What is the optimal exercise regime for Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint? Results of a Systematic Review of patient related evidence
Kate Lane – Senior Occupational Therapist – Cardiff & Vale University Health Board
Background: Exercise is recommended for people with hand and thumb OA (Zhang et al 2007), but the design and intensity/frequency of an exercise programme based on patient outcomes specifically for OA of the thumb is absent.
Aims/Objectives:
To complete
a systematic
review of patient related
evidence
for
exercise
programmes for OA of the
thumb and the effect on pain,
range of movement (ROM),
strength and function; and to
formulate
a
best‐evidence
protocol
for
exercise
programmes from evaluation of
the evidence.
Results:
Ten quantitative studies met the inclusion criteria.
These studies were critically appraised, their exercise
programmes analysed, evaluated and synthesised in
order to develop a best‐evidence protocol to help guide
clinical practice.
It was discovered that there is not one optimal exercise
protocol for reducing pain and increasing strength,
ROM and function for the OA thumb CMC joint. It was
therefore identified that a combination of the most
commonly cited exercises and average dosage
(frequency, repetitions and duration) from the most
effective exercise programmes, through which
improvements were gained, is the optimal regime to
adopt at this present time.
Methods:
A search of six databases and manual
searches were carried out between 17th
and 21st June 2015. This was then
repeated between 29th November 2015
and 5th December 2015 to ensure
nothing further had been published.
The search strategy aimed to identify
any published studies of conservative
exercise programmes for OA of the
thumb with patient reported results.
Included studies were appraised using
the
Critical
Appraisal
Skills
Programme (CASP 2013) checklists. A
narrative synthesis of the findings was
completed in order to establish the
optimal exercise regime.
Conclusion/Programme:
Warm up
• Heat application
•Rub hands together and gentle arm swings
•Adductor Muscle Release
•Mobilisation Distraction
•Mobilisation‐Reduce Dorsal Subluxation
Range of Movement
•Thumb opposition
•CMCj extension/Abduction Exercises (passive then active).
Strengthening
•Resisted CMCj extension/abduction‐
adduction exercises
•Grip strengthening exercises
•Resisted Key Pinching
•Resisted finger tip pinching
•First Dorsal interossei strengthening
Repetitions
10‐12
Frequency of Exercises
1‐2 times per day
Duration of Exercises
Exercise programme 8‐9 weeks
References:
Boustedt, C., Nordenskiold, U. & Nilsson, A. (2009) Effects of a hand‐joint protection programme with an addition of splinting and exercise: one year follow‐up, Clinical Rheumatology, 28(7), pp. 793‐9.
Critical Appraisal Skills Programme (CASP). (2013) Critical Appraisal Skills Programme: Making sense of the evidence. [Online]. Available at: http://www.casp‐uk.net/ (Accessed 21st April 2015).
Davenport, B.J., Jansen, V. & Yeandle, N. (2012) Pilot randomised controlled trial comparing specific dynamic stability exercises with general exercises for thumb carpometacarpal joint osteoarthritis, Journal of Hand Therapy, 17(3), pp. 60‐7.
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