BACKGROUND Thumb carpometacarpal osteoarthritis (CMC-1 OA) is a common and debilitating condition, particularly among older adults and women. With the aging population, the prevalence of CMC-1 OA is expected to rise, emphasizing the need to find effective nonoperative strategies. So far, for determining the most effective nonoperative interventions in CMC-1 OA, two network meta-analyses (NMAs) have been published. However, these NMAs were limited to specific intervention types: one comparing multiple splints and the other comparing different intraarticular injections. Therefore, an NMA that compared all nonoperative intervention types is urgently needed. QUESTIONS/PURPOSES This study aimed to assess and compare the effectiveness of available nonoperative interventions (both nonpharmacologic and pharmacologic) for CMC-1 OA to establish which nonoperative options are more effective than control in terms of (1) pain, (2) function, and (3) grip strength. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) NMA guidelines (PROSPERO: CRD2021272247) and conducted a comprehensive search across Medline, Embase, CENTRAL, and CINAHL up to March 2023. We included randomized controlled trials (RCTs) and quasi-RCTs evaluating nonoperative interventions for symptomatic CMC-1 OA, excluding inflammatory or posttraumatic arthritis. Studies comparing ≥ 2 interventions or against a control, focusing on pain reduction, functional improvement, and grip strength, were selected. We assessed methodologic quality using the modified Coleman Methodology Score, including only studies scoring > 70. Risk of bias was evaluated with the Risk of Bias 2.0 tool, and evidence quality with Confidence in Network Meta-Analysis (CINeMA). Of 29 screened studies, 22 (21 RCTs and one quasi-RCT) were included, involving 1631 women and 331 men. We analyzed eight different nonoperative interventions, including splints, hand exercises, injections, and multimodal treatment (≥ 2 nonpharmacologic interventions or nonpharmacologic with a pharmacologic intervention). Six studies had a low risk of bias, eight had a high risk, and the remainder were moderate. We extracted mean and SD scores, and NMA and pairwise analyses were performed at short- (≤ 3 months) and medium-term (> 3 to ≤ 12 months) time points. Standardized mean differences were re-expressed into common units for interpretation, which were the VAS (range 0 to 10) for pain, the DASH test (range to 100) for function, and pounds for grip strength. Clinical recommendations were considered strong if the mean differences exceeded the minimum clinically important difference-1.4 points for VAS, 10 points for DASH, and 14 pounds for grip strength-and were supported by moderate or high confidence in the evidence, as assessed using CINeMA methodology. RESULTS Our NMA (based on moderate or high confidence) showed a clinically important reduction in pain at the short-term time point for multimodal treatment and hand exercises versus control (mean difference VAS score -5.3 [95% confidence interval (CI) -7.6 to -3.0] and -5.0 [95% CI -8.5 to -1.5]). At the medium-term time point, only the rigid carpometacarpal-metacarpophalangeal (CMC-MCP) splint was superior to control (mean difference VAS score -1.9 [95% CI -3.1 to -0.6]) and demonstrated clinical importance. For function, only the rigid CMC-MCP splint demonstrated a clinically important improvement at the medium-term time point versus control (mean difference DASH score -11 [95% CI -21 to -1]). Hand exercises resulted in a clinically important improvement in short-term grip strength versus control (mean difference 21 pounds [95% CI 11 to 31]). CONCLUSION This systematic review and NMA show that multimodal treatment and hand exercises reduce short-term pain and improve grip strength, while a rigid CMC-MCP splint enhances medium-term function. Future research should evaluate long-term efficacy. LEVEL OF EVIDENCE Level I, therapeutic study.

中文翻译：

---

拇指腕掌骨关节炎临床上最有效的非手术干预措施是什么？最新的系统评价和网络荟萃分析。


背景 拇指腕掌骨关节炎 （CMC-1 OA） 是一种常见且使人衰弱的疾病，尤其是在老年人和女性中。随着人口老龄化，预计 CMC-1 OA 的患病率将上升，强调需要找到有效的非手术策略。到目前为止，为了确定 CMC-1 OA 中最有效的非手术干预措施，已经发表了两项网络荟萃分析 （NMA）。然而，这些 NMA 仅限于特定的干预类型：一种比较多个夹板，另一种比较不同的关节内注射。因此，迫切需要一种比较所有非手术干预类型的 NMA。问题/目的本研究旨在评估和比较可用的非手术干预措施（非药物和药物）对 CMC-1 OA 的有效性，以确定哪些非手术选择在 （1） 疼痛、（2） 功能和 （3） 握力方面比对照组更有效。方法 我们遵循系统评价和荟萃分析的首选报告项目 （PRISMA） NMA 指南 （PROSPERO： CRD2021272247），并在截至 2023 年 3 月的 Medline、Embase、CENTRAL 和 CINAHL 中进行了全面检索。我们纳入了随机对照试验 （RCTs） 和半 RCTs，这些试验评估了症状性 CMC-1 OA 的非手术干预，不包括炎症性或创伤后关节炎。选择≥ 2 种干预措施或对照进行比较的研究，重点关注减轻疼痛、功能改善和握力。我们使用改良的 Coleman 方法学评分评估方法学质量，仅包括评分为 > 70 的研究。使用偏倚风险 2.0 工具评估偏倚风险，并使用网络荟萃分析置信度 （CINeMA） 评估证据质量。 在 29 项筛选研究中，纳入了 22 项（21 项 RCT 和 1 项半 RCT），涉及 1631 名女性和 331 名男性。我们分析了 8 种不同的非手术干预措施，包括夹板、手部锻炼、注射和多模式治疗 （≥ 2 种非药物干预或非药物联合药物干预）。6项研究的偏倚风险较低，8项研究的偏倚风险较高，其余为中等偏倚风险。我们提取平均值和 SD 评分，并在短期 （≤ 3 个月） 和中期 （> 3 至 ≤ 12 个月） 时间点进行 NMA 和成对分析。标准化平均差被重新表示为常用单位进行解释，即疼痛的 VAS（范围 0 到 10）、功能的 DASH 测试（范围到 100）和握力的磅。如果平均差异超过最小临床重要差异（VAS 为 1.4 分，DASH 为 10 分，握力为 14 磅），并且得到中等或高度证据可信度的支持，则认为临床建议是强的，如使用 CINeMA 方法评估的那样。结果：我们的 NMA（基于中等或高可信度）显示，与对照组相比，多模式治疗和手部锻炼在短期时间点的疼痛有临床意义的减轻 （平均差 VAS 评分 -5.3 [95% 置信区间 （CI） -7.6 至 -3.0] 和 -5.0 [95% CI -8.5 至 -1.5]）。在中期时间点，只有刚性腕掌掌指 （CMC-MCP） 夹板优于对照组 （平均差 VAS 评分 -1.9 [95% CI -3.1 至 -0.6]）并显示出临床重要性。对于功能，与对照组相比，只有刚性 CMC-MCP 夹板在中期时间点显示出临床上重要的改善 （平均差 DASH 评分 -11 [95% CI -21 至 -1]）。 与对照组相比，手部锻炼导致短期握力有临床意义的改善 （平均差 21 磅 [95% CI 11， 31]）。结论 本系统评价和 NMA 表明，多模式治疗和手部锻炼可减轻短期疼痛并提高握力，而刚性 CMC-MCP 夹板可增强中期功能。未来的研究应评估长期疗效。证据级别 I 级，治疗研究。