Effect of physical therapy interventions in individuals with primary thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of pain, hand function, grip or pinch strength.

METHODS: RCTs that used some type of physiotherapeutic intervention compared to a passive or active control group were included. The quality of the evidence was assessed using the GRADE approach and, for the calculation of the meta-analysis, the standardized difference of means (SMD) was used.

RESULTS: Nineteen studies ( n  = 1477) were included and eight studies ( n  = 568) underwent meta-analysis. Orthosis intervention was superior to passive control group for pain improvement (SMD = -1.02, p  = 0.03, very low evidence), grip strength (SMD = 0.45, p  = 0.02, very low evidence) and pinch strength (SMD = 1.78, p  = 0.01, very low evidence), but there was no improvement in hand function ( p  = 0.54). The use of a neoprene orthosis was similar to the use of a thermoplastic orthosis in improving pain ( p  = 0.38), hand function ( p  = 0.50), grip strength ( p  = 0.42) and pinch strength ( p  = 0.14). The use of short thermoplastic orthosis was also similar to long thermoplastic orthosis in improving pain ( p  = 0.88) and hand function ( p  = 0.58).

CONCLUSION: The use of orthoses is superior to no intervention in all outcomes, exception hand function.IMPLICATIONS FOR REHABILITATIONThe use of orthosis is recommended for the treatment of patients with rhizoarthrosisUse of orthosis is better than no intervention in improving pain, grip and pinch strength.The type of orthosis (neoprene or thermoplastic, short or long thermoplastic) does not affect the clinical improvement of the individual to the outcomes of pain, hand physical function, grip and pinch strength.