The Efficacy of Dynamic Stabilization of the First CMC: A Prospective Randomized Study
Kimberly McVeigh, OTR/CHT1, Stephanie Nicole Kannas, OTR/L, CHT2, Cindy Clare Ivy, MEd, BS, OT3, Carolyn Barnes, OT, CHT4, Garner Hillary, MD1, Michael Heckman, MS1, Brushaber Danielle, BS5 and Peter M. Murray, MD6, (1)Mayo Clinic, Jacksonville, FL, (2)Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, (3)Hand Therapy, Mayo Clinic, Phoenix, AZ, (4)Mayo Clinic, Scottsdale, AZ, (5)Mayo Clinic, Rochester, MN, (6)Department of Orthopedic Surgery/Division of Hand Surgery, Mayo Clinic, Jacksonville, FL
Introduction: This prospective randomized study compared standard conservative therapy (SCT) versus the same SCT plus a dynamic stabilization home-exercise program (SCT + HE) for thumb carpometacarpal (CMC) degenerative joint disease (DJD). Comparisons included the change in VAS (Visual Analogue Scale) pain score, QuickDASH score, range of motion, grip, and pinch from baseline to 6-week follow-up between the two groups, change in VAS pain score and QuickDASH score from baseline to 6-month follow-up between the two groups, and outcomes between patients with baseline Eaton radiographic stage I-II disease versus stage III-IV disease in the SCT + HE group at 6-week and 6-month follow-up.
Methods: 67 patients between 18 and 85 years old, who fit the inclusion criteria, and were diagnosed with thumb CMC DJD by physician and radiographic examination at three academic medical centers between May 2016 and October 2018 were recruited for prospective computer-based randomization into the SCT (N=34) or SCT + HE treatment groups (N=33). Changes in outcome measures at 6-week and 6-month follow-up relative to baseline were calculated and compared between SCT and SCT + home exercise groups using a Wilcoxon rank sum test.
Results: There were no statistically significant differences in outcomes from baseline to 6-week follow-up between the SCT and SCT + HE groups (all P≥0.056). Of interest, the VAS pain score did decrease slightly more from baseline to 6-week follow-up for the SCT + HE group when compared to the SCT group, however it was not statistically significant (P=0.36). There was a similar non-significant decrease in QuickDASH score from baseline to 6-week follow-up for the SCT + HE patients compared to SCT patients (P=0.48). The degree of change from baseline to 6 months was similar between SCT + HE and SCT patients for VAS pain score (P=0.52) and QuickDASH score (P=0.97). There was no significant difference in outcomes in the SCT + HE group based on the Eaton radiographic stage.
Conclusions: The results of this study indicates that SCT + HE does not result in a significant improvement in VAS pain score, QuickDASH score, or other outcomes after 6 weeks of treatment in comparison to SCT alone. We observed small (non-significant) improvements in VAS pain score and QuickDASH for the SCT + HE patients compared to the SCT patients. There were no noticeable differences between the two groups regarding changes in VAS pain score or QuickDASH score from baseline to 6 months.
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