Name: Iris

PICO Question: What is the evidence that occupational therapy using orthoses (I) improves
participation in daily activities (O) of people with thumb CMC osteoarthritis (P)?
Search terms:
P- thumb, osteoarthritis, osteoarthri*
I- occupational therapy, splint, joint protection, orthos*, thumb orthosi*, hand therapy
C- None
O- participat*
Databases: CINAHL and PubMed
Example of search strategy performed on Ebscohost-CINAHL:

Abstract with Best Evidence:

From Disability & Rehabilitation: Assistive Technology, May2013; 8(3): 232-237. (6p)
http://dx.doi.org/10.3109/17483107.2012.699992
Comparison of custom-made and prefabricated neoprene splinting In patients with the first
carpometacarpal joint osteoarthritis
Authors: Bani, Monireh Ahmadi; Arazpour, Mokhtar; Kashani, Reza Vahab; Mousavi,
Mohammad Ebrahim; Hutchins, Stephen William

Aim: The objective of this study was to compare the effect of prefabricated and custom made
thumb splints on pain, function, grip strength and key pinch In patients with basilar joint
osteoarthritis. Method: Volunteer patients (n = 35) with first carpometacarpal joint osteoarthritis
were assigned randomly to wear either a prefabricated or custom-made thumb splint or assigned
to a control group. This was designed as a cross over study with two 4-week treatment periods, 2
weeks of wash out time for intervention groups between the test conditions and 10-weeks followup for the control group. All parameters were measured at the first visit and during the 4th, 6th
and 10th weeks In the three groups. Results: In the control group, pain increased and pinch
strength decreased but no statistically significant differences were found in function and grip
strength. Both splints changed grip strength with no significant differences between them. Pain
was reduced with the splints, and functions and pinch strength increased significantly as
compared to the baseline and control groups. In comparing the two splints only significant
differences were observed In pain. Conclusion: In comparing two splints, pain was the only
significantly different parameter between tested parameters; with the custom-made splints
demonstrating better results In pain reduction.
References
Bani, M. A., Arazpour, M., Kashani, R. V., Mousavi, M. E., & Hutchins, S. W. (2013).
Comparison of custom-made and prefabricated neoprene splinting in patients with the
first carpometacarpal joint osteoarthritis. Disability & Rehabilitation: Assistive
Technology, 8(3), 232-237. doi:10.3109/17483107.2012.699992. Level 2.
Becker, S.J., Bot, A.G., Curley, S.E., Jupiter, J.B., Ring, D. (2013). A prospective
randomized comparison of neoprene vs thermoplast hand-based
thumb spica splinting for trapeziometacarpal arthrosis. Osteoarthritis
Cartilage, 21(5), 668-75. doi: 10.1016/j.joca.2013.02.006. Level 3.
Colditz, J. (2000). The biomechanics of a thumb carpometacarpal immobilization splint: design
and fitting. Journal Of Hand Therapy, 13(3), 228-235. Level 5.
Dunn, J., Pearce, O., & Khoo, C. (2002). The adventures of a hygienist's hand: a case report and
surgical review of the effects of osteoarthritis. Dental Health, 41(6), 6-9. Level 5.
Heim, D. (1999). The skier's thumb. Acta Orthopaedica Belgica, 65(4), 440-6.
Level 5.
Landsman, J.C., Seitz, W.H. Jr., Froimson, A.I., Leb, R.B., & Bachner, E.J.
(1995). Splint immobilization of gamekeeper's thumb. Orthopedics,
18(12) 1161-5. Level 4.
Maddali-Bongi, S., Del Rosso, A., Galluccio, F., Sigismondi, F., & MatucciCerinic, M. (2014). Is an intervention with a custom-made splint and an
educational program useful on pain in patients with trapeziometacarpal
joint osteoarthritis in a daily clinical setting?. International Journal of
Rheumatic Diseases. Level 3.

