Postoperative rehabilitation following thumb base surgery: a systematic review of the literature

Publication date: Available online 10 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Robbert M. Wouters, Jonathan Tsehaie, Steven E.R. Hovius, Burcu Dilek, Ruud W. Selles
ObjectiveTo provide an overview of rehabilitation for patients who underwent CMC-1 arthroplasty, with emphasis on early active mobilization.Data Sources/Study SelectionPubMed/MEDLINE, Embase, CINAHL and Cochrane were searched for articles written in English that described postoperative regime (including immobilization period/method and/or description of exercises/physical therapy, follow-up ≥six weeks) on CMC-1 arthroplasty.Data ExtractionThe PRISMA statement was used as guidance in this review and methodological quality was assessed using the Effective Public Health Practice Project quality assessment tool. Randomized studies were additionally scored using the Physiotherapy Evidence Database scale.Data SynthesisTwenty-seven studies were included, concerning 1015 participants in whom 1118 surgical procedures were performed. A summary on the components of postoperative rehabilitation used in the included studies on CMC-1 OA is presented for different surgical interventions. We found that early active recovery (including short immobilization, early initiation of ROM and strength exercises) provides positive outcomes on pain, limitations in ADL and grip & pinch strength, but comparative studies are lacking. Furthermore, three postoperative exercises/therapy phases were identified in the literature: the 'acute phase', the 'unloaded phase' and the 'functional phase', but again comparative studies are lacking.ConclusionsEarly active recovery is used more often in the literature and does not lead to worse outcomes or more complications. This systematic review provides guidance for clinicians in the content of postoperative rehabilitation on CMC-1 arthroplasty. The review also clearly identifies the almost complete lack of high quality, comparative studies on postoperative rehabilitation after CMC-1 arthroplasty.



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