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Titre : | Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study (2020) |
Auteurs : | Robbert M. Wouters ; Harm P. Slijper ; Lisa Esteban Lopez |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 101, n° 3, 2020) |
Article en page(s) : | p. 434-441 |
Note générale : | https://doi.org/10.1016/j.apmr.2019.08.485 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Articulations carpométacarpiennes ; Instabilité articulaire ; Orthèses ; Pouce ; Réadaptation ; Syndrome d'Ehlers-Danlos ; Techniques de physiothérapie ; Traitement par les exercices physiques |
Résumé : |
Objective
To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. Design Prospective cohort study. Setting A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. Participants A consecutive sample of patients with symptomatic CMC-1 instability (N=431). Intervention Nonsurgical treatment including exercise therapy and an orthosis. Main Outcome Measures Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). Results VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001 no difference was present at months for mhq total score but the subscales activities of daily living work pain and satisfaction improved by ci points respectively after median follow-up years only participants were surgically treated. both in subgroups that did not convert to surgery vas scores decreased compared with baseline whereas improve subgroups. however remained worse patients who eventually converted> Conclusions In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999319311207 |