand OA.

Methods

Twenty-one studies dated between 1986 and 2009 were included in the systematic review for analysis.

Results

The current evidence provides varied support for the interventions of orthotics, hand exercises, joint protection techniques, the utilization of adaptive devices, and paraffin. Findings for the use of joint protection techniques are supported for improvements in function and pain reduction. Minimal evidence exists for paraffin used for the treatment of hand OA.

Conclusions

The current literature supports the use of orthotics, hand exercises, application of heat, and joint protection education combined with provision of adaptive equipment to improve grip strength and function.

Level of Evidence

2A.

Section snippets

Data Identification and Study Characteristics

Literature searches were performed using computerized databases. See Quorom diagram (Figure 1). English language-only key word searches were used with combinations of terms including OA, hand, occupational therapy, physical therapy, hand therapy, and interventions (paraffin, exercise, ROM, splinting, and joint protection). The key words were searched in various combinations; for example, osteoarthritis AND occupational therapy, osteoarthritis AND exercise, and so on. The articles were chosen

Results

Many of the studies reviewed received high scores for study design and for their thorough review of the current literature regarding OA. The more recent studies received higher SEQES scores because the authors were more likely to use standardized outcome measures and reported findings in terms of clinical significance. Four studies by Rogers and Wilder,¹⁵ Boustedt et al.,¹⁶ Rannou et al.,¹⁷ and Brosseau et al.¹⁸ reported their findings in regard to minimally clinically important difference.

The

Summary of Evidence

1.
There is moderate evidence supporting hand exercises for increased grip strength.
2.
There is moderate evidence to support hand exercises for improved function.
3.
There is moderate evidence to support hand exercises for improved ROM.
4.
There is moderate evidence to support hand exercises for pain reduction.
5.
There is moderate evidence to support JPE and provision of adaptive equipment for increased hand function.
6.
There is moderate evidence to support JPE and provision of adaptive equipment for pain

Conclusion

This systematic review synthesizes the evidence of common hand therapy interventions for hand OA. Unfortunately, there is a greater abundance of studies that support conservative therapy interventions for OA of the hip and knee than for hand OA. The shortage of studies for many of the interventions that are currently used in clinical practice makes it difficult to make strong conclusions supporting the efficacy of the interventions. The lack of current evidence weakens the strength of the

Quiz: Article #166

Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go toJHTReadforCredit.com. There is only one best answer for each question.

#1.
The design of the study is
- a.
  random clinical trials (RTC)
- b.
  prospective
- c.
  a case series
- d.
  a systematic review
#2.
The study demonstrated that
- a.
  home exercise is the least effective
- b.
  protective splinting is the most effective
- c.
  a variety of interventions provide a variety of beneficial effects
- d.
  paraffin

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Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists
2023, Journal of Hand Therapy
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.
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.
This was a consensus paper via the modified Delphi approach.
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.
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.
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.
Effectiveness of proprioception training in functional recovery of thumb osteoarthritis. Single, multicenter, non-blind randomized clinical trial
2023, Reumatologia Clinica
La osteoartritis de la base del primer metacarpiano (OA CMC-1) es una patología que afecta mayormente a mujeres posmenopáusicas. Los síntomas principales que acompañan esta patología son el dolor, la pérdida de fuerza y la disminución de capacidad motora fina. A pesar de que se ha demostrado un déficit propioceptivo en personas con OA CMC-1, no hay evidencia suficiente sobre los efectos del trabajo propioceptivo. El objetivo de este estudio es determinar la efectividad del entrenamiento propioceptivo en la recuperación funcional.
Se incluyeron un total de 57 pacientes, 29 del grupo control y 28 en el experimental. Ambos grupos llevaron a cabo el programa de intervención, y al grupo experimental se le incluyó además un protocolo de trabajo propioceptivo. Las variables de estudio fueron el dolor (EVA), percepción del desempeño ocupacional (COMP), sensación de posición (SP) y sensación de fuerza (SF).
Se observó una mejora estadísticamente significativa en el grupo experimental en el dolor (p < 0,05) y el desempeño ocupacional (p < 0,001) a los 3 meses de tratamiento. No se encontraron diferencias estadísticas en la sensación de posición (SP) y la sensación de fuerza (FS).
La correlación de nuestros resultados y los de estudios precedentes en cuanto a la efectividad del entrenamiento propioceptivo sobre las variables de estudio nos permite afirmar que la incorporación de un protocolo de ejercicios propioceptivos disminuye el dolor y mejora notablemente el desempeño ocupacional.
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.
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).
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).
The results concord with previous studies focussing on proprioception training. The incorporation of a proprioceptive exercise protocol reduces pain and significantly improves occupational performance.
Reduced pain and improved daily activities for individuals with hand osteoarthritis using a silicone wrist hand orthosis
2023, Journal of Hand Therapy
Symptoms of hand osteoarthritis (OA), such as pain, reduced grip strength, loss of range of motion (ROM) and joint stiffness, can lead to impaired hand function and difficulty with daily activities. Rehabilitative interventions with orthoses are commonly in the treatment of hand OA to reduce pain, improve hand strength and ROM, provide support for improved function and help with joint stability.
The objectives of this perception-based study were to evaluate the effect of a silicone wrist hand orthoses (SWHO) on pain and daily functioning.
This study is a qualitative descriptive study. The patient received outcome (PRO) questions in the study were based on the Patient Rated Wrist and/or Hand Evaluation (PRWHE), a 15-item questionnaire designed to measure wrist pain and disability in activities of daily living.
Patients with OA using a SWHO were asked to complete a questionnaire about the effectiveness of the brace after wearing it for 3 weeks. Primary outcome measure was general daily functioning with and without the use of the SWHO. Secondary outcome measures were change in pain symptoms and limitations for certain activities with and without the aid.
The results of this large-scale PROM study of 551 patients on the effectiveness of SWHOs in patients with hand OA show an improvement in overall daily functioning of 77% and a 61% reduction in perceived pain. This study adds to the evidence reported by systematic reviews of conservative interventions for hand OA and further quantifies the effects of a tailor made SWHO. This study confirms that wearing a wrist orthosis has a particularly significant impact on the execution of static and repetitive wrist-straining activities.
The study on the effectiveness of a SWHO in patients with hand OA shows that the use of a SWHO contributes to general daily function, reduces pain and increases the breadth of potential daily activities. This study shows that the use of a SWHO appears to offer pain relief and suitable support to the joint.
Effect of a stabilization exercise program versus standard treatment for thumb carpometacarpal osteoarthritis: A randomized trial
2023, Journal of Hand Therapy
Randomized, interventional trial with 1 year follow-up.
Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA).
To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength).
A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons.
Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥ .398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤ .011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥ .080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study.
The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown.
The biomechanics of osteoarthritis in the hand: Implications and prospects for hand therapy
2022, Journal of Hand Therapy
The unique anatomy of the human hand makes it possible to carefully manipulate tools, powerfully grasp objects, and even throw items with precision. These apparent contradictory functions of the hand, high mobility for manual dexterity vs high stability during forceful grasping, imply that daily activities impose a high strain on a relatively instable joint. This makes the hand susceptible to joint disorders such as osteoarthritis. Both systemic (eg, genetics, hormones) and mechanical factors (eg, joint loading) are important in the development of osteoarthritis, but the precise pathomechanism remains largely unknown. This paper focuses on the biomechanical factors in the disease process and how hand therapists can use this knowledge to improve treatment and research.
Multiple factors are involved in the onset and development of osteoarthritis in the hand. Comprehension of the biomechanics helps clinicians establish best practices for orthotics intervention, exercise, and joint protection programs even in de absence of clear evidence-based guidelines. The effect and reach of hand therapy for OA patients can be expanded substantially when intervention parameters are optimized and barriers to early referrals, access reimbursement, and adherence are addressed. Close and early collaboration between hand therapists and primary care, women's health, rheumatology, and hand surgery providers upon diagnosis, and with hand surgeons pre and postoperatively, combined with advances in the supporting science and strategies to enhance adherence, appear to be a promising way forward.
Incorporation of occupational based intervention into joint protection education for individuals with thumb carpometacarpal osteoarthritis: A case series
2022, Journal of Hand Therapy
To our knowledge, the use of occupational performance in education on joint protection techniques has not been studied for individuals with thumb carpometacarpal (CMC) osteoarthritis.
This case series was designed to investigate if occupation-based instruction inside the clinic was useful and found satisfactory as an educational tool for individuals with thumb CMC joint arthritis.
Three participants with thumb CMC joint osteoarthritis performed washing, rinsing, and drying a dish, moving a pot and pan, maneuvering a laundry basket, and pouring from a pitcher during joint protection education in the therapy clinic with a skilled hand therapist in addition to routine treatment. Satisfaction with this intervention was assessed via a 3-question satisfaction survey. Pain with activity and function via the Thumb Disability Examination were assessed at baseline and a 4week follow up.
Patients in this study expressed satisfaction with the inclusion of the performance of occupations in their joint protection education in the clinic. Pain with activity improved by an average of 1.7/10 on a 10-point Numeric Pain Rating Scale and function improved by an average of 10.04 on the Thumb Disability Examination.
Although no causal relationships can be assumed in this study, hand therapists should consider adding occupation-based intervention as a component of patient education on joint protection for individuals with thumb CMC joint osteoarthritis.

View all citing articles on Scopus

View full text

Scientific/Clinical ArticleA Systematic Review of Conservative Interventions for Osteoarthritis of the Hand

Abstract

Study Design

Introduction

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Data Identification and Study Characteristics

Results

Summary of Evidence

Conclusion

Quiz: Article #166

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Osteoarthritis Cartilage

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J Hand Ther

J Hand Ther

Arch Phys Med Rehabil

Aust J Physiother

J Hand Ther

J Hand Ther

J Hand Surg

J Hand Surg Am

Activity limitations and participation restrictions in women with hand osteoarthritis: patients' descriptions and associations between dimensions of functioning

Ann Rheum Dis

Hand osteoarthritis—an increasing need for treatment and rehabilitation

Curr Opin Rheumatol

EULAR evidence based recommendations for the management of hand osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapies (ESCISIT)

Ann Rheum Dis

There is inadequate evidence to determine the effectiveness of nonpharmacological and nonsurgical interventions for hand osteoarthritis: an overview of high-quality systematic reviews

Phys Ther

Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence

Am J Occup Ther

Spa therapy in rheumatology. Indications based on the clinical guidelines of the French National Authority for health and the European League Against Rheumatism, and the results of 19 randomized clinical trials

Bull Acad Natl Med

Thermotherapy for treatment of osteoarthritis

Cochrane Database Syst Rev

Thermotherapy for treating rheumatoid arthritis

Cochrane Database Syst Rev

Scientific/Clinical Article
A Systematic Review of Conservative Interventions for Osteoarthritis of the Hand