Combination of Conservative Therapies significantly improves osteoarthritis: JAMA
People with thumb-base osteoarthritis (OA) who receive a combination of conservative treatments, including education in self-management, ergonomics and hand exercises, may experience clinically meaningful improvements in hand function, a study suggests.Findings have been put forth in JAMA Internal Medicine.
A combination of conservative treatments is commonly used in clinical practice for thumb base osteoarthritis despite limited evidence for this approach.The recent study was undertaken to determine the efficacy of a 6-week combination of conservative treatments compared with an education comparator.
Researchers randomized 204 people with thumb-base OA (1:1) to receive education on self-management and ergonomics alone (comparator) or in combination with a base-of-thumb splint, hand exercises and diclofenac sodium 1% gel (intervention). The primary endpoints were improvements in hand function scores (0–30 point Functional Index for Hand OA) and pain (0–100 mm visual analog scale) at six weeks. The intervention group (n = 102) received education on self-management and ergonomic principles, a base-of-thumb splint, hand exercises, and diclofenac sodium, 1%, gel. The comparator group (n = 102) received education on self-management and ergonomic principles alone. Intervention use was at participants' discretion from 6 to 12 weeks.
Hand function (Functional Index for Hand Osteoarthritis; 0-30) and pain (visual analog scale; 0-100 mm) were measured at week 6 (primary time point) and week 12. An α of .027 was used at week 6 to account for co–primary outcomes.
Data analysis revealed some interesting facts.
- Of the 204 participants randomized, 195 (96%) and 194 (95%) completed follow-ups at 6 and 12 weeks, respectively; the mean (SD) age of the population was 65.6 (8.1) years, and 155 (76.0%) were female.
- At week 6, hand function improved significantly more in the intervention group than the comparator (between-group difference, −1.7 units; 97.3% CI, −2.9 to −0.5; P = .002). This trend was sustained at 12 weeks (−2.4 units; 95% CI, −3.5 to −1.3; P < .001).
- Pain scores improved similarly at week 6 (between-group difference, −4.2 mm; 97.3% CI, −11.3 to 3.0; P = .19).
- At week 12, pain reduction was significantly greater in the intervention group (−8.6 mm; 95% CI, −15.2 to −2.0; P = .01).
- There were 34 nonserious adverse events, all in the intervention group—mostly skin reactions and exercise-related pain exacerbations.
For the full article follow the link: doi: 10.1001/jamainternmed.2020.7101.
Primary source:JAMA Internal Medicine