title: A systematic review of postoperative hand therapy management of basal joint arthritis.
abstract: BACKGROUND
  There are a variety of postoperative immobilization and therapy options for patients with basal joint arthritis. Although prior systematic reviews have compared surgical procedures used to treat basal joint arthritis, none to our knowledge compares therapy protocols for this condition, which are considered an important part of the treatment.
  
  
  OBJECTIVE
  (1) We sought to determine whether differences in the length and type of postoperative immobilization affect clinical results after basal joint arthritis surgery. (2) We also compared specific therapy protocols that were prescribed. (3) Finally, we evaluated published protocols to determine when patients were released to full activity to see whether these appeared to affect clinical results.
  
  
  METHODS
  A systematic review of English-language studies in the PubMed and Cochrane databases was performed. Studies were then reviewed to determine what postoperative immobilization and therapy protocols the authors used and when patients were released to full activities. A total of 19 studies were identified using the search criteria.
  
  
  RESULTS
  All but one of the studies included a postoperative period of immobilization in either a cast or splint. Immobilization time varied depending on whether Kirschner wires were used for the surgery and whether an implant was placed. Postoperative therapy protocols also varied but followed three general patterns. Some therapy protocols involved teaching patients a home exercise program only, whereas some authors described routine referral to a therapist. The third group consisted of studies in which patients were only referred for therapy if the physicians determined it was necessary during followup. Many studies did not give a specific time for full return to activity and instead described a gradual transition to full activity after immobilization was discontinued. Because of the variability and small numbers, no conclusive recommendations could be made on any of the three study questions.
  
  
  CONCLUSIONS
  Comparative, multicenter studies comparing different immobilization and therapy protocols after the surgical treatment of basal joint arthritis would be helpful for both surgeons and therapists looking to refine their treatment protocols.
authors.affiliation: Hand and Upper Body Rehabilitation Center, 300 State Street, Suite 206, Erie, PA, 16507, USA, terriwolfe@eriehandcenter.com.
authors.forename: Terri
authors.initials: T
authors.lastname: Wolfe
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Chu
authors.forename: Tammy
authors.initials: T
authors.lastname: Woods
authors.forename: John D
authors.initials: JD
authors.lastname: Lubahn
mesh_terms: D001168:Arthritis / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D001864:Bone Wires; D052737:Carpometacarpal Joints / Q000503:physiopathology / Q000601:surgery*; D002370:Casts, Surgical; D005592:Fracture Fixation / Q000295:instrumentation; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D020127:Recovery of Function; D013165:Splints; D013997:Time Factors; D051222:Trapezium Bone / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome