Off-the-Shelf Splints Versus Occupational Therapy Splints for Treatment of Trapeziometacarpal Arthrosis
The specific aim is to compare the effectiveness of Off-the-Shelf splints and splints provided by Occupational Therapy for treatment of trapeziometacarpal (TMC) arthrosis.
Trapeziometacarpal (TMC) Arthrosis
Device: Off-the-shelf splint
Device: OT Splint
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
- Disabilities of the Arm, Shoulder and Hand Quick Questionnaire (Quick-DASH) [ Time Frame: At enrollment ] [ Designated as safety issue: No ]The Quick-DASH measures the patient's ability to do following activities in the week before a visit.
- Change from the baseline in the Disabilities of the Arm, Shoulder and Hand Quick Questionnaire (Quick-DASH) at 2 months after enrollment [ Time Frame: 2 months after enrollment ] [ Designated as safety issue: No ]2-month change in the Quick-DASH, which measures the patient's ability to do following activities in the week before a visit.
- Thumb pain at enrollment [ Time Frame: At enrollment ] [ Designated as safety issue: No ]Patient's thumb pain will be recorded on a numerical rating scale
- Average thumb pain and satisfaction with the splint 2 months after enrollment [ Time Frame: At 2 months after enrollment ] [ Designated as safety issue: No ]Average thumb pain on a numerical scale and satisfaction with splint treatment will be assessed 2 months after enrollment.
- Patient Reported Outcomes Measurement Information System (PROMIS) - Depression [ Time Frame: At Enrollment ] [ Designated as safety issue: No ]A computerized assessment of depression measured at enrollment.
- PROMIS Pain - Interference [ Time Frame: At Enrollment ] [ Designated as safety issue: No ]A computerized assessment of pain interference measured at enrollment.
- Thumb metacarpophalangeal (MCP) hyperextension, and grip and pinch strength [ Time Frame: At Enrollment ] [ Designated as safety issue: No ]Various measurements of thumb extension, grip and punch strength will be measured at enrollment.
|Study Start Date:||February 2013|
|Estimated Primary Completion Date:||February 2015 (Final data collection date for primary outcome measure)|
Experimental: Off-the-Shelf Splint
Subjects in this arm will be managed with off-the-shelf splints for TMC arthrosis.
Device: Off-the-shelf splint
Subjects will use an off-the-shelf splint
Active Comparator: OT Splint
Subjects in this arm will be managed with a custom-made splint made by the MGH Occupational Therapists.
Device: OT Splint
Subjects will use a splint custom-made by MGH Occupational Therapists.
Trapeziometacarpal (TMC) arthrosis is so common, particularly in women, that it should be considered a normal part of the aging process. Overall radiographic prevalence of TMC arthrosis has been described to be as high as 91% in patients older than eighty years of age. It increases steadily from the age of 41 years, more rapidly in women than in men. Another study, conducted in the Netherlands, showed that in a population of 55 years and older, 67% of women and 55% of men had radiographic signs of arthrosis of the hand. It also found that the distal interphalangeal (DIP) joints are most commonly affected (47%), followed by the TMC joint (36%). However, it has been reported that in symptomatic arthrosis, TMC arthrosis contributes more to pain and disability than arthrosis of the interphalangeal joints. Psychosocial factors have been recognized as the strongest determinants of highly variable pain intensity and arm-specific disability. The pathophysiologic and psychosocial differences between patients who present to the doctor for treatment and those who do not are incompletely understood.
A hand-based thumb spica splint with the interphalangeal (IP) joint free is a specific nonoperative palliative treatment for TMC arthrosis. The goals of splint wear are improved comfort and function. The data regarding specific splint materials are limited, but suggest that shorter more flexible splints are preferred by patients and equally effective. Recently, the investigators looked into if there was a difference between thermoplast and neoprene hand-based thumb spica splints for treatment of TMC arthrosis. The neoprene splint was rated more comfortable than the thermoplast splint but otherwise there was no difference.
To the investigators' knowledge no studies have looked at the added value of occupational therapy in splint treatment for TMC arthrosis. The investigators believe that the time spent by occupational therapists (OTs) coaching patients on adaptive and palliative measures is valuable in addition to their technical skills but the investigators cannot draw any conclusions until the investigators research this in a prospective trial.
The investigators propose a two arm unblinded, randomized (1:1) controlled trial to evaluate if there is a difference between prefabricated off-the-shelf splints and splints provided by an OT with standard care coaching. The investigators want to determine if there is a difference in arm-specific disability, average pain, and satisfaction at an average of 2 months between splints provided by an OT and prefabricated off-the-shelf splints.
|United States, Massachusetts|
|Massachusetts General Hospital|
|Boston, Massachusetts, United States, 02114|
|Principal Investigator:||David C Ring, MD, PhD||Massachusetts General Hospital|