Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice

Autor: Reinier Feitz, Erik T. Walbeehm, H.P. Slijper, D.J.J.C. van der Avoort, S. Evers, F. Moussault, G.M. van Couwelaar, M. Jansen-Landheer, Steven E.R. Hovius, O.T. Zöphel, Jak Dekker, Jarry T. Porsius, Jonathan Tsehaie, J.J. Veltkamp, Lisa Esteban Lopez, K.P. de Haas, Ralph Poelstra, P.O. Sun, A. Fink, J.H. van Uchelen, M.J.W. van der Oest, J. Debeij, Xander Smit, T.M. Moojen, Robbert M. Wouters, Ruud W. Selles, P. Zagt, W.A. de Ridder, H.L. de Boer, Harm P. Slijper, B.J.R. Sluijter, R.M. Wouters, S. E. R. Hovius, Kim R. Spekreijse, J.S. Souer, J.P. de Schipper, R.A.M. Blomme, J.F.M. Temming, Guus M. Vermeulen, Y.E. van Kooij, F.J. van Ewijk, P.Y. Pennehouat, M.C. Janssen, C. Zhou, M. ter Stege, V.J.M.M. Schrier, A. Kroeze, R. van Huis, K. Schoneveld, J. Smit
Přispěvatelé: Plastic and Reconstructive Surgery and Hand Surgery, Rehabilitation Medicine, Pulmonary Medicine, General Practice, Business Economics, Cardiology, Economics, Pediatrics
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Joint Instability
Male
030506 rehabilitation
medicine.medical_specialty
Visual analogue scale
Hand therapy
Physical Therapy
Sports Therapy and Rehabilitation
03 medical and health sciences
0302 clinical medicine
All institutes and research themes of the Radboud University Medical Center
Surveys and Questionnaires
Carpometacarpal joint
Activities of Daily Living
medicine
Humans
Outpatient clinic
Prospective Studies
Prospective cohort study
book
Netherlands
Pain Measurement
business.industry
Rehabilitation
Carpometacarpal Joints
Hand surgery
Orthotic device
Surgery
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10]
medicine.anatomical_structure
book.journal
Female
0305 other medical science
business
030217 neurology & neurosurgery
Cohort study
Zdroj: Archives of Physical Medicine and Rehabilitation, 101(3), 434-441. W.B. Saunders
Archives of Physical Medicine and Rehabilitation, 101, 3, pp. 434-441
Archives of Physical Medicine and Rehabilitation, 101, 434-441
ISSN: 1532-821X
0003-9993
Popis: To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment.Prospective cohort study.A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands.A consecutive sample of patients with symptomatic CMC-1 instability (N=431).Nonsurgical treatment including exercise therapy and an orthosis.Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y).VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P.001). No difference was present at 3 months for MHQ total score, but the subscales activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI, 1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively (P.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared with baseline (P.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients who eventually converted to surgery (P.001).In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.
Databáze: OpenAIRE
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