Osteoarthritis Wrist
Conditions
Brief summary
A randomized controlled trial comparing partial wrist denervation to a self-managed exercise therapy program in 140 patients with wrist osteoarthritis.
Detailed description
Backgroud: High quality evidence regarding the effectiveness of non-operative and operative treatments in wrist osteoarthritis are lacking. Aim: To analyze: 1. Does partial wrist denervation and self-managed exercise therapy improve patient-reported outcomes, pain, grip strength and range of motion (ROM) in wrist OA? 2. Is any of the two treatment concepts partial wrist denervation and self-managed exercise therapy more efficient than the other in terms of patient-reported outcomes, pain relief, grip strength and range of motion? Method: A multicenter parallel group, two-arm, randomized, controlled, assessor blinded, trial of 140 patients. The study is conducted at the departments of hand surgery at Södersjukhuset Stockholm and Malmö University hospital. Group1: Self-managed exercise therapy program containing: * Patient education: * Exercise therapy program: The exercise therapy program is designed by Sara Larsson (physiotherapist at the Department of hand surgery in Malmö, Sweden), influenced by previous studies on wrist stability and proprioception. Focus is on functional re-learning and strengthening of the musculoskeletal system with the aim to create a stable wrist that can be used in a pain-free manner in activities of daily living. The program consists of neuromuscular exercises that focus on coordination, wrist stability and strength. Group 2: Surgery will be performed under local anesthesia (+ blood-less field or wide-awake local anesthesia no torniquet (WALANT) according to the surgeon's preference) through a single dorsal incision. AIN and PIN neurectomy will be performed as described by Berger (Berger, 1998). Primary outcome: Patient Rated Wrist Evaluation (PRWE) score (0-100) (MacDermid et al., 1998) 12 months after intervention.
Interventions
BEHAVIORALSelf-managed exercise therapy program
Exercise program focusing on functional re-learning and strengthening of the musculoskeletal system with the aim to create a stable wrist that can be used in a pain-free manner in activities of daily living.
PROCEDUREPartial wrist denervation
AIN and PIN neurectomy through a dorsal approach as described by Berger (Berger, 1998).
Sponsors
Karolinska Institutet
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Data assessors and analysts will be masked for treatment allocation (covered wrist / anonymous data sheet).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years. * Chronic wrist pain (≥6 months) due to Scapholunate advanced collapse (SLAC) / Scaphoid non-union advanced collapse (SNAC) grade 1-3 osteoarthritis. * Radiological signs of osteoarthritis on posteroanterior and lateral radiograph.
Exclusion criteria
* Previous PIN or AIN neurectomy. * Rheumatoid arthritis or other chronic inflammatory arthritis. * Symptomatic osteoarthritis in the distal radio-ulnar (DRU), Scapho-trapezio-trapezoid (STT) or thumb carpometacarpal (CMC) joints. * Ongoing infection. * Inability to co-operate with the follow-up protocol. * Systemic or intra-articular glucocorticoids or intraarticular PRP or Hyaluronic acid injections in the affected joint within 3 months prior to enrollment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PRWE | 6 months | Patient Rated Wrist Evaluation (PRWE) score (0-100 (high score worse outcome)) (MacDermid et al., 1998) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain NRS | 3 months | Pain at rest and on load measured by a Numerical Rating Scale (NRS, 0-100 (higher score worse outcome) (Salaffi et al 2004) |
| EQ5D | 3 months | EQ-5D-5L (0-1 (higher score better outcome)) (Brooks, 1996) |
| GROC | 3 months | Global rating of change (GROC, -5-+5, higher score better outcome) |
| Pain catastrophizing | 3 months | PCS (Pain catastrophizing scale, 0-52, higher score worse outcome) (Sullivan et al, 1995) |
| ROM | 3 months | Range of motion (ROM) of the wrist. |
| Grip | 3 months | Grip strength (Jamar). |
| PRWE | 3 months | Patient Rated Wrist Evaluation (PRWE) score (0-100 (high score worse outcome)) (MacDermid et al., 1998) |
| Radiology | 5 years | Radiological grade of osteoarthritis 5 years after inclusion compared to baseline. |
| Cost | 12 months | Differences in direct costs associated with treatment and indirect costs. |
| sick leave | 12 months | length of sick leave |
| work | 12 months | ability to return to previous work |
| Survival | 12 months | Success of the intervention, i.e no additional surgery during the study period due to lack of treatment effect or recurrence of symptoms. |
| Complications | 3 months | Complications related to treatment |
Countries
Sweden
Contacts
Primary ContactElin Swärd, MD, PhD
Outcome results
None listed