Investigators: Eric E. Sabelman, PhD and V. Rodney Hentz, MD Project Staff: Michael M. Ward, MD; Beatrice Netter, MS; Deborah E. Kenney, MS OTR; James H. Anderson, JEM; and Katherine Dawson, PhD Project Category: Arthritis - 2000 Objectives: People with musculoskeletal impairment (particularly arthritis) of the hand and wrist are subject to loss of manipulative function essential to carrying out daily activities. We hypothesize that loss of function may be avoided, reduced or restored by reducing pain during physical therapy. The objective of this study is to establish whether exercise used in combination with non-pharmacological pain reduction will provide superior results to conventional therapy (separate heat, exercise and retrograde massage of the hand and wrist). Contrast baths (alternating heat and cold) and agitated water are currently used for treating hand and wrist conditions. We hypothesize that these elements in combination will provide pain reduction with results superior to exercise alone. In order to study the effects of contrast baths compared to conventional therapies in a short-duration study on a limited patient population, it is necessary to select an acute condition in which similar therapy is commonly prescribed. Such is the case with carpometacarpal (CMC) joint arthroplasty - the placement of a cartilage substitute in the joint at the base of the thumb where cartilage has been destroyed because of arthritis. In a test population of CMC arthroplasty patients, conventional therapy will be compared to exercise performed in warm water, with or without water jets focused on painful areas, alternating with hand immersion in cool water. Background: Based on the literature and on interviews with therapists, it is apparent that controlled exercise shows promise for restoring or maintaining hand function. While it is possible to motivate patients to overcome joint pain in the clinic, long-term post-clinical enforcement of the therapeutic regimen is rarely achieved. Studies on the use of warm water, warm water with exercise, exercise only, and cold water show that these may be beneficial; no studies were found that evaluated the use of contrast baths or agitated water. This area is controversial, despite being in common practice. Research Plan: Subjects will be up to 30 adults, 18 to 80 years old, who have had hand therapy prescribed by a physician following CMC arthroplasty. Conventional therapy (retrograde massage sequentially with heat and/or exercise) will be compared with a new device consisting of hot (up to 110 degrees F) and cold (55 to 65 degrees F) water basins; the former is equipped with a flexible nozzle that can aim a water jet at a selected region of the hand. The experimental group of 15 subjects will perform active range of motion exercises in the warm bath, beginning upon cast removal; after two weeks, resistive exercise is added. An occupational therapist who is blind to the type of therapy will assess standard measures such as range of motion, key pinch strength and flexion/extension joint torques. Expected Outcomes: The primary target population comprises veterans with arthritis (osteoarthritis, rheumatoid or traumatic) in the hand and wrist, focusing in this pilot project on those who have undergone CMC joint surgery. Broader populations include non-surgical arthritis therapy and post-spinal cord injury tendon transfer to restore certain hand functions. Future studies will evaluate this system for use by hand or wrist disability patients, including repetitive stress injury (Carpal Tunnel Syndrome). Increasing numbers of veterans are entering the age at which musculoskeletal conditions affect their ability to care for themselves and/or remain usefully employed. Correct exercises can delay loss of function, but are seldom performed outside the clinic because of the pain involved. Funding Source: VA RR&D Merit Review Funding Status: Approved Letter of Intent |
