Biomechanical analysis of hand orthoses for osteoarthritis

Osteoarthritis (OA) is the most common joint condition globally and is strongly associated with aging. Patients suffer from pain and loss of function, which impacts on their ability to work and perform activities of daily living. There is no cure for hand OA. The main non-surgical treatments are pain relief and removable orthoses. Surgical treatment is preserved for severe, end-stage disease. NICE guidance recommends the use of splints for the treatment of OA, but the evidence for orthoses use is lacking, in part owing to the inability to quantify patient compliance and usage. Clinical trials comparing splints with other treatment options, such as surgery, are therefore unreliable. For example, recent systematic reviews of splinting for base of thumb OA identified two randomised controlled trials that concluded that splints reduce pain when compared to no intervention, but do not improve function or grip strength. In addition, none of the studies provided a coherent hypothesis for the mechanism of effect of splinting or defined a primary function of the splint. Possible actions include reducing inflammation through immobilization of the first carpometacarpal joint or restoring joint alignment.
This project builds upon current research that is being conducted in Kedgley's group in collaboration with Oxford and Leeds Universities to establish patient compliance with orthosis use. It also links with fundamental biomechanical studies that have been ongoing within the group to tease out the anatomical reasons for the development of base of thumb OA.
Aims and objectives:
The aims are to quantify the biomechanical effect of orthoses and, if appropriate, offer recommendations to improve their design and/or use in the treatment of OA. The objectives are:
-integration of a multi-element force sensor with commercial and custom-made orthoses
-establishment of optimal sensor positioning for biomechanical determination of splint performance
-acquisition of kinematic and kinetic data during clinical assessments and activities of daily living
-use of a musculoskeletal model of the hand to quantify the effect of the orthosis on the muscle and joint forces