Purpose
In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS.
Methods
A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized.
Results
This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%).
Conclusions
There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research.
Clinical relevance
This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.
Andrea Copeland, Lucas Gallo, Christina Weber, Syena Moltaji, Matteo Gallo, Jessica Murphy, Daniel Axelrod, Achilleas Thoma
Disease Category: Rheumatology
Disease Name: Thumb carpometacarpal joint arthritis
Age Range: 18 - 100
Sex: Either
Nature of Intervention: Surgery
- None
- Systematic review of outcomes measured in trials
- Systematic review
Inclusion Criteria:
1. Primary studies (randomized control trials and non-randomized controlled studies) written in English
2. The treatment is a surgical procedure including one of: trapeziectomy, trapeziectomy with TI, trapeziectomy with LR, trapeziectomy with LRTI, CMC arthrodesis, joint replacement, Artelon joint resurfacing, volar ligament reconstruction, metacarpal osteotomy, autologous fat transfer, denervation
3. Studies must include at least one well-described outcome and/or outcome measure
Exclusion Criteria:
1. Cohort and case control studies with n<50, descriptive studies, anecdotes and case reports
2. Exclude studies comparing non-surgical management with surgery
Search Strategy:
The electronic databases 1) OVID Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present, 2) Embase 1974 to Present, 3) Cochrane Library, and 4) CINAHL were searched with the following search terms:
Screening:
Following the removal of duplicates, two review authors will independently review the titles and abstracts of all retrieved articles based on the aforementioned inclusion and exclusion criteria. Full-text documents of potentially relevant reports will be retrieved and independently assessed for inclusion by 2 reviewers. Disagreements will be resolved by consensus between the two review authors and further discordance will be settled by a third author. Review authors will not be blinded to author(s), institution or site of publication. Authors of documents requiring further information or delineation will be contacted if necessary. Inter-rater agreement will be calculated using Kappa statistics.
Data Extraction:
Prior to data extraction, a representative sample of articles will be piloted to ensure that participating authors are retrieving similar results. Two review authors will independently perform data extraction in duplicate, based on a data collection form designed a priori. Disagreements will be resolved through discussion between the two review authors; further discordance will be settled by a third author. Completed data collection forms will include study characteristics, list of all outcomes and outcome measures included, and information on the types of outcomes and outcome measurements included. Inter-rater agreement will be calculated using Kappa statistics. Data will be extracted from papers included in the review using the standardized data extraction tool.
Data Synthesis:
Outcomes and outcome measures will be grouped (e.g. subjective vs. objective, patient- vs. clinician-reported, cost-related, quality of life measures, etc.) to help organize and summarize the data.