Extracorporeal Shock Waves Therapy (ESWT) vs Exercise in Thumb Osteoarthritis (SWEX-TO): Prospective Clinical Trial at 6 Months

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Abstract
Background: Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. Recent studies support the possibility of providing Extracorporeal Shock Wave Treatment in patients suffering from osteoarthritis. Shock wave biostimulation may be able to modulate joint inflammation and stimulate chondorocytes in a reparative sense. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. Methods: A prospective clinical study was designed, in which seventy-two patients suffering from rhizoarthrosis were randomized to treatment with shock waves or exercises; in both groups an immobilization brace of the first finger was used. At recruitment and at 1, 3 and 6 months, patients received assessments of pain (VAS), functionality (FIHOA), disability (DASH); furthermore, the perception of improvement was monitored during follow-ups (Roles and Maudsley Score). Results: In both groups there was a significant improvement in all scores in the comparison between recruitment and 6 months; this improvement was confirmed for VAS, FIHOA and DASH in the comparison between individual time points in both groups, except for the comparison between 3 and 6 months for all scales in the exercise group and for FIHOA in both groups. The perception of improvement was statistically better in the shock wave group than in the exercise group at 1, 3 and 6 months. The regression analysis showed that the reduction of VAS and DASH are statistically influenced by shock wave treatment (p<0.001). Conclusions: Both shock waves and exercises, together with the use of the brace, are effective in managing pain, functionality and disability in patients suffering from arthritis of the first finger. The shock wave treatment ensured further improvement at 6 months

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