title: Rigid versus semi-rigid orthotic use following TMC arthroplasty: a randomized controlled trial.
abstract: BACKGROUND
  The trapeziometacarpal (TMC) joint of the human thumb is the second most common joint in the hand affected by osteoarthritis. TMC arthroplasty is a common procedure used to alleviate symptoms. No randomized controlled trials have been published on the efficacy of different post-operative orthotic regimes.
  
  
  METHODS
  Fifty six participants who underwent TMC arthroplasty were allocated to either rigid orthotic or semi-rigid orthotic groups. Both groups started an identical exercise program at two weeks following surgery. Outcome measures were assessed by an assessor blinded to group allocation. The primary outcome was the Patient Rated Wrist and Hand Evaluation (PRWHE) and secondary outcomes included the Michigan Hand Questionnaire (MHQ), thumb palmar abduction, first metacarpophalangeal extension and three point pinch grip. Measures were taken pre-operatively, at six weeks, three months and one year post-operatively. Between-group differences were analyzed with linear regression.
  
  
  RESULTS
  Both groups performed equally well. There was no significant between-group difference for PRWHE scores (0.47, CI -11.5 to 12.4), including subscales for pain and function, or for any of the secondary outcomes at one year follow-up.
  
  
  CONCLUSIONS
  We found no difference in outcomes between using a rigid or semi-rigid orthosis after TMC arthroplasty. Patient comfort, cost and availability may determine choice between orthoses in clinical practice.
  
  
  METHODS
  1b RCT.
authors.affiliation: Sydney Hand Therapy & Rehabilitation Centre, Sydney, Australia. Electronic address: rosemary_hands@msn.com.au.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Prosser
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hancock
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: Leslie
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: Sydney Hand Therapy & Rehabilitation Centre, Sydney, Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Merry
authors.affiliation: Sydney Hand Therapy & Rehabilitation Centre, Sydney, Australia.
authors.forename: Felicity
authors.initials: F
authors.lastname: Thorley
authors.affiliation: Hand Surgery Centre, St Lukes Hospital Hand Unit, Potts Point, Sydney, Australia.
authors.forename: Douglass
authors.initials: D
authors.lastname: Wheen
mesh_terms: D000368:Aged; D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation*; D052737:Carpometacarpal Joints / Q000503:physiopathology / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices / Q000145:classification*; D010003:Osteoarthritis / Q000175:diagnosis / Q000601:surgery; D010149:Postoperative Pain / Q000503:physiopathology / Q000628:therapy; D011182:Postoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012016:Reference Values; D013933:Thumb / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arthroplasty; Orthosis; Osteoarthritis; Thumb