UBC Theses and Dissertations
Comparison of two carpometacarpal stabilizing splints for individuals with thumb osteoarthritis Sillem, Helia Suzanne
OBJECTIVE: To compare the effect of two different splints on hand function, pain and hand strength in adults with carpometacarpal osteoarthritis (CMC OA): the prefabricated neoprene Comfort CoolTM a long opponens design, and a custom-made thermoplastic and neoprene splint, the Hybrid, a short opponens design. STUDY DESIGN: Equivalence trial, 2 phase crossover design. METHODS AND MEASURES: Participants with CMC OA from 3 out-patient clinics were assigned randomly to splint order in a 2 phase crossover trial. Each splint was worn for 4 weeks separated by a 1 week wash-out period. Hand function, the primary outcome, was assessed using the Australian Canadian Hand Osteoarthritis Index (AUSCAN) numerical rating scale (NRS) version. Secondary outcomes included pain (AUSCAN pain subscale), and grip and lateral pinch strength measured with dynamometers. Participants were assessed at baseline, after each splint phase and after the 1 week washout period. AUSCAN alone was administered at 3 months. Data were analysed using descriptive statistics, paired t-tests and chi-square tests. RESULTS: Fifty-four participants (mean age = 64 years, time since diagnosis = 2.99 years) were randomized and completed the study. They wore the assigned splints for an average of 8 hrs/day. Differences between the effect of Comfort Cool™ and Hybrid splints were not statistically significant for hand function, grip and pinch strength. However, the Hybrid resulted in a greater average reduction in pain scores compared to the Comfort Cool™ (3.72 points, p = 0.02). No carryover or order effects were present. Compared to the baseline measures, modest improvements were noted for all outcomes after 4 weeks with both splints. At the 3 month follow-up, both hand function and pain had improved significantly over baseline. CONCLUSION: The splints demonstrated similar, modest improvement in hand function and similar to previous published studies, neither thumb splint had a significant effect on grip or pinch strength. The findings of equivalence for both splints allow therapists to use a client centred approach to splinting. This study supports exisiting evidence that splinting benefits individuals with CMC OA by providing pain relief. Thumb splinting may have a continued effect on pain and function with longer term intervention.
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