A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Does transcutaneous electrical nerve stimulation improve the physical performance of people with knee osteoarthritis? Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial.
Forty-three patients were randomly allocated to undergo either trapeziectomy alone (control) or with a ligament reconstruction and tendon interposition (LRTI) using an abductor pollicis longus tendon slip. The patients were reviewed at a median 13 (range, 7-29) months after surgery. The demographic characteristics, severity of disease and pre-operative clinical measurements of the two study groups were indistinguishable but LRTI lengthened the operation by approximately 15 minutes. Both groups expressed equal satisfaction with the operation and there were no significant differences between the two treatment groups. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit. This prospective study compared the outcome--subjective, objective and radiographic--of two surgical techniques for treating basal joint arthritis of the thumb: a "simple" trapeziectomy (group I) and a ligament reconstruction/tendon (group II) interposition technique. There were respectively 22 patients in group I and 34 in group II, all women with primary osteoarthritis. Both techniques gave favourable results and there were no significant differences for pain relief, patient satisfaction, mobility, DASH-score, key pinch force and gripping force. However in group II, the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited. There was also a significant correlation between the remaining trapezial space and key pinch force. : According to a recent metaanalysis study, there is strong evidence to support the view that transcutaneous electrical nerve stimulation (TENS) is an effective treatment for managing osteoarthritis (OA) knee pain. However, there is limited evidence showing its effectiveness in improving physical function. This study examined whether TENS alone can improve physical function in terms of range of knee motion and the Timed-Up-and-Go Test.
                : Subjects were randomly allocated into 2 groups receiving TENS at 100 Hz or a placebo TENS. Outcome measures included: 1) visual analog scale for measuring the intensity of the present pain, 2) Timed-Up-and-Go Test, and 3) range of knee motion (ROM). Repeated-measures analysis of variance and Pearson correlation were used for data analyses.
                : By day 10, TENS produced a significantly greater increase in maximum knee ROM than the placebo group (P = 0.033). TENS also significantly increased the pain-limited knee ROM across sessions, but the between-group difference was short of significance (P = 0.067). The decrease in time in performing the Timed-Up-and-Go Test was also not significantly different between the 2 groups. A moderate correlation was observed between the reduction in pain scores and the improvement in the Timed-Up-and-Go Test.
                : Our findings suggested that TENS did improve some of the physical parameters but over 10 days was unable to produce significant improvement in functional performance among people with knee OA. A larger-scale study with the assessment of other functional outcomes may be required to clarify if TENS could improve function in people with knee OA. Also, exercise can be considered to be an important adjunct treatment to TENS to improve function significantly. A randomized parallel-group comparative trial with a 1-year follow-up period was performed.
                To compare the effect of a comprehensive functional restoration program involving intensive physical training, ergonomic training, and behavioral support (39 hours per week for 3 weeks) with the effect of outpatient intensive physical training (1.5 hours three times per week for 8 weeks).
                Nonrandomized studies conducted in the United States favor functional restoration for patients with chronic low back pain. Two previously reported randomized studies from the authors' Back Center in Copenhagen concur with this recommendation, although the positive effects in one of the studies had faded out after 2 years. Randomized functional restoration studies in Canada and Finland have failed to demonstrate any substantive effect.
                Initially, 138 patients with chronic low back pain were included in the current study. They then were randomized to either functional restoration (n = 64) or outpatient intensive physical training (n = 74). Of the initial 138 patients, 11 never started (5 and 6, respectively); 21 dropped out during treatment (8 and 13); and 7 of the graduates did not take part in the 1-year follow-up evaluation (3 and 4). The conclusions were drawn from the 99 patients (48 and 51, respectively) who graduated and participated in a 1-year follow-up evaluation. The median age of the patients was 42 years (range, 21-55 years) The female-to-male ratio was 68 to 31, and the median sick leave days during the preceding 3 years was 180 (range, 0-1080 days). The average back pain was rated 5.5 on a scale of 0 (no pain) to 10 (maximal pain). For these variables, there were no important differences between the groups. However, the functional restoration group tended to be more capable of work at baseline (58% vs 42%; P = 0.09).
                At the 1-year follow-up evaluation, overall assessment favored functional restoration. Otherwise, no significant differences were observed regarding work capability, sick leave for those at work, health care contacts,back pain, leg pain, or self-reported activities of daily living.
                Only in terms of overall assessment, the functional restoration program was superior to a comparatively short time-consuming outpatient physical training program.
                It may be that lower economic benefits during sick leave in the United States lead to favorable results from functional restoration programs, whereas greater benefits in Canada, Finland, and Denmark result in different conclusions. Finally, it may be that the difference in results across studies points simply to whether the studies were randomized. To assess the effects of a stress-reduction program on pain, psychological function, and physical function in persons with systemic lupus erythematosus (SLE) who experience pain.
                Ninety-two SLE patients were assigned randomly to receive either biofeedback-assisted cognitive-behavioral treatment (BF/CBT), a symptom-monitoring support (SMS) intervention, or usual medical care (UC) alone.
                BF/CBT participants had significantly greater reductions in pain and psychological dysfunction compared with the SMS group (pain, P = 0.044; psychological functioning, P < 0.001) and the UC group (pain, P = 0.028; psychological functioning, P < 0.001). BF/CBT had significantly greater improvement in perceived physical function compared with UC (P = 0.035), and improvement relative to SMS was marginally significant (P = 0.097). At a 9-month followup evaluation, BF/CBT continued to exhibit relative benefit compared with UC in psychological functioning (P = 0.023).
                This study supports the utility of a brief stress management program for short-term improvement in pain, psychological function, and perceived physical function among persons with SLE who experience pain.
Although it appears that no one procedure produces greater benefit in terms of pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy has fewer complications than trapeziectomy with LRTI.