Aebischer Bernhard, Elsig Simone, Taeymans Jan
Physiotherapie Wirtshausmatte, Schmitten, Switzerland.
School of Health Sciences, Physiotherapy, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland.
Hand Ther. 2016 Mar;21(1):5-15. doi: 10.1177/1758998315614037. Epub 2015 Nov 4.
Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life.
A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case-control studies were included. The risk of bias was assessed.
Out of 218 studies, 27 were retained. A narrative summary and a series of meta-analyses were performed. Concerning pain reduction, the meta-analysis showed parity of pre-fabricated neoprene and custom-made thermoplastic splints: standardized mean difference (SMD) -0.01 (95%CI -0.43, 0.40) (p=0.95). Multimodal interventions are more effective on pain compared to single interventions: standardized mean difference -3.16 (95%CI -5.56, -0.75) ( = 0.01).
Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Pre-fabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.
由于拇指功能的重要性，与其他手部骨关节炎相比，第一掌腕关节骨关节炎会带来更多疼痛和活动受限。虽然手术和药物干预的有效性已得到广泛研究，但对于第一掌腕关节骨关节炎保守非药物治疗缺乏具体证据。本系统评价的目的是提供基于证据的知识，以了解物理治疗和职业治疗对疼痛、功能和生活质量的有效性。
对医学期刊数据库（Medline）、护理学与健康领域数据库（CINAHL）、循证医学数据库（PEDro）、职业疗法搜索数据库（OTseeker）、欧洲医学与健康数据库（EMB Dare）、Cochrane系统评价数据库和Cochrane中心对照试验注册库进行文献检索。纳入随机和半随机对照试验以及相应的系统评价、观察性研究、实用性研究和病例对照研究。评估偏倚风险。
在218项研究中，保留了27项。进行了叙述性总结和一系列荟萃分析。关于疼痛减轻，荟萃分析显示预制氯丁橡胶夹板和定制热塑性夹板效果相当：标准化均数差（SMD）为-0.01（95%可信区间-0.43，0.40）（p=0.95）。与单一干预相比，多模式干预对疼痛更有效：标准化均数差为-3.16（95%可信区间-5.56，-0.75）（p=0.01）。
物理治疗和职业治疗相关干预，尤其是多模式干预，似乎对治疗第一掌腕关节骨关节炎患者的疼痛有效。预制氯丁橡胶夹板和定制热塑性夹板减轻疼痛的效果可能相同。单一干预似乎无效。未发现对功能和生活质量有效性的显著证据。
