Predictive factors affecting functional outcomes following conservative treatment in trapeziometacarpal osteoarthritis: A systematic review.

BACKGROUND

Trapeziometacarpal osteoarthritis (TMC OA) is a common degenerative condition, characterized by pain and functional limitations, predominantly affecting older women. While conservative treatments are the primary approach, functional outcomes are highly variable, and the predictive factors influencing these outcomes remain uncertain.

PURPOSE: This systematic review aims to identify demographic, clinical, and psychological factors that predict functional outcomes following conservative management of TMC OA.

STUDY

DESIGN

Systematic Review.

METHODS

The protocol was prospectively registered in PROSPERO (CRD42024626957). A systematic literature search was conducted in MEDLINE, PubMed, Cochrane Library, Scopus, and Web of Science up to December 2024, following PRISMA guidelines. Eligible studies included longitudinal observational studies and randomized controlled trials reporting on functional outcomes of conservative treatments within 3-12 months. Functional outcomes were assessed using validated tools such as the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Michigan Hand Outcomes Questionnaire (MHQ), and the Functional Index for Hand Osteoarthritis (FIHOA). Data synthesis focused on predictive factors including pain levels, radiographic severity and psychosocial variables.

RESULTS

Six studies (n=1040 patients) met the inclusion criteria. The most consistently reported patient factors included baseline pain levels (5/6 studies), radiographic severity (3/6 studies), gender (3/6 studies), and psychosocial factors such as depression and treatment expectations (2/6 studies). Radiographic staging was associated with functional outcomes in a complex manner: advanced stages predicted poorer outcomes, while early stages were linked to acute impairments due to synovitis. Biopsychosocial factors, such as psychological health and education level, accounted for substantial variance in functional outcomes.

CONCLUSION

Individual demographic, clinical, and psychosocial factors predict functional outcomes following conservative TMC osteoarthritis treatment. Clinicians should take into account baseline pain levels, radiographic severity, gender, and psychological factors when counseling patients and setting realistic treatment expectations. Future prospective studies are needed to confirm these predictive factors, followed by research to determine which specific interventions may be most effective for patients with different predictor profiles.