BACKGROUND: Some guidelines recommend splinting for base-of-thumb osteoarthritis, despite lack of evidence of efficacy. OBJECTIVE: To assess the efficacy and acceptability of a splint for base-of-thumb osteoarthritis. DESIGN: Multicenter, randomized trial. Randomization was computer-generated, and allocation was concealed by faxing centralized treatment assignment to investigators at the time of enrollment. Patients and investigators were not blinded to assignment, and patients self-reported outcomes. SETTING: 2 tertiary care hospitals in France. PATIENTS: 112 patients (101 women) with base-of-thumb osteoarthritis. INTERVENTION: Custom-made neoprene splint (n = 57) or usual care (n = 55). MEASUREMENTS: Primary outcome was change in pain level assessed on a visual analogue scale (VAS) (range, 0 to 100 mm) from baseline to 1 month. Secondary outcomes were change in measures of hand disability at 1 month and change in pain level and measures of disability at 12 months. Tolerance and adherence with the splint were recorded. RESULTS: At 1 month, no difference in change occurred in pain level from baseline in the intervention and control groups (adjusted mean change, -10.1 vs. -10.7; between-group difference, 0.6 [95% CI, -7.9 to 9.1]; P = 0.89). Disability was assessed by the Cochin Hand Function Scale score (range, 0 to 90) or patient-perceived disability (VAS, 0 to 100 mm). At 12 months, change in pain from baseline was greater in the intervention group than in the control group (adjusted mean change, -22.2 vs. -7.9; between-group difference, -14.3 [CI, -23.4 to -5.2]; P = 0.002). The Cochin Hand Function Scale score was -1.9 versus 4.3 (between-group difference, -6.3 [CI, -10.9 to -1.7]; P = 0.008) and patient-perceived disability was -11.6 versus 1.5 (between-group difference, -13.1 [CI, -21.8 to -4.4]; P = 0.003). At 12 months, 86% of the intervention group had worn the splint for more than 5 nights a week, and no adverse effects were observed. LIMITATION: Patients, health care providers, and outcome assessors were not blinded. CONCLUSION: For patients with base-of-thumb osteoarthritis, wearing a splint had no effect on pain at 1 month but improved pain and disability at 12 months. PRIMARY FUNDING SOURCE: Programme Hospitalier de Recherche Clinique National.
RCT Entities:
BACKGROUND: Some guidelines recommend splinting for base-of-thumb osteoarthritis, despite lack of evidence of efficacy. OBJECTIVE: To assess the efficacy and acceptability of a splint for base-of-thumb osteoarthritis. DESIGN: Multicenter, randomized trial. Randomization was computer-generated, and allocation was concealed by faxing centralized treatment assignment to investigators at the time of enrollment. Patients and investigators were not blinded to assignment, and patients self-reported outcomes. SETTING: 2 tertiary care hospitals in France. PATIENTS: 112 patients (101 women) with base-of-thumb osteoarthritis. INTERVENTION: Custom-made neoprene splint (n = 57) or usual care (n = 55). MEASUREMENTS: Primary outcome was change in pain level assessed on a visual analogue scale (VAS) (range, 0 to 100 mm) from baseline to 1 month. Secondary outcomes were change in measures of hand disability at 1 month and change in pain level and measures of disability at 12 months. Tolerance and adherence with the splint were recorded. RESULTS: At 1 month, no difference in change occurred in pain level from baseline in the intervention and control groups (adjusted mean change, -10.1 vs. -10.7; between-group difference, 0.6 [95% CI, -7.9 to 9.1]; P = 0.89). Disability was assessed by the Cochin Hand Function Scale score (range, 0 to 90) or patient-perceived disability (VAS, 0 to 100 mm). At 12 months, change in pain from baseline was greater in the intervention group than in the control group (adjusted mean change, -22.2 vs. -7.9; between-group difference, -14.3 [CI, -23.4 to -5.2]; P = 0.002). The Cochin Hand Function Scale score was -1.9 versus 4.3 (between-group difference, -6.3 [CI, -10.9 to -1.7]; P = 0.008) and patient-perceived disability was -11.6 versus 1.5 (between-group difference, -13.1 [CI, -21.8 to -4.4]; P = 0.003). At 12 months, 86% of the intervention group had worn the splint for more than 5 nights a week, and no adverse effects were observed. LIMITATION: Patients, health care providers, and outcome assessors were not blinded. CONCLUSION: For patients with base-of-thumb osteoarthritis, wearing a splint had no effect on pain at 1 month but improved pain and disability at 12 months. PRIMARY FUNDING SOURCE: Programme Hospitalier de Recherche Clinique National.
Authors: David Moher; Sally Hopewell; Kenneth F Schulz; Victor Montori; Peter C Gøtzsche; P J Devereaux; Diana Elbourne; Matthias Egger; Douglas G Altman Journal: BMJ Date: 2010-03-23
Authors: Jean-Yves L Reginster; Nigel K Arden; Ida K Haugen; Francois Rannou; Etienne Cavalier; Olivier Bruyère; Jaime Branco; Roland Chapurlat; Sabine Collaud Basset; Nasser M Al-Daghri; Elaine M Dennison; Gabriel Herrero-Beaumont; Andrea Laslop; Burkhard F Leeb; Stefania Maggi; Ouafa Mkinsi; Anton S Povzun; Daniel Prieto-Alhambra; Thierry Thomas; Daniel Uebelhart; Nicola Veronese; Cyrus Cooper Journal: Semin Arthritis Rheum Date: 2017-12-07 Impact factor: 5.532
Authors: Christian Karl Spies; Martin Langer; Peter Hahn; Lars Peter Müller; Frank Unglaub Journal: Dtsch Arztebl Int Date: 2018-04-20 Impact factor: 5.594
Authors: Anusha Ratneswaran; Jason S Rockel; Daniel Antflek; John J Matelski; Konstantin Shestopaloff; Mohit Kapoor; Heather Baltzer Journal: Front Immunol Date: 2022-01-20 Impact factor: 7.561