Menendez Mariano E, Thornton Emily, Kent Suzanne, Kalajian Tyler, Ring David
Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA, 02114, USA,
Int Orthop. 2015 Aug;39(8):1563-9. doi: 10.1007/s00264-015-2779-6. Epub 2015 Apr 28.
There is no consensus on the best protocol for splint wear in the non-operative management of de Quervain tendinopathy. This study aimed to determine if there is a difference between prescription of strict splint wear compared to selective splint wear in patients with de Quervain tendinopathy. We tested the primary null hypothesis that there is no difference in upper-extremity disability eight weeks after initiating splinting between patients prescribed full-time or as-desired splint wear. Secondary study questions addressed differences in grip strength, pain intensity, and treatment satisfaction. Additionally, we evaluated the influence of psychological factors on disability.
Eighty-three patients diagnosed with de Quervain tendinopathy were randomly allocated into two different splint-wearing instructions: full-time wear (N = 43) or as-desired wear (N = 40). At enrollment, patients had grip strength measured and completed measures of upper-extremity disability, pain intensity, and psychological distress. An average of 7.5 weeks later, patients returned for a second visit. Analysis was by intention-to-treat and with use of mean imputation for missing data.
Fifty-eight patients (70 %; 26 in the full-time cohort and 32 in the as-desired cohort) completed the study. There were no statistically significant differences in disability (p = 0.77), grip strength (p = 0.82), pain intensity (p = 0.36), and treatment satisfaction (p = 0.91) between patients instructed to wear the splint full-time and those instructed to use it as desired. Disability at final evaluation correlated significantly with baseline levels of pain anxiety (p = 0.008), catastrophic thinking (p = 0.001), and symptoms of depression (p < 0.001). The best multivariable linear regression model included symptoms of depression alone and accounted for 32 % of the variability in disability (p < 0.001).
There is no difference in patient-reported outcomes and grip strength with prescription of full-time or as-desired splinting, and patients can wear the splint as they prefer. These results suggest that splinting for de Quervain tendinopathy is palliative at best and strict rest is not disease modifying.
在桡骨茎突狭窄性腱鞘炎的非手术治疗中，对于夹板佩戴的最佳方案尚无共识。本研究旨在确定在桡骨茎突狭窄性腱鞘炎患者中，严格规定夹板佩戴与选择性夹板佩戴之间是否存在差异。我们检验了主要无效假设，即在开始夹板治疗八周后，规定全职佩戴夹板或按需佩戴夹板的患者在上肢功能障碍方面没有差异。次要研究问题涉及握力、疼痛强度和治疗满意度的差异。此外，我们评估了心理因素对功能障碍的影响。
83例被诊断为桡骨茎突狭窄性腱鞘炎的患者被随机分配到两种不同的夹板佩戴指导方案中：全职佩戴（N = 43）或按需佩戴（N = 40）。在入组时，测量患者的握力，并完成上肢功能障碍、疼痛强度和心理困扰的测量。平均7.5周后，患者返回进行第二次就诊。分析采用意向性分析，并对缺失数据使用均值插补法。
58例患者（70%；全职组26例，按需组32例）完成了研究。在被指示全职佩戴夹板的患者和被指示按需佩戴夹板的患者之间，在功能障碍（p = 0.77）、握力（p = 0.82）、疼痛强度（p = 0.36）和治疗满意度（p = 0.91）方面没有统计学上的显著差异。最终评估时的功能障碍与疼痛焦虑的基线水平（p = 0.008）、灾难性思维（p = 0.001）和抑郁症状（p < 0.001）显著相关。最佳的多变量线性回归模型仅包括抑郁症状，并且解释了功能障碍变异性的32%（p < 0.001）。
全职或按需佩戴夹板在患者报告的结果和握力方面没有差异，患者可以根据自己的喜好佩戴夹板。这些结果表明，桡骨茎突狭窄性腱鞘炎的夹板治疗充其量只是姑息性的，严格休息并不能改善病情。
