The clinical and cost effectiveness of splints for thumb base osteoarthritis: a randomised controlled trial

Jo Adams*, Paula Barratt, Ines Rombach, Nigel Arden, Sofia Barbosa Bouças, Sarah Bradley, Michael Doherty, Susan J Dutton, Rachael Gooberman-Hill, Kelly Hislop-Lennie, Corinne Hutt-Greenyer, Victoria Jansen, Ramon Luengo-Fernandez, Mark Williams, Krysia Dziedzic

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objectives
To investigate the clinical effectiveness, efficacy and cost effectiveness of splints (orthoses) in people with symptomatic basal thumb joint OA (BTOA).

Methods
A pragmatic, multicentre parallel group randomized controlled trial at 17 National Health Service (NHS) hospital departments recruited adults with symptomatic BTOA and at least moderate hand pain and dysfunction. We randomized participants (1:1:1) using a computer-based minimization system to one of three treatment groups: a therapist supported self-management programme (SSM), a therapist supported self-management programme plus a verum thumb splint (SSM+S), or a therapist supported self-management programme plus a placebo thumb splint (SSM+PS). Participants were blinded to group allocation, received 90 min therapy over 8 weeks and were followed up for 12 weeks from baseline. Australian/Canadian (AUSCAN) hand pain at 8 weeks was the primary outcome, using intention to treat analysis. We calculated costs of treatment.

Results
We randomized 349 participants to SSM (n = 116), SSM+S (n = 116) or SSM+PS (n = 117) and 292 (84%) provided AUSCAN Osteoarthritis Hand Index hand pain scores at the primary end point (8 weeks). All groups improved, with no mean treatment difference between groups: SSM+S vs SSM −0.5 (95% CI: −1.4, 0.4), P = 0.255; SSM+PS vs SSM −0.1 (95% CI: −1.0, 0.8), P = 0.829; and SSM+S vs SSM+PS −0.4 (95% CI: −1.4, 0.5), P = 0.378. The average 12-week costs were: SSM £586; SSM+S £738; and SSM+PS £685.

Conclusion
There was no additional benefit of adding a thumb splint to a high-quality evidence-based, supported self-management programme for thumb OA delivered by therapists.
Original languageEnglish
Article numberkeaa726
Number of pages16
JournalRheumatology
Early online date30 Nov 2020
DOIs
Publication statusE-pub ahead of print - 30 Nov 2020

Bibliographical note

The acceptance date for this record is provisional and based upon the month of record creation.

Keywords

  • thumb splint
  • orthosis
  • symptomatic basal thumb joint osteoarthritis
  • clinical trial

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