Osteoarthritis of the hands and muscle strengthening exercises: an integrative update and review of the literature

Souza, Isabelle Ferreira da Silva; Neta, Rosa Sá de Oliveira; Caldas, Renata Trajano Jorge; Nery, Michely; Souza, Marcelo Cardoso de

doi:10.5935/2595-0118.20180014

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REVIEW ARTICLES • BrJP 1 (1) • Jan-Mar 2018 • https://doi.org/10.5935/2595-0118.20180014 copy

Osteoarthritis of the hands and muscle strengthening exercises: an integrative update and review of the literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Osteoarthritis of the hands is a highly prevalent disease that can lead to significant deformity and disability. The therapeutic approach in the management of osteoarthritis of the hands is based on pharmacological and non-pharmacological approaches. However, none of these treatments demonstrated a reduction of joint damage, and it presents itself in a purely symptomatic way. Yet, expert practitioners strongly recommend and use hand muscle strengthening in patients with hand osteoarthritis, but there is no consensus for such conduct. The objective of the study was to review the concepts about hand osteoarthritis as well as to bring the current evidence on muscle strengthening as a non-pharmacological treatment for this disease.

The study reviewed the United States National Library of Medicine database (Pubmed). The words used were: hand osteoarthritis, exercises, physiotherapy and rehabilitation. We included 5 articles in English, published in the last 10 years, focused on muscle strengthening exercises for osteoarthritis patients.

CONCLUSION:

There is no consensus, nor a more effective exercise protocol, although exercises and physiotherapy are still recommended. We suggest conducting randomized controlled clinical trials to improve the evidence on this subject.

Keywords:
Hands; Muscle strengthening; Osteoarthritis

Authors	Objective of the studies	Types of studies	Conclusion
Østerås et al.¹²12 Østerås N, Hagen KB, Grotle M, Sand-Svartrud AL, Mowinckel P, Kjeken I. Limited effects of exercises in people with hand osteoarthritis: results from a randomized controlled trial. Osteoarthritis Cartilage. 2014;22(9):1224-33.	To determine the clinical efficacy of an exercises program on the function of the hand in patients with OA of hands.	Clinical trial	The exercise program was well tolerated by the individuals with OA of hands, but in comparison with the usual care, it produced only a slight improvement in short-term (after 3 months).
Stukstette et al.¹⁷17 Stukstette MJ, Dekker J, den Broeder AA, Westeneng JM, Bijlsma JW, van den Ende CH. No evidence for the effectiveness of a multidisciplinary group-based treatment program in patients with osteoarthritis of hands on short term; results of a randomized controlled trial. Osteoarthritis Cartilage. 2013;21(7):901-10.	To examine the efficacy of a multidisciplinary non-pharmacological intervention in patients with OA of hands.	Clinical trial	There is not enough evidence to confirm a clinically relevant effect in short-term in the patients followed in the multidisciplinary treatment program and those that have just received information in writing.
Carreira, Jones and Natour¹⁸18 Carreira AC, Jones A, Natour J. Assessment of the effectiveness of a functional splint for osteoarthritis of the trapeziometacarpal joint of the dominant hand: a randomized controlled study. J Rehabil Med. 2010;42(5):469-74.	To evaluate the efficacy of a functional trapeziometacarpal splint in patients with trapeziometacarpal OA.	Clinical trial	The results indicate that the use of the functional splint during daily life activities reduced pain in short- and long-term, but did not change the function, the prehension strength, the grasping strength or the dexterity in individuals with OA.
Dziedzic et al.¹⁹19 Dziedzic K, Nicholls E, Hill S, Hammond A, Handy J, Thomas E, et al. Self-management approaches for osteoarthritis in the hand: a 2x2 factorial randomised trial. Ann Rheum Dis. 2015;74(1):108-18.	To report the results of a broad randomized study to investigate the clinical efficacy of two programs for adults over 50 years with OA of hands.	Clinical trial	The results show that occupational therapies can support the treatment of the elderly with OA. Moreover, the joint protection provides an effective intervention in mid-term.
Oppong et al.²⁰20 Oppong R, Jowett S, Nicholls E, Whitehurst DG, Hill S, Hammond A, et al. Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials. Rheumatology (Oxford). 2015;54(5):876-83.	To evaluate the cost-effectiveness of combined protective exercises for OA of hands.	Clinical trial	The results offer a choice for the patient and the health professional when selecting the best approach to manage OA of the hands.

Authors	Sample size	Performed exercises	Results
Østerås et al.¹²12 Østerås N, Hagen KB, Grotle M, Sand-Svartrud AL, Mowinckel P, Kjeken I. Limited effects of exercises in people with hand osteoarthritis: results from a randomized controlled trial. Osteoarthritis Cartilage. 2014;22(9):1224-33.	CG (n=65)IG (n=65)	Shoulder extension; biceps bending;shoulder flexion; movements with the fingers and the wrist; abduction/extension of the thumb and squeezing strength.	Small significant differences found in the IG for pain in the hands, stiffness and daily activities; No significant differences observed in manual dexterity or maximum prehension strength.
Stukstette et al.¹⁷17 Stukstette MJ, Dekker J, den Broeder AA, Westeneng JM, Bijlsma JW, van den Ende CH. No evidence for the effectiveness of a multidisciplinary group-based treatment program in patients with osteoarthritis of hands on short term; results of a randomized controlled trial. Osteoarthritis Cartilage. 2013;21(7):901-10.	CG (n=75)IG (n=76)	Exercises with the wrist and fingers.	No significant differences observed between the groups.
Carreira, Jones and Natour¹⁸18 Carreira AC, Jones A, Natour J. Assessment of the effectiveness of a functional splint for osteoarthritis of the trapeziometacarpal joint of the dominant hand: a randomized controlled study. J Rehabil Med. 2010;42(5):469-74.	CG (n=20)IG (n=20)	Use of an orthosis for daily life activities.	The pain was significantly different between the groups over time.
Dziedzic et al.¹⁹19 Dziedzic K, Nicholls E, Hill S, Hammond A, Handy J, Thomas E, et al. Self-management approaches for osteoarthritis in the hand: a 2x2 factorial randomised trial. Ann Rheum Dis. 2015;74(1):108-18.	IG (n=65) Joint protection recommendation (n=62) exercises CG (n=65) protection + exercises (n=65)	Flexion and extension of the wrist, pronation and supination; sliding tendon, radial finger walking; doing an "O" with the thumb and the index finger, and extension of the thumb, abduction and opposition to the base of the 5th finger.	Significant differences were found in the improvement of pain to joint protection.
Oppong et al.²⁰20 Oppong R, Jowett S, Nicholls E, Whitehurst DG, Hill S, Hammond A, et al. Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials. Rheumatology (Oxford). 2015;54(5):876-83.	Recommendation (n=65) joint protection (n=62) exercises (n=65) protection + exercises (n=65)	Flexion and extension of the wrist, pronation and supination; sliding tendon, radial finger walking; doing an "O" with the thumb and the index finger, and extension of the thumb, abduction and opposition to the base of the 5th finger.	Hand exercises were the most cost-effective treatment strategies over 12 months when compared to alternative methodological approaches.

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Osteoarthritis of the hands and muscle strengthening exercises: an integrative update and review of the literature

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: