Initial Nonoperative Treatment Choices for Thumb Carpometacarpal Osteoarthritis

The authors evaluated whether baseline patient-reported outcome measures (PROMs) are associated with initial treatment choice of hand therapy (HT) or corticosteroid injection. The authors hypothesized that patients with worse baseline PROMs would choose corticosteroid injection.

The authors have an ongoing prospective study of patients aged 35 to 85 years with thumb carpometacarpal osteoarthritis. The authors track initial treatments and PROMs, including visual analog scale (VA)/numerical rating scale (NRS) subscales, brief Michigan Hand Outcomes Questionnaire, and Patient-Reported Outcomes Measurement Information System Pain Interference and Global Health modules. Global Mental Health, Global Physical Health, and EuroQol were calculated. The authors retrospectively identified patients from 2019 to 2022 who initially chose HT or corticosteroid injection. The authors performed pairwise comparisons of independent variables between HT and corticosteroid injection groups, and then exploratory bivariate logistic regression (LR) analyses for independent variables. The authors then performed more stringent multivariable LR analyses.

We included 156 patients with 191 thumbs (average age, 61 ± 9 years; 77% female). A total of 158 thumbs received initial HT, and 33 received corticosteroid injection. For exploratory bivariate LR analyses, baseline and activity-related VA/NRS pain and brief Michigan Hand Outcomes Questionnaire scores were worse for patients pursuing corticosteroid injection. Each multivariable LR model demonstrated higher VA/NRS activity-related pain levels and was still independently associated with increased odds of choosing corticosteroid injection.

Adjusting for covariates, baseline activity-related pain was associated with increased odds for choosing corticosteroid injection. Other baseline Patient-Reported Outcomes Measurement Information System/demographics were not associated with initial treatments. Our findings can inform providers, patients, and investigators considering HT and corticosteroid injection, and their potential comparative outcomes, for initiating nonoperative thumb carpometacarpal osteoarthritis care.