Details

Autor(en) / Beteiligte

• Wouters, Robbert M.
• Slijper, Harm P.
• Esteban Lopez, Lisa
• Hovius, Steven E.R.
• Selles, Ruud W.
• Blomme, R.A.M.
• Sluijter, B.J.R.
• van der Avoort, D.J.J.C.
• Kroeze, A.
• Smit, J.
• Debeij, J.
• Walbeehm, E.T.
• van Couwelaar, G.M.
• Vermeulen, G.M.
• de Schipper, J.P.
• Temming, J.F.M.
• van Uchelen, J.H.
• de Boer, H.L.
• de Haas, K.P.
• Zöphel, O.T.
• Feitz, R.
• Souer, J.S.
• Hovius, S.E.R.
• Moojen, T.M.
• Smit, X.
• van Huis, R.
• Pennehouat, P.Y.
• Schoneveld, K.
• van Kooij, Y.E.
• Wouters, R.M.
• Zagt, P.
• van Ewijk, F.J.
• Moussault, F.
• Veltkamp, J.J.
• Fink, A.
• de Ridder, W.A.
• Slijper, H.P.
• Selles, R.W.
• Porsius, J.T.
• Spekreijse, K.R.
• Zhou, C.
• Tsehaie, J.
• Poelstra, R.
• Janssen, M.C.
• van der Oest, M.J.W.
• Evers, S.
• Sun, P.O.
• Schrier, V.J.M.M.
• Dekker, J.
• Jansen-Landheer, M.
• ter Stege, M.

Titel

Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study

Ist Teil von

• Archives of physical medicine and rehabilitation, 2020-03, Vol.101 (3), p.434-441

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• 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.