Comparison to hand therapy and placebo in the treatment of thumb carpometacarpal osteoarthritis
The purpose of this study was to compare the effect of hand therapy intervention to a placebo control group over a 4-week treatment period for participants with thumb carpometacarpal (CMC) osteoarthritis. Although hand therapy is recommended treatment for thumb CMC osteoarthritis, there is insufficient high quality evidence, particularly placebo and non-splint RCT's, to support hand therapy intervention (orthoses, therapeutic exercise, and joint protection techniques) for treatment of patients suffering with the symptoms of thumb CMC osteoarthritis. Thirty-five thumbs from 26 participants, 25 female and 1 male, (9 with bilateral involvement) were included after it was determined the participants had a positive grind test. The participants were randomly assigned to two groups: the treatment group, N = 17, were fitted with two orthoses (a neoprene Hely Weber Contoller and a rigid orthoplastic custom orthosis), taught therapeutic exercises and shown joint protection techniques. The control group, N = 18, was given sham cream to lightly apply to the thumb CMC joint. Trained testers, who were blinded to the participants' assignment group, administered the Australian Canadian Hand Osteoarthritis Index (AUSCAN), the lateral pinch strength measurement and accessed the participants' pain while pinching using the VAS scale. The AUSCAN was used as the primary outcome measure. The participants were accessed prior to treatment and 4 weeks later. The between subjects effect of the treatment group and the control group for the post-test AU SCAN post-test scores were statistically significant (p = 0.016) and the within subjects effect for the pretest AUSCAN and post-test AU SCAN scores of the treatment group were significant (p = 0.0001). The within subjects effect for the pretest VAS pain and post-test VAS pain scores was significant for the treatment group (p = 0.0001 ). The pinch strength test was not found to be significantly different between the treatment and the control group.