OP0157-HPR CHANGES IN PAIN AND HAND FUNCTION AFTER MULTIMODAL OCCUPATIONAL THERAPY AND/OR SURGERY IN PATIENTS WITH CARPOMETACARPAL OSTEOARTHRITIS

Abstract

Background:Carpometacarpal osteoarthritis (CMC1 OA) is a subset of hand OA, often leading to pain and functional limitations. The EULAR recommends conservative treatment as first-line management, and a recent study showed significant short-term effect of multimodal occupational therapy on pain and hand function in patients referred to surgical consultation1. However, long-term results are lacking.Objectives:To explore the long-term effect of multimodal occupational therapy on pain and hand function in patients with CMC1 OA, and to assess the differences between those undergoing surgery or not in the two groups.Methods:This project presents secondary analyses of a multicentre RCT. Patients referred by their general practitioner to surgical consultation due to CMC1 OA at three Norwegian hospitals from 2013-2015 were eligible. During the waiting period between referral and surgical consultation, 180 patients were randomized to usual care (information, n=90) or a 3-month multimodal occupational therapy intervention (patient education, hand exercises, orthoses and assistive devices, n=90). Patients were assessed at baseline, and 4 (before surgical consultation), 18 and 24 months. Pain at rest was assessed using a 11-point numeric rating scale, and hand function was self-reported with the MAP-Hand (1-4, 1=no problem). The long-term within- and between-group differences on pain and hand function were assessed using repeated measure ANOVA. Sub-analyses were done among those undergoing surgery or not in the two groups. P-value <0.05.Results:163 patients (63 (8) years, 81% women) were included in the analyses. Both groups showed a significant reduction in pain and improvement in hand function over time (p<0.001), with a significant between-group difference for pain (F (1, 161) = 8.56, p = 0.004), in favour of the intervention group, but not hand function.After 2 years, 22 patients had undergone surgery in the intervention group vs 29 in the control group. No significant difference over time were found in pain or hand function between those undergoing surgery or not in the two groups. However, at the time of the surgical consultation, significantly higher pain (Figure 1) and poorer hand function were reported among those later undergoing surgery in the control group (p≤0.001). Surgery did not lead to further improvement in pain and hand function in the intervention group.Figure 1.Between-group difference on pain over a 2-year period. The control group is marked in light grey and the intervention group in black. Those who underwent surgery are marked with dotted lines, while those who did not are marked with solid lines (n=163)Conclusion:The results showed that the positive effect of multimodal occupational therapy on pain and hand function persisted over the 2-year period, however, no significant between-groups difference over time was found. No significant between-group differences were found when dividing into sub-groups, however, those later undergoing surgery in the control group scored significantly worse on pain and hand function at the time of surgical consultation. The results may imply that patients who would benefit from surgery were identified, and that surgery does not give an additional benefit in patients who have received multimodal occupational therapy. This needs to be further investigated.