Abstract
Objective
To investigate if shorter immobilization is noninferior to longer immobilization after
Weilby procedure for thumb carpometacarpal osteoarthritis
Design
Prospective cohort study with propensity score matching.
Setting
Data collection took place in 16 outpatient clinics for hand surgery and hand therapy.
Participants
A total of 131 participants with shorter immobilization and 131 participants with
longer immobilization (N=262).
Intervention
Shorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including
wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14
days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks
postoperatively) after Weilby procedure for first carpometacarpal joint osteoarthritis.
Propensity score matching was used to control for confounders.
Main Outcome Measures
Outcomes were pain measured with a visual analog scale and hand function measured
with the Michigan Hand Outcomes Questionnaire at 3 and 12 months. Secondary outcomes
were complications, range of motion, grip and pinch strength, satisfaction with treatment,
and return to work.
Results
No significant differences were found in visual analog scale pain (effect size, 0.03;
95% confidence interval [CI], −0.21 to 0.27) or the Michigan Hand Outcomes Questionnaire
(effect size, 0.01; 95% CI, −0.23 to 0.25) between the groups at 3 months or at 12
months. Furthermore, no differences were found in complication rate or in other secondary
outcomes.
Conclusions
In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure
is equal to longer immobilization for outcomes on pain, hand function, and our secondary
outcomes. These results indicate that shorter immobilization is safe and can be recommended,
since discomfort of longer immobilization may be prevented and patients may be able
to recover sooner, which may lead to reduced loss of productivity. Future studies
need to investigate effectiveness of early active and more progressive hand therapy
following first carpometacarpal joint arthroplasty.
Keywords
List of abbreviations:
CMC-1 (first carpometacarpal joint), FCR (flexor carpi radialis), MCP-1 (first metacarpophalangeal joint), MHQ (Michigan Hand Outcomes Questionnaire), OA (osteoarthritis), ROM (range of motion), VAS (visual analog scale)To read this article in full you will need to make a payment
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References
- Osteoarthritis: an update with relevance for clinical practice.Lancet. 2011; 377: 2115-2126
- Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study.Ann Rheum Dis. 2011; 70: 1581-1586
- Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study).Ann Rheum Dis. 2005; 64: 682-687
- Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham study.Am J Epidemiol. 2002; 156: 1021-1027
Van Uchelen J, Beumer A, Brink SM, Hoogvliet P, Moojen TM, Spaans AJ VG. Guideline conservative and surgical treatment of primary osteoarthritis of thumb base. Amsterdam: NVPC, NVVH, NOV, VRA, VvBN, 2014. Available at: https://www.nvpc.nl/uploads/stand/150416DOC-MB-Definitieve_richtlijn_Conservatieve_en_Chirurgische_behandeling_duimbasisartrose_28-10-2014_aangenomen_ALV_14_april_2015149.pdf. Accessed April 30, 2019.
- Surgery for thumb (trapeziometacarpal joint) osteoarthritis.The Cochrane database of systematic reviews. 2015; 2: CD004631
- Postoperative rehabilitation following thumb base surgery: a systematic review of the literature.Arch Phys Med Rehabil. 2017;
- Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.J Hand Surg Am. 2011; 36: 157-169
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb.J Hand Surg Am. 1985; 10: 645-654
- Tendon interposition arthroplasty of the first carpo-metacarpal joint.J Hand Surg Br. 1988; 13: 421-425
- Comparison of arthroplasties with or without bone tunnel creation for thumb basal joint arthritis: a randomized controlled trial.J Hand Surg Am. 2014; 39: 1692-1698
Janse S. Guideline handtherapy after trapeziectomy and ligament reconstruction. Available at: http://hprn.info/wp-content/uploads/sites/15/trapeziectomie-2015-12-1-ZHPC.protected.pdf. Accessed April 30, 2019.
- Measures of hand function: Arthritis Hand Function Test (AHFT), Australian Canadian Osteoarthritis Hand Index (AUSCAN), Cochin Hand Function Scale, Functional Index for Hand Osteoarthritis (FIHOA), Grip Ability Test (GAT), Jebsen Hand Function Test (JHFT), and Michigan Hand Outcomes Questionnaire (MHQ).Arthritis Care Res (Hoboken). 2011; 63: S189-S199
- The minimal clinically important difference of the Michigan hand outcomes questionnaire.J Hand Surg Am. 2009; 34: 509-514
- Determining the Michigan Hand Outcomes Questionnaire minimal clinically important difference by means of three methods.Plast Reconstr Surg. 2014; 133: 616-625
- Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).Arthritis Care Res (Hoboken). 2011; 63: S240-S252
- Clinical Assessment Recommendations.2nd ed. American Society of Hand Therapists, Chicago1992
- Grip and pinch strength: normative data for adults.Arch Phys Med Rehabil. 1985; 66: 69-74
- Reliability and validity of an electronic dynamometer for measuring grip strength.Int J Ther Rehabil. 2011; 18: 258-264
- Reliability and validity of grip and pinch strength evaluations.J Hand Surg. 1984; 9: 222-226
- Understanding noninferiority trials.Korean J Pediatr. 2012; 55: 403-407
- Statistical power analysis for the behavioral sciences.2nd ed. L. Erlbaum Associates, Hillsdale, NJ1988
- Collagenase clostridium histolyticum versus limited fasciectomy for Dupuytren's contracture: outcomes from a multicenter propensity score matched study.Plast Reconstr Surg. 2015; 136: 87-97
- The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials.Stat Med. 2007; 26: 20-36
- Making inferences on treatment effects from real world data: propensity scores, confounding by indication, and other perils for the unwary in observational research.BMJ. 2013; 347: f6409
- The central role of the propensity score in observational studies for causal effects.Biometrika. 1983; 70: 41-55
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study.Stat Med. 2007; 26: 734-753
- The reliability and measurement error of protractor-based goniometry of the fingers: a systematic review.J Hand Ther. 2017; 30: 457-467
- Early versus late mobilisation after simple excision of the trapezium.J Bone Joint Surg Br. 2002; 84: 1111-1115
- Rigid versus semi-rigid orthotic use following TMC arthroplasty: a randomized controlled trial.J Hand Ther. 2014; 27 ([quiz 271]): 265-270
- Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition.J Hand Surg Am. 2004; 29: 1069-1077
- Healthcare costs and loss of productivity in patients with trapeziometacarpal osteoarthritis.J Hand Surg Eur. 2015; 40: 927-934
Article info
Publication history
Published online: April 23, 2019
Footnotes
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
