Pilot randomized controlled trial comparing specific dynamic stability exercises with general exercises for thumb carpometacarpal joint osteoarthritis

Abstract

Introduction Exercises are widely used and recommended for peripheral joint and hand osteoarthritis (OA); however, the evidence on which specific exercise regimen is most effective is unclear. Methods A pilot randomized controlled trial was conducted to compare the effect of specific first carpometacarpal (CMC) joint stabilizing exercises and general exercise on function, pain and strength. Thirty-nine participants with OA of the first CMC joint were recruited and randomly assigned into one of two exercise groups. Exercises were taught as a home programme then reviewed and only progressed as tolerated. The participant and assessing physiotherapist were blinded. Primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire at three and six months. Pinch and grip strength, pain scores at rest and during pinch and abductor pollicis longus (APL) moment were secondary measures. Results Twenty-two patients completed follow-up at six months. At baseline the general exercise group had significantly stronger pinch and APL moments but was not different in any other measures. The improvement (reduction) of DASH scores at three and six months was not significantly different between the two groups; however, the general exercise group had a greater reduction in DASH score from baseline to three months (13 points P = 0.001). The outcomes were not affected ( P > 0.05) by any variables except APL moment at baseline. Increased APL moment at baseline was associated with an improved outcome in both groups ( P = 0.01). Conclusions While this pilot study was inadequately powered the results can be used to plan a future large-scale trial.