Merritt, M. (2012, January). Comparison of hand therapy to placebo in the treatment of thumb
carpometacarpal osteoarthritis. Comparison of Hand Therapy to Placebo in the
Treatment of Thumb Carpometacarpal Osteoarthritis, 154. Level 2.
Rannou, F., Dimet, J., Boutron, I., Baron, G., Fayad, F., Mac, Y., & Poiraudeau, S. (2009).
Splint for base-of-thumb osteoarthritis: a randomized trial. Annals Of Internal
Medicine, 150(10), 661-669. Level 1.
Rocchi, L., Merolli, A., Morini, A., Moteleone, G., & Foti, C. (2014). A modified
spica-splint in postoperative early-motion management of skier's
thumb lesion: a randomized clinical trial. European Journal of Physical
and Rehabilitation Medicine, 50(1), 49-57. Level 2.
Schramm, J.M., Nguyen, M., Wongworawat, M.D., & Kjellin, I. (2008). Does
thumb immobilization contribute to scaphoid fracture stability?. Hand,
3(1), 41-3. doi: 10.1007/s11552-007-9067-x. Level 2.
Sillem, H., Backman, C. L., Miller, W. C., & Li, L. C. (2011). Comparison of two
carpometacarpal stabilizing splints for individuals with thumb osteoarthritis. Journal Of
Hand Therapy, 24(3), 216-226. doi:10.1016/j.jht.2010.12.004. Level 2.
Summary
A case report of a dental hygienist, referred to a hand surgeon was given two different
splints to wear after initial assessment, and was instructed to wear them at all times (Dunn,
Pearce & Khoo, 2002-CINAHL). Purportedly the splint helped allay pain and her manual grip of
instruments was enhanced so she was able to carry out her occupational performance patterns
more smoothly. This case report demonstrates the importance of having a splint, to help improve
the performance patterns of a client with osteoarthritis. The reasoning behind how the CMC
thumb splint helps the thumb metacarpophalangeal and wrist joints is in how it's designed
(Colditz, 2000- CINAHL). This splint, in essence, helps balance out the extrinsic and intrinsic
muscles, in terms of extension/abduction and flexion/abduction. Having knowledge of this helps
readers understand why these splints are important for patients with osteoarthritis.Merrit (2012CINAHL) also demonstrated in a placebo study of treating the thumb carpometacarpal
osteoarthritis that having patients use orthotics and educating them on joint protection training
helped alleviate pain much more so than the group that was just given cream to rub on the
thumb. This is significant because it adds to evidence that having orthotics and education about
joint protection are beneficial to a patient with osteoarthritis.
Furthermore, in a study that Rannou et al. (2009-CINAHL) conducted, over 12 months,
change in pain from baseline was greater in the intervention group that received a thumb-based
splint than in the control group which demonstrates that orthotics are highly beneficial in helping
reduce pain in this sample, which was from a population of patients with thumb osteoarthritis.
Sillem, Backman, Miller, and Li (2011-CINAHL) conducted a study to see if there were
differences between two different splints on hand function, pain, and hand strength in adults with
CMC OA. While both splints revealed improvement in hand functions, custom-made splint

showed a greater average reduction in pain scores which further puts forth the point that "client
centered" splints are important. A study Bani et al. (2013-CINAHL) conducted revealed function
and grip strength were not significantly different in custom-made and prefabricated neoprene
splints in patients with first carpometacarpal joint osteoarthritis but results also yielded that
custom-made splinting was by far more signficant in reducing pain than the custom-made splint.
This relates to Sillem et al. (2011) in the sense that it provides additional evidence that custommade splints are important. Again, custom-made splints for a population of patients with
trapeziometacarpal joint osteoarthritis had shown significant reduction in pain symptoms after 12
months (Maddali et al., 2014- Pubmed). Before 12 months, even, they had significantly
improved on muscle and pinch strength as well (Maddali et al., 2014). To note, for the condition
of trapeziometacarpal arthrosis, however, pre-fabricated neoprene hand-based thumb spica
splints were more comfortable, cost-effective and just as effective as the custom-made
thermoplast splints (Becker, 2013- Pubmed).
After the operation, when a functional hand-based splint is made for the thumb, it
facilitates one's motions right after and was more beneficial for the joint so not only is the splint
helpful, but the timeliness of the splint as an immediate intervention after operations also helps
(Rocchi et al, 2014- Pubmed). In another study, splint immobilization was also shown to be an
important treatment after surgery for many patients with thumb metacarpophalangeal joint
conditions (Landsman et al, 1995- Pubmed). A specific condition called the "skier's thumb" is a
first metacarphophalangeal joint condition in which there is a tear in its ulnar collateral ligament,
and it was found that conservative and an example of postoperative care that helps is
immobilizing the joint in a thumb spica cast for 4 weeks first (Heim, 1999) so it just adds to the
signficance of thumb spica in facilitating the healing and movement of the CMC joint in the long
run. Finally, in Schramm et al.'s study (2008- Pubmed), results showed that wrist immobilization
was important for scaphoid fractures but short arm casting was just as effective as thumb spica to
prevent fracture awareness so this opens up possibilities for a therapist wanting to casting the
client with a scaphoid fracture. Though this study is not completely relevant to the condition
thumb osteoarthritis, it shows that the effectiveness of thumb spica cast immobilization for other
conditions may not exactly be relevant.