Greater Efficacy of a combination of Conservative therapies
A Study was conducted to investigate the heterogeneous effects of a combination of conservative therapies compared with an education comparator for thumb base (TB) osteoarthritis (OA) according to clinically relevant characteristics.

Pre-planned subgroup analysis of the COMBO trial (n=204) which compared a combination of education on self-management and ergonomic principles, a prefabricated neoprene splint, hand exercises, and diclofenac sodium gel, with education alone for radiographic and symptomatic TB OA. Primary outcomes were change in pain and hand function from baseline to week-6.

Other outcomes were grip and tip-pinch strength and patient’s global assessment (PGA) (VAS, 0-100mm). Possible treatment effect modifiers were the presence of interphalangeal joint pain, erosive hand OA, radiographic thumb carpometacarpal joint subluxation, and baseline radiographic OA severity.

--The treatment effects of the combined intervention at 6 weeks were greater in participants with lower joint subluxation compared with those with greater subluxation (pain -11.6 respectively, difference between the subluxation groups 14.2 units; and PGA -14.0), respectively, difference between the subluxation groups 15.5 units.
--There was no statistically significant heterogeneity for the other subgroups.

In conclusion, a combination of conservative therapy may provide better advantages in persons with lower joint subluxation over the course of 6 weeks, albeit the clinical relevance is unknown due to the large confidence intervals. For people with more severe joint subluxation, treatment options may need to be tailored.