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Splint for Base-of-Thumb Osteoarthritis: A Randomized Trial

François Rannou, MD, PhD; Jérôme Dimet, PharmD; Isabelle Boutron, MD, PhD; Gabriel Baron, PhD; Fouad Fayad, MD, MS; Yann Macé, MD; Johann Beaudreuil, MD, PhD; Pascal Richette, MD, PhD; Philippe Ravaud, MD, PhD; Michel Revel, MD; and Serge Poiraudeau, MD, PhD
[+] Article and Author Information

ClinicalTrials.gov registration number: NCT00350896.


From Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Hôpital Bichat, and Hôpital Lariboisière; Université Paris Descartes; Université Paris 7 Denis Diderot; Institut National de la Santé et de la Recherche Médicale; and Institut Fédératif de Recherche sur le Handicap, Paris, France, and Unité de Recherche Clinique, Centre Hospitalier Régional, La Roche-sur-Yon, France.


Acknowledgment: Laura Heraty participated as a medical editor in the elaboration of the final version of the manuscript.

Grant Support: By the Programme Hospitalier de Recherche Clinique National (PHRC AOM grant 02038).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol, statistical code, and data set: Available (in French) from Dr. Poiraudeau (e-mail, serge.poiraudeau@cch.aphp.fr).

Requests for Single Reprints: Serge Poiraudeau, MD, PhD, Service de Médecine Physique et Réadaptation, Hôpital Cochin, 27 Rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France; e-mail, serge.poiraudeau@cch.aphp.fr.

Current Author Addresses: Drs. Rannou, Dimet, Boutron, Baron, Fayad, Macé, Beaudreuil, Richette, Ravaud, Revel, and Poiraudeau: Service de Médecine Physique et Réadaptation, Hôpital Cochin, 27 Rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France.

Author Contributions: Conception and design: F. Rannou, I. Boutron, P. Ravaud, M. Revel, S. Poiraudeau.

Analysis and interpretation of the data: F. Rannou, J. Dimet, I. Boutron, G. Baron, P. Ravaud, S. Poiraudeau.

Drafting of the article: F. Rannou, S. Poiraudeau.

Critical revision of the article for important intellectual content: F. Rannou, J. Dimet, I. Boutron, G. Baron, F. Fayad, Y. Macé, J. Beaudreuil, P. Richette, P. Ravaud, M. Revel, S. Poiraudeau.

Final approval of the article: F. Rannou, J. Dimet, I. Boutron, G. Baron, F. Fayad, Y. Macé, J. Beaudreuil, P. Richette, P. Ravaud, M. Revel, S. Poiraudeau.

Provision of study materials or patients: F. Rannou, F. Fayad, Y. Macé, J. Beaudreuil, P. Richette, M. Revel, S. Poiraudeau.

Statistical expertise: J. Dimet, I. Boutron, G. Baron, P. Ravaud.

Obtaining of funding: S. Poiraudeau.

Administrative, technical, or logistic support: J. Dimet, S. Poiraudeau.

Collection and assembly of data: F. Rannou, F. Fayad, Y. Macé, J. Beaudreuil, P. Richette.


Ann Intern Med. 2009;150(10):661-669. doi:10.7326/0003-4819-150-10-200905190-00003
Text Size: A A A

Background: Some guidelines recommend splinting for base-of-thumb osteoarthritis, despite lack of evidence of efficacy.

Objective: To assess the efficacy and acceptability of a splint for base-of-thumb osteoarthritis.

Design: Multicenter, randomized trial. Randomization was computer-generated, and allocation was concealed by faxing centralized treatment assignment to investigators at the time of enrollment. Patients and investigators were not blinded to assignment, and patients self-reported outcomes.

Setting: 2 tertiary care hospitals in France.

Patients: 112 patients (101 women) with base-of-thumb osteoarthritis.

Intervention: Custom-made neoprene splint (n = 57) or usual care (n = 55).

