Occupational Therapy for Thumb Arthritis

Overseen By Bryce T Fletcher, BS, CCRP

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Julie Nuelle

Disqualifiers: Revision CMC arthroplasty, Traumatic dislocation, MCP hyperextension

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 6 weeks

180 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Home Exercise Program, Occupational Therapy for thumb arthritis?

Research shows that occupational therapy, including hand exercises, can significantly relieve pain for 75% to 80% of people with thumb arthritis. It may also delay or reduce the need for surgery in some cases. ^{1 2 3 4 5}

Is occupational therapy for thumb arthritis safe?

Occupational therapy for thumb arthritis is generally considered safe, with a long history of use and no significant safety concerns reported in the available research. ^{4 6 7 8 9}

How does occupational therapy differ from other treatments for thumb arthritis?

Occupational therapy for thumb arthritis is unique because it focuses on using hand exercises, splints, and adaptive techniques to improve daily function and reduce pain, potentially delaying or avoiding the need for surgery. This approach is holistic, addressing not just the physical symptoms but also helping patients maintain their daily activities and quality of life. ^{2 4 5 10 11}

What is the purpose of this trial?

The study is a randomized, controlled trial to evaluate the efficacy of formal occupational therapy on outcomes following CMC arthroplasty

Research Team

Julia A.V. Nuelle, MD

Principal Investigator

University of Missouri-Columbia

Eligibility Criteria

This trial is for individuals with thumb carpometacarpal (CMC) arthritis who have undergone a trapeziectomy and suture suspensionplasty. The study aims to determine if in-clinic occupational therapy is necessary after the surgery.

Inclusion Criteria

Ability to read and write in English

I am undergoing or have undergone CMC joint surgery.

Ability to provide informed consent

Exclusion Criteria

I need surgery for a recent severe dislocation of my wrist joint.

I am having a second surgery on my thumb joint.

I am receiving treatment for MCP joint over-straightening.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are randomized to either in-clinic occupational therapy or at-home exercise therapy following trapeziectomy and suture suspensionplasty

6 weeks

1-2 visits per week (in-person) for OT group; weekly check-ins for HEP group

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments of key pinch strength, grip strength, Kapandji score, radial abduction, and PROMIS measures

1 year

Regular follow-up visits at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year

Treatment Details

Interventions

• Home Exercise Program
• Occupational Therapy

Trial Overview The trial compares two post-surgery treatments: one group will follow a home exercise program, while another will receive formal occupational therapy. It's designed to see which method is more effective for recovery.

Participant Groups

Group I: Occupational Therapy Experimental Treatment 1 Intervention

Participants in this arm will receive weekly occupational therapy for 6 weeks

Group II: Home Exercise Active Control 1 Intervention

Participants in this arm will complete an informal home exercise program provided by their treating physician

Who Is Running the Clinical Trial?

Julie Nuelle

Lead Sponsor

Trials

2

Recruited

430+

Arthrex, Inc.

Industry Sponsor

Trials

48

Recruited

30,200+

Findings from Research

A systematic review of 20 articles found that most adverse events (AEs) from manual therapy to peripheral joints were benign and transient, with only a few serious AEs reported, primarily related to acupuncture or massage.

The study highlights the need for awareness of potential risks associated with various manual therapy techniques, but overall, serious adverse events are rare, suggesting that manual therapy is generally safe for treating peripheral joint issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events associated with manual therapy of peripheral joints: A scoping review. Sheldon, A., Karas, S.[2022]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

What is the role of the occupational therapist? [2005]

2. Australia pubmed.ncbi.nlm.nih.gov

Effectiveness of occupational therapy interventions on function and occupational performance among adults with conditions of the hand, wrist, and forearm: A systematic review and meta-analysis. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Short-Term Effects of Occupational Therapy on Hand Function and Pain in Patients With Carpometacarpal Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Making a difference: hand therapy. [2011]

5. England pubmed.ncbi.nlm.nih.gov

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial. [2020]

6. England pubmed.ncbi.nlm.nih.gov

Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: analysis of a national cohort of 43 076 surgeries. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Adverse events associated with manual therapy of peripheral joints: A scoping review. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Occupational injury and illness of the thumb. Causes and solutions. [2017]

9. United States pubmed.ncbi.nlm.nih.gov

Nonoperative Management of Carpometacarpal Joint Arthritis. [2022]

10. England pubmed.ncbi.nlm.nih.gov

The benefits of and challenges to the use of occupation in hand therapy. [2013]

11. England pubmed.ncbi.nlm.nih.gov

Reduction in the need for operation after conservative treatment of osteoarthritis of the first carpometacarpal joint: a seven year prospective study. [2022]