Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms Gata 5, 205 03, Malmö, Sweden.
BMC Musculoskelet Disord. 2024 Jan 5;25(1):38. doi: 10.1186/s12891-023-07157-4.
Individuals with wrist osteoarthritis (OA) can suffer from pain, muscular weakness, and impaired motion of the wrist, which can reduce the quality of life. While there is strong evidence that all patients with OA should receive first-line treatment with education and exercises, this approach has not yet been proposed for individuals with wrist OA. Therefore, this trial aimed to evaluate the effectiveness of a first line neuromuscular joint-protective exercise therapy program compared to a training program with range of motion (ROM) exercises in patients with wrist OA.
In this randomized controlled trial (RCT), 48 patients with symptomatic and radiographically confirmed wrist OA were randomly allocated to a 12-week self-management program with either a neuromuscular joint-protective exercise therapy program (intervention group) or a training program with ROM exercises only (control group). Our primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) with secondary outcome measures of grip strength, range of wrist motion, the Numerical Pain Rating, Scale (NPRS), the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Generalized Self-Efficacy Scale (GSES). The outcome measures were evaluated by a blinded assessor at baseline and 12 weeks. Between-groups differences were analyzed using the Mann-Whitney U test and within-group differences were analyzed with the Wilcoxon signed-rank test.
A total of 41 participants were analyzed at 12 weeks. There were no significant differences in PRWE between the groups at 12 weeks (p = 0.27). However, DASH improved significantly in the intervention group compared to the control group (p = 0.02) and NPRS on load within the intervention group (p = 0.006). The difference in DASH should be interpreted with caution since it could be due to a non-significant increase (worsening) from baseline in the control group in combination with a non-significant decrease (improvement) in the intervention group.
This RCT showed that the novel neuromuscular joint-protective exercise therapy program was not superior in reducing pain and improving function compared to a training program with ROM exercises at 12 weeks. Future research is warranted to evaluate the effectiveness of forthcoming exercise therapy treatment programs for patients with wrist OA.
ClinicalTrials.gov, NCT05367817. Retrospectively registered on 10/05/2022. https://clinicaltrials.gov .
腕骨关节炎（OA）患者会出现疼痛、肌肉无力和腕关节运动受限，这会降低生活质量。虽然有强有力的证据表明，所有 OA 患者都应接受以教育和运动为基础的一线治疗，但这种方法尚未针对腕 OA 患者提出。因此，本试验旨在评估与仅进行关节活动度（ROM）运动训练的方案相比，一线神经肌肉关节保护运动疗法方案对腕 OA 患者的有效性。
在这项随机对照试验（RCT）中，48 名有症状和放射学确诊的腕 OA 患者被随机分配到为期 12 周的自我管理计划中，分别接受神经肌肉关节保护运动疗法方案（干预组）或仅进行 ROM 运动训练的方案（对照组）。我们的主要结局指标是患者自评腕关节评分（PRWE），次要结局指标包括握力、腕关节活动范围、数字疼痛评分量表（NPRS）、手臂、肩部和手残疾问卷（DASH）和一般自我效能感量表（GSES）。在基线和 12 周时由盲法评估者进行结局测量。使用 Mann-Whitney U 检验分析组间差异，使用 Wilcoxon 符号秩检验分析组内差异。
共有 41 名参与者在 12 周时进行了分析。两组在 12 周时的 PRWE 无显著差异（p=0.27）。然而，与对照组相比，干预组的 DASH 显著改善（p=0.02），且干预组的负重 NPRS 也显著降低（p=0.006）。由于对照组的 DASH 从基线开始出现非显著增加（恶化），而干预组的 DASH 出现非显著降低（改善），因此对 DASH 的差异应谨慎解释。
本 RCT 表明，与仅进行 ROM 运动训练的方案相比，新型神经肌肉关节保护运动疗法方案在 12 周时并未在减轻疼痛和改善功能方面表现出优势。需要进一步研究来评估针对腕 OA 患者的未来运动疗法治疗方案的有效性。
ClinicalTrials.gov，NCT05367817。于 2022 年 10 月 5 日回顾性注册。https://clinicaltrials.gov。
