Response to Conservative Treatment for Thumb Carpometacarpal Osteoarthritis Is Associated With Conversion to Surgery: A Prospective Cohort Study.

There was no untreated control group, so the study cannot show whether the pain improvement during conservative treatment was caused by the treatment or by natural fluctuation or spontaneous improvement. The outcome was the decision by surgeon and patient to undergo surgery, not a surgical outcome, and the study did not examine psychological factors such as depression, anxiety, or catastrophic thinking. There was substantial missing questionnaire data, although the authors found no significant differences between participants who did and did not complete follow-up questionnaires. The analysis did not account for possible differences between clinic locations and surgeons, so the reported uncertainty around the estimates may have been underestimated. The models' ability to separate patients who converted to surgery from those who did not was only moderate to good for pain and moderate for function.

Do not conclude that an orthosis, hand therapy, and home exercises prevent surgery. The study had no untreated control group, so the pain improvement and lower conversion rate could reflect natural fluctuation or spontaneous improvement rather than the treatment.