Abstract
Objective
To evaluate the best option among orthoses for carpometacarpal (CMC) osteoarthritis
(OA) of the thumb, using a network meta-analysis.
Data Sources
Medline, Embase, Cochrane, and ClinicalTrials.gov registry databases were used. PubMed, Embase, Cochrane Controlled Trials Register,
Cochrane, and other databases were used without language restrictions.
Study Selection
We searched randomized controlled trials (RCTs) on adults with OA of the thumb by
studying any orthosis from the beginning to March 10, 2020.
Data Extraction
Data were extracted and checked for accuracy and completeness by pairs of reviewers.
Outcomes were pain and function. Comparative treatment effects were analyzed by random-effects
model for direct pairwise comparisons and Bayesian network meta-analyses to integrate
direct and indirect evidence.
Data Synthesis
Eleven RCTs involving 619 patients were included. We evaluated 5 groups, for 4 different
orthoses: short thermoplastic CMC splint (rigid CMC) (n=5), long thermoplastic carpometacarpal-metacarpophalangeal
splint (rigid CMC-MCP) (n=7), short neoprene CMC splint (soft CMC) (n=1), long neoprene
CMC-MCP splint (soft CMC-MCP) (n=5), and one as a control group (n=5). Our results
show that all splints were superior to placebo to reduce pain intensity and the top-ranked
intervention was the rigid CMC-MCP (surface under the cumulative ranking curve analysis
[SUCRA], score: 65.4). In function evaluation, we report a 71.6 SUCRA for rigid CMC.
Conclusions
Although the current evidence is unclear on the use of the splint in OA of the thumb,
it is not known which orthosis is more effective and whether the orthosis is more
effective than other interventions. The network meta-analysis shows that a long thermoplastic
splint it is the best choice for pain relief and the short thermoplastic CMC splint
is the best treatment to increase function. These results may suggest initial treatment
with a long rigid orthosis and then a short rigid orthosis.
Keywords
List of abbreviations:
CMC (carpometacarpal), CMC-MCP (carpometacarpal-metacarpophalangeal), MCP (metacarpophalangeal), OA (osteoarthritis), RCT (randomized controlled trial), SMD (standardized mean difference), SUCRA (surface under the cumulative ranking curve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 11, 2020
Footnotes
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
