http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, Early Online: 1–19 ! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2014.996299 REVIEW PAPER Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis Lucia Bertozzi 1 , Kristin Valdes 2 , Carla Vanti 1 , Stefano Negrini 3,4 , Paolo Pillastrini 1 , and Jorge Hugo Villafan ˜e 4 1 School of Physical Therapy, Alma Mater Studiorum, University of Bologna, Bologna, Italy, 2 Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA, 3 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, and 4 IRCCS Don Gnocchi Foundation, Milan, Italy Abstract Purpose: The purpose of this study was to conduct a current review of randomized controlled trials regarding the effect of conservative interventions on pain and function in people with thumb carpometacarpal (CMC) osteoarthritis (OA), perform a meta-analysis of the findings and summarize current knowledge. Method: Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to May 2014. Reference lists of relevant literature reviews were also searched. All published randomized trials without restrictions to time of publication or language were considered for inclusion. Study subjects were symptomatic adults with thumb CMC OA. Two reviewers independently selected studies, conducted quality assessment and extracted results. Data were pooled in a meta-analysis, when possible, using a random-effects model. Quality of the body evidence was assessed using GRADE approach. Results: Sixteen RCTs involving 1145 participants met the inclusion criteria. Twelve were of high quality (PEDro score46). We found moderate quality evidence that manual therapy and therapeutic exercise combined with manual therapy improve pain in thumb CMC OA at short- and intermediate-term follow-up, and from low to moderate quality evidences that magneto therapy improves pain and function at short-term follow-up. Orthoses (splints) were found to improve function at long-term follow-up and pinch strength at short- term follow-up. Finally, we found from very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long- term follow-up. Conclusions: Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain. Additional research is required to determine the efficacy of other therapeutic interventions that are performed with patients with thumb CMC OA. ä Implications for Rehabilitation  Manual therapy and exercise are an effective means of improving pain and function at short-term follow-up by patients with thumb CMC OA.  Magneto therapy, manual therapy, manual therapy and exercise and Orthoses (splints) were found to have clinically significant results.  Very few of the included studies showed a clinically significant effect size in favor of treatment. Keywords Carpometacarpal joints, hand joints, osteoarthritis, physical therapy modalities, thumb carpometacarpal History Received 10 August 2014 Revised 30 November 2014 Accepted 4 December 2014 Published online 26 December 2014 Introduction The thumb carpometacarpal (CMC) joint is the most frequent site of OA in the hand [1]. CMC OA affects 15% of adults older than 30 years and 66% of women older than 55 years [2]. Furthermore, OA of the radial three digits of the hand has been associated with more severe upper extremity disabilities as determined by DASH scores [3]. Individuals with CMC OA can have difficulty opening jars, turning keys in locks, opening food packages and wringing out washcloths. Therapists can employ a variety of interventions to improve thumb range of motion (ROM), grip strength and decrease pain in an attempt to improve hand function. There exists a plethora of interventions, that have varying degrees evidence to support their use, that can be employed by therapists that treat CMC OA and it is important that therapists understand which interventions have been found to be the most efficacious to improve the individual’s quality of life. Mahendira and Towheed performed a systematic review on published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients Address for correspondence: Jorge Hugo Villafan ˜e, Regione Generala 11/16, 10045 Piossasco, Italy. Tel: +39 011 9065495/+39 339 5857563. Fax: +39 011 9065495. E-mail: mail@villafane.it Disabil Rehabil Downloaded from informahealthcare.com by 79.50.217.37 on 01/05/15 For personal use only.