None listed
Conditions
Brief summary
Arthritis at the base of the thumb is common in ageing adults. It can result in pain and impact on function and quality of life. There are many treatments available to help relieve pain and improve hand function. Currently, it is common practice in Australia and overseas for health care providers (such as General Practitioners, Surgeons, Rheumatologists and Hand Therapists) to initially recommend non-surgical/conservative treatments for their patients. Treatments can include splinting the joint to relieve pain and enable hand function; injection of corticosteroid into the joint to reduce inflammation and provide pain relief; and hand therapy to provide exercises and patient education to inform on strategies for protecting the joints, managing pain and improving function. Preliminary research on these types of treatments has had mixed results, yet, health care professionals continue to offer these as treatments. This study will compare the effectiveness of the following non-surgical treatments: Push BraceTM splint; corticosteroid injection; and hand therapy treatment in relieving symptoms and improving function in adults with osteoarthritis at the base of the thumb. There has been no previous randomised controlled trial comparing the outcomes of these types of treatments.
Interventions
Intervention Group 1: Basic hand therapy program including a standardised exercise program; advice on pain management including thermal modalities; joint protection and activity modification provided in a 15 minute consultation with a qualified occupational therapist AND Push brace orthosis fitted by a qualified occupational therapist.
Intervention Group 2: Basic hand therapy program (as above) AND Ultra-sound guided Corticosteriod injection (1mL of celestone chronodose and 1mL 0.5% marcaine) t
Intervention Group 1: Basic hand therapy program including a standardised exercise program; advice on pain management including thermal modalities; joint protection and activity modification provided in a 15 minute consultation with a qualified occupational therapist AND Push brace orthosis fitted by a qualified occupational therapist. Intervention Group 2: Basic hand therapy program (as above) AND Ultra-sound guided Corticosteriod injection (1mL of celestone chronodose and 1mL 0.5% marcaine) to the CMC joint (of the thumb) provided by a qualified radiologist Intervention Group 3: Basic hand therapy program (as above) AND Push brace orthosis (as above) AND Ultra-sound guided Corticosteriod injection (as above)
Sponsors
Brisbane Hand and Upper Limb Research Institute
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1- 18 years and over 2- Clinical diagnosis of primary idiopathic 1st CMC joint osteoarthritis 3 - Minimal level of symptoms of either a pain score of at least 30 (out of 100) on VAS or 22 (out of 90) on the AUSCAN NRS 4.1 subscale
Exclusion criteria
1- Inflammatory joint conditions including rheumatoid arthritis and gout 2- Significant untreated Dupuytren's Disease resulting in severely impaired function 3- History of previous conservative management of 1st CMC joint arthritis including use of a splint within the last 3 months 4- History of corticosteriod injection or Hyaluronate injection in either of the hands 5- Previous soft tissue injury or fracture of the thumb or wrist joints that has resulted in significant function limitation 6- Pregnancy 7- High medical dependency that may interfere with ability to return for assessments or compliance with interventions
Outcome results
None listed