Abstract
BackgroundEvidence for non-pharmacological interventions in hand osteoarthritis is promising but still scarce. Combined interventions are most likely to best cover the clinical needs of patients with hand osteoarthritis (OA). The aim of this study was to evaluate the effect of a combined, interdisciplinary intervention feasible in both primary and specialist care compared to routine care plus placebo in patients with hand OA.MethodsThis was a randomised, controlled 2-month trial with a blinded assessor. In the combined-intervention group, rheumatology-trained health professionals from different disciplines delivered a one-session individual intervention with detailed information on functioning, activities of daily living, physical activity, nutrition, assistive devices, instructions on pain management and exercises. Telephone follow up was performed after 4 weeks. The primary outcome was grip strength after 8 weeks. Secondary outcomes were self-reported pain, satisfaction with treatment, health status, two of the Jebsen-Taylor Hand Function subtests and the total score of the Australian/Canadian Hand Osteoarthritis Index (AUSCAN). Statistical significance was calculated by Student’s t test or the Mann-Whitney U test depending on data distribution. Binominal logistic regression models were fitted, with the primary outcome being the dependent and the group allocation being the independent variable.ResultsThere were 151 participating patients (74 in the combined-intervention and 77 in the routine-care-plus-placebo group) with 2-month follow-up attendance of 84% (n = 128). Grip strength significantly increased in the combined-intervention group and decreased in the routine-care group (dominant hand, mean 0.03 bar (SD 0.11) versus − 0.03 (SD 0.13), p value = 0.001, baseline corrected values) after 8 weeks.ConclusionThe combined one-session individual intervention significantly improved grip strength and self-reported satisfaction with treatment in patients with hand OA. It can be delivered by different rheumatology-trained health professionals and is thus also feasible in primary care.Trial registrationISRCTN registry, ISRCTN62513257. Registered on 17 May 2012.
Highlights
Evidence for non-pharmacological interventions in hand osteoarthritis is promising but still scarce
Given the importance of being able to use the hands in daily life, it is apparent that hand OA affects body functions and structures and several activities of daily living and societal participation [10, 11]
We fitted logistic regression models to explore the accuracy of our results: we explored the influence of the group allocation as an independent binary variable on the primary outcome, namely a potential improvement in grip strength of the dominant hand(s) from baseline to week 8
Summary
Evidence for non-pharmacological interventions in hand osteoarthritis is promising but still scarce. Combined interventions are most likely to best cover the clinical needs of patients with hand osteoarthritis (OA). The prevalence of rheumatic diseases rises with age and with increasing longevity of the population [1]. OA affects 60–70% of the population above the age of 65 years [3,4,5]. Almost 80% of the population can expect to live through most of their seventh decade of life, the impact of OA is likely to increase even further in the future [3]. Given the importance of being able to use the hands in daily life, it is apparent that hand OA affects body functions and structures and several activities of daily living and societal participation [10, 11]. Hand OA is a burden for the individual and for society [12]
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