Measurements: Primary outcome was change in pain level assessed on a visual analogue scale (VAS) (range, 0 to 100 mm) from baseline to 1 month. Secondary outcomes were change in measures of hand disability at 1 month and change in pain level and measures of disability at 12 months. Tolerance and adherence with the splint were recorded.

Results: At 1 month, no difference in change occurred in pain level from baseline in the intervention and control groups (adjusted mean change, −10.1 vs. −10.7; between-group difference, 0.6 [95% CI, −7.9 to 9.1]; P = 0.89). Disability was assessed by the Cochin Hand Function Scale score (range, 0 to 90) or patient-perceived disability (VAS, 0 to 100 mm). At 12 months, change in pain from baseline was greater in the intervention group than in the control group (adjusted mean change, −22.2 vs. −7.9; between-group difference, −14.3 [CI, −23.4 to −5.2]; P = 0.002). The Cochin Hand Function Scale score was −1.9 versus 4.3 (between-group difference, −6.3 [CI, −10.9 to −1.7]; P = 0.008) and patient-perceived disability was −11.6 versus 1.5 (between-group difference, −13.1 [CI, −21.8 to −4.4]; P = 0.003). At 12 months, 86% of the intervention group had worn the splint for more than 5 nights a week, and no adverse effects were observed.

Limitation: Patients, health care providers, and outcome assessors were not blinded.

Conclusion: For patients with base-of-thumb osteoarthritis, wearing a splint had no effect on pain at 1 month but improved pain and disability at 12 months.

Primary Funding Source: Programme Hospitalier de Recherche Clinique National.

Figures

Grahic Jump Location
Figure 1.
Dorsal view (top) and palmar view (bottom) of a custom-made neoprene splint for base-of-thumb osteoarthritis.
Grahic Jump Location
Grahic Jump Location
Figure 2.
First web closure and measurement of maximal abduction.

Top. Example of a closure of the first web in base-of-thumb osteoarthritis. Bottom. Measurement of the angle in maximal abduction. The angle between the line measured along the medial side of the thumb after the axis of the first and second phalanges and the line measured along the lateral side of the index after the axis of the first and second phalanges was calculated by using a goniometer.

Grahic Jump Location

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Comments

Submit a Comment
Evolution Towards Carpal-Metacarpal OA Nonsurgical Cure
Posted on July 4, 2009
Daniel G. Arkfeld
USC Keck School of Mediicne
Conflict of Interest: None Declared

In treating many patients with OA of the base of the thumb, I have been both frustrated and satisfied with patient outcomes. Easy cures are infrequent. Analgesics,Nsaids, cortisone injections, and bracing have been the mainstay of therapy.Too often these haven't worked in the short term and surgery has been done with variable results. For these reasons, I appreciated the article entitled "Splint for Base-of-Thumb Osteoarthritis" by Rannou et al. MY experience does concur that one can obtain a long term benefit with conservative treatment. Additional benefit may be obtained from topical therapy, intra-articular hyaluronate injections and other physical therapy modalities such as ultrasound. Further, complementary therapies with fish oils, glucosame, plant antiinflammatories can add to the management. Unfortunately, OA of the thumb is at a disadvantage in our society due to rapidly increasing use of our hands with technological devices such as PDA's, game devices and the Internet. OA of the thumb is here to stay and it will take hundreds of years for evolutionary changes to help. Thus we need to establish a multidisciplinary approach to find a solution.

Conflict of Interest:

None declared

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Summary for Patients

The Effects of Splinting on Thumb Arthritis

The summary below is from the full report titled “Splint for Base-of-Thumb Osteoarthritis. A Randomized Trial.” It is in the 19 May 2009 issue of Annals of Internal Medicine (volume 150, pages 661-669). The authors are F. Rannou, J. Dimet, I. Boutron, G. Baron, F. Fayad, Y. Macé, J. Beaudreuil, P. Richette, P. Ravaud, M. Revel, and S. Poiraudeau.

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