Shankland Barbara, Beaton Dorcas, Ahmed Sara, Nedelec Bernadette
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
J Hand Ther. 2017 Jul-Sep;30(3):307-313. doi: 10.1016/j.jht.2017.03.004. Epub 2017 Apr 25.
Prepost design.
Previous research regarding the non-surgical treatment of thumb carpometacarpal joint osteoarthritis has been based on protocol driven research designs that primarily examined impairment level changes. Exploration is therefore needed to determine the benefits of individually prescribed orthoses, joint protection and assistive device education programs that are based on the activities the person needs to regularly perform.
The primary objective of this study was to examine the effect of client-centered multimodal treatment on activity, participation, impairment, and satisfaction of people with thumb carpometacarpal joint osteoarthritis.
A total of 60 participants completed the study that used a prepost design. The Canadian Occupational Performance Measure (COPM) was used to identify the participants' performance and satisfaction concerning their self-identified occupational performance issues. Additional outcome measures that were used included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, total active range of motion (TAROM), lateral pinch strength, and the visual analog scale for pain. All participants completed a client-centered 6-week program that consisted of the use of an orthosis, joint protection, and assistive device education as well as exercises.
At 6 weeks after initiation of treatment, pain, pinch strength, TAROM, the DASH questionnaire and the performance and satisfaction scales of the COPM had significantly improved. The changes in pain, TAROM, and the performance and satisfaction scales of the COPM were all greater than the minimal clinically important difference. The changes in pain and lateral pinch strength were significantly associated with changes in activity and participation.
This study demonstrated that a multimodal, client-centered treatment approach resulted in statistically and clinically significant improvement in pain, TAROM and performance and satisfaction as measured by the COPM. The improvement in pain was associated with the participants' improved ability to engage in activities assessed by the DASH.
Our results support the use of client-centered treatment strategies that are targeted to control pain during meaningful activity when working with patients with thumb carpometacarpal joint osteoarthritis therapists.
前后对照设计。
以往关于拇指腕掌关节骨关节炎非手术治疗的研究基于方案驱动的研究设计，主要考察功能障碍水平的变化。因此，需要进行探索，以确定根据个体日常活动需求开具的矫形器、关节保护及辅助器具教育方案的益处。
本研究的主要目的是检验以患者为中心的多模式治疗对拇指腕掌关节骨关节炎患者的活动、参与、功能障碍及满意度的影响。
共有60名参与者完成了本项采用前后对照设计的研究。使用加拿大职业表现测量量表（COPM）确定参与者对其自我认定的职业表现问题的表现及满意度。使用的其他结局指标包括手臂、肩部和手部功能障碍（DASH）问卷、总主动活动范围（TAROM）、侧捏力以及疼痛视觉模拟量表。所有参与者均完成了一项为期6周的以患者为中心的方案，该方案包括使用矫形器、关节保护、辅助器具教育以及锻炼。
治疗开始6周后，疼痛、捏力、TAROM、DASH问卷以及COPM的表现和满意度量表均有显著改善。疼痛、TAROM以及COPM的表现和满意度量表的变化均大于最小临床重要差异。疼痛和侧捏力的变化与活动和参与的变化显著相关。
本研究表明，多模式、以患者为中心的治疗方法在统计学和临床上均能显著改善疼痛、TAROM以及COPM所测量的表现和满意度。疼痛的改善与参与者参与DASH评估活动的能力提高相关。
我们的结果支持在治疗拇指腕掌关节骨关节炎患者时，使用以患者为中心的治疗策略，以在有意义的活动中控制疼痛。
4级。
