Functional Tests vs Patient-Reported Outcomes in Predicting Thumb CMC Arthritis Progression: a Prospective, Longitudinal Study
Joseph A. Gil, MD; Justin E Kleiner, BS; Joseph Crisco, PhD; Amy Ladd, MD; Arnold Peter C Weiss, MD,
Brown University / Rhode Island Hospital, Providence, RI
The purpose of this study is to examine functional variables and patient reported outcomes over time to determine their relation to the radiographic progression of CMC OA. Specifically, we asked (1) are functional assessments or patient reported outcomes more sensitive for identifying progression of CMC OA at 1.5 and 3 year follow-up, and (2) which specific functional assessment or patient reported outcome most strongly correlated with radiographic progression of CMC OA.
91 subjects with early symptomatic and radiographic thumb CMC OA and 46 asymptomatic healthy control subjects were recruited in a multi-site prospective, longitudinal case-control study. Demographic information, comprehensive history, plain film radiographs, functional test assessments and patient-reported outcome questionnaires were collected on all 137 subjects. Linear regression models were used to correlate progression of CMC OA with the percent change of force with functional testing and percent change in patient-reported scores.
After adjusting for age, sex, and dominance was used for data collection, the linear regression model demonstrated that lateral key pinch and lateral grasp at baseline were significant predictors for thumb CMC OA (P=0.0311 and P=0.0115, respectively). Functional variables were more strongly correlated with OA progression, correlating with 18.8% of OA progression at 18 months, compared to 4.2% for patient reported variables. This relationship was also present at 3-year follow-up, where functional variables correlated with 21.9% of progression, compared with 5.7% for patient reported variables. Of the individual tests, lateral grasp and lateral key pinch most correlated with OA progression, with 7.1% and 5.8% of the 18-month progression in OA respectively. Three-year OA progression presented equally between male and female subjects (P=0.8712); between dominant and non-dominant wrists (P=0.1595); and between obese and non-obese subjects (P=0.7757).
Functional assessments are more strongly correlated with OA progression than patient reported outcomes at 1.5-year and 3-year follow up. Of the individual tests examined, lateral grasp and lateral key pinch most correlated with OA progression.
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