Long-term effects of neuromuscular exercise therapy and the need for surgical conversion in wrist osteoarthritis: 24-month results from a randomized controlled trial

Wrist osteoarthritis can cause persistent pain, reduced joint mobility, and difficulty performing daily activities, negatively impacting quality of life. Although patient education and exercise therapy are recommended as first-line treatments for osteoarthritis in other joints, evidence supporting these strategies for wrist osteoarthritis remains limited. This randomized controlled trial aimed to evaluate the long-term effects of neuromuscular exercise therapy, designed to improve joint strength and movement control, compared with range-of-motion exercises in individuals with wrist osteoarthritis, including the need for surgical conversion over 24 months. Forty-eight participants with symptomatic wrist osteoarthritis were randomly assigned to a 12-week self-management program. Participants received either a neuromuscular exercise therapy program (intervention group) or a program focused solely on range-of-motion exercises (control group). The primary outcome was the Patient-Rated Wrist Evaluation (PRWE) questionnaire, and secondary outcomes included grip strength, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, pain ratings, and overall patient-rated improvement. Outcomes were assessed at baseline, 6 months, and 12 months, and surgical conversion was recorded from medical records at 24 months. No statistically significant between-group differences were observed for the PRWE questionnaire or any secondary outcomes at 6 or 12 months. The calculated effect sizes for PRWE were 0.018 at 6 months and 0.0073 at 12 months, indicating very small effects and supporting the lack of clinically meaningful differences between the groups. Similarly, surgical conversion rates at 24 months did not differ significantly between the groups, although rates were relatively low in both the intervention group (21%) and the control group (17%). We found no clinically meaningful differences between the neuromuscular exercise therapy program and range-of-motion training in the treatment of wrist osteoarthritis at 6 and 12 months. Nevertheless, few participants in either group required surgery at 24 months, indicating that both exercise programs may contribute to symptom management over time. Further studies are warranted to refine and evaluate exercise-based interventions for the long-term management of wrist osteoarthritis. ClinicalTrials.gov, NCT05367817. Retrospectively registered on 27/04/2022. https://clinicaltrials.gov.