title: The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial.
abstract: METHODS
  Double-blind, randomized controlled trial.
  
  
  OBJECTIVE
  To examine the effectiveness of a manual therapy and exercise approach relative to a placebo intervention in individuals with carpometacarpal (CMC) joint osteoarthritis (OA).
  
  
  BACKGROUND
  Recent studies have reported the outcomes of exercise, joint mobilization, and neural mobilization interventions used in isolation in patients with CMC joint OA. However, it is not known if using a combination of these interventions as a multimodal approach to treatment would further improve outcomes in this patient population.
  
  
  METHODS
  Sixty patients, 90% female (mean ± SD age, 82 ± 6 years), with CMC joint OA were randomly assigned to receive a multimodal manual treatment approach that included joint mobilization, neural mobilization, and exercise, or a sham intervention, for 12 sessions over 4 weeks. The primary outcome measure was pain. Secondary outcome measures included pressure pain threshold over the first CMC joint, scaphoid, and hamate, as well as pinch and strength measurements. All outcome measures were collected at baseline, immediately following the intervention, and at 1 and 2 months following the end of the intervention. Mixed-model analyses of variance were used to examine the effects of the interventions on each outcome, with group as the between-subject variable and time as the within-subject variable.
  
  
  RESULTS
  The mixed-model analysis of variance revealed a group-by-time interaction (F = 47.58, P<.001) for pain intensity, with the patients receiving the multimodal intervention experiencing a greater reduction in pain compared to those receiving the placebo intervention at the end of the intervention, as well as at 1 and 2 months after the intervention (P<.001; all group differences greater than 3.0 cm, which is greater than the minimal clinically important difference of 2.0 cm). A significant group-by-time interaction (F = 3.19, P = .025) was found for pressure pain threshold over the hamate bone immediately after the intervention; however, the interaction was no longer significant at 1 and 2 months postintervention.
  
  
  CONCLUSIONS
  This clinical trial provides evidence that a combination of joint mobilization, neural mobilization, and exercise is more beneficial in treating pain than a sham intervention in patients with CMC joint OA. However, the treatment approach has limited value in improving pressure pain thresholds, as well as pinch and grip strength. Future studies should include several therapists, a measure of function, and long-term outcomes.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN37143779.
  
  
  METHODS
  Therapy, level 1b.
authors.affiliation: 　Department of Physical Therapy. Residenza Sanitaria Assistenziale A. Maritano, Sangano, Italy .
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Villafañe
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D052737:Carpometacarpal Joints / Q000503:physiopathology*; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations; D010003:Osteoarthritis / Q000503:physiopathology / Q000628:therapy*; D017288:Pain Threshold; D013933:Thumb / Q000503:physiopathology*; D016896:Treatment Outcome