title: Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 score > 6). 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a School of Physical Therapy, Alma Mater Studiorum, University of Bologna , Bologna , Italy .
authors.forename: Lucia
authors.initials: L
authors.lastname: Bertozzi
authors.affiliation: b Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , PA , USA .
authors.forename: Kristin
authors.initials: K
authors.lastname: Valdes
authors.affiliation: a School of Physical Therapy, Alma Mater Studiorum, University of Bologna , Bologna , Italy .
authors.forename: Carla
authors.initials: C
authors.lastname: Vanti
authors.affiliation: c Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy , and.|d IRCCS Don Gnocchi Foundation , Milan , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Negrini
authors.affiliation: a School of Physical Therapy, Alma Mater Studiorum, University of Bologna , Bologna , Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Pillastrini
authors.affiliation: d IRCCS Don Gnocchi Foundation , Milan , Italy.
authors.forename: Jorge Hugo
authors.initials: JH
authors.lastname: Villafañe
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008663:Metacarpus / Q000503:physiopathology*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D009989:Orthotic Devices; D010003:Osteoarthritis / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D013933:Thumb / Q000503:physiopathology*
keywords: Carpometacarpal joints; hand joints; osteoarthritis; physical therapy modalities; thumb carpometacarpal