The influence of an abductor pollicis longus strengthening program on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the 1st carpo-metacarpal joint : a pilot study for an experimental pre-test/post-test design.

Abstract

Introduction: Elderly females are predominantly left impaired by the degenerative impact which osteoarthritis has on the 1st CMC joint. Research supports the successful implementation of early stage conservative management. Aim: To determine the viability of performing a full scale study to investigate the influence of an abductor pollicis longus strengthening program on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the 1st CMC joint. Objectives: Validating data gathering instruments; evaluating methods and procedures used for recruiting, randomization; retaining, assessing and facilitating compliance of participants. Evaluation of the data capturing process. Required resources and sample size for a scientifically valid full scale study was estimated. Method: The pilot study made use of the quantitative research design proposed for a full scale study. Tools such as cost sheets and compliance logbooks were implemented along with qualitative components such as feedback questionnaires and field notes. Three retirement homes participated; 25 residents qualified to participate of which 15 were allocated to the experimental group and 10 to the control group. The experimental group participated in an 8 week exercise program; while the control group received an assistive device. Both the experimental and control groups were assessed at baseline; four weeks and after eight weeks. The assessment battery included the Kapandji index for thumb opposition, voluntary isometric total grip, 2-point pincer, 3-point pincer and key grasp strength, Visual Analogue Scale for pain and the Michigan Hand Outcome Questionnaire (MHQ). Data analysis: Data was captured by the researcher; the MHQ and feedback questionaires were independantly completed by the partiticpants. Data cleansing was conducted manually where corectness was verified by a third uninvolved party. Quantitative data was summarized and tested with the vi Generalized Estimating Equations (GEE) to detect possible changes over time. Inferential analysis and comparisons of results for the experimental and control groups could not be made. The researcher detected themes and subthemes within the qualitative data. Results/Discussion: Recruitment techniques’ response rate did not exceed 27%; qualitative data sets identified influencing factors An inclusion age of 60 years and older were suggested and to extend the research to various ethic groups. A large enough sample group for randomization was not obtained. Recommended adjustments to the assessment battery: using an adjusted MHQ as the full MHQ includes unapplicable questions; using a Numerical Rating Scale (NRS) for pain potentially being more user friendly for an elderly population; and an additional abduction active range of motion goniometer assessment for the thumb is recommended as the Kapandji scale for opposition provided limited information concerning the range of motion of the 1st CMC joint. The calculated cost per participant was R1921.60 for the control group and R3179.79 for the experimental group. Human resources were calculated at 64.2% of the entire budget. Compliance was affected by poor memory and health. Population attrition rates were calculated at an average of 48%. The feedback questionaires indentified personal gain and the feeling of contributing to a research initiative as the predominant themes for retaining the target population. Conclusion:The conducted pilot study can be used to define the parameters necessary to conduct then mentioned full scale research study, as well as assist with research designs envolving a similar target population. One more pilot study is recommended prior to a full scale study addressing topics such as including diverse races; recommended additional assessment tools and intervnetion components.