Outcomes of an exercise program in patients with dorsal or volar midcarpal laxity: a cohort study of 213 patients

• Published in: Disability and rehabilitation Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 7
• Main Authors: Brands, Mart, Selles, Ruud W., van Kooij, Yara E., Feitz, Reinier, Videler, Annemieke J., Slijper, Harm P., Wouters, Robbert M.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.05.2024
• Subjects: Adult; Cohort Studies; conservative treatment; Exercise Therapy - methods; Female; Hand; Humans; Joint Instability - physiopathology; Joint Instability - rehabilitation; Male; Middle Aged; Pain Measurement; Patient Satisfaction; physical therapy modalities; Prospective Studies; Range of Motion, Articular - physiology; surgical procedures; Treatment Outcome; wrist injuries; Wrist Joint - physiopathology; surgical procedures; physical therapy modalities; conservative treatment; Hand; wrist injuries
• ISSN: 0963-8288; 1464-5165
• DOI: 10.1080/09638288.2023.2207219

Midcarpal instability (MCI) is a disabling condition and treatment options are limited. Patients with MCI can benefit from an exercise program aiming to improve the strength and coordination of the wrist muscles. Participants improved in hand/wrist function and 78% did not convert to surgery. Non-invasive treatment should be the primary treatment choice for these patients. Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36-30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.