An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale—A randomized controlled trial

Abstract

Non-blinded randomized controlled trial Introduction: Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC). Purpose: To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects. Methods: A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI), or a physical exercisebased intervention with occupation-focus (PEI). The primary outcome, functioning, was measured using the DASH questionnaire. Primary endpoint was at three months. Patients were followed for a year. Results: No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times. Conclusions: OBI as delivered in this study was not superior to PEI in this patient group. However, in taking a client-centred approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their 2 occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice. Level of Evidence: 2b * DASH, SOC, EQ-5D only calculated for 503 patients. One patient with strong SOC in EPI group withdrew before 1 month follow-up and therefore baseline data for this participant were excluded from baseline data. **only calculated on acute injuries

Occupation-based intervention in therapy for upper limb musculoskeletal conditions: A systematic review

“…Of the 12 studies included in this review, three 1,24,25 were high quality RCTs, one 26 was a quantitative longitudinal pre-test post-test research intervention study of fair quality and one 27 was a mixed method study of poor quality. Three of the studies were considered as being limited due to non-blinding of therapists, 24 small sample size and the inability to blind therapists, 25 and small sample size and lack of double-blinding. 1 Two studies were viewed as poor 27 and fair 26 quality studies respectively, due to lack of random and concealed allocation and lack of blinding of clients, therapists and assessors.…”

“…A total of 667 participants were included across the twelve studies, with sample sizes ranging from 1 9,28–31,33 to 504 participants. 24 Study participants presented with various upper limb conditions, as shown in Table 1. Most studies included in the review originated in high income countries, namely the USA ( n = 6) 9,27,28,30–32 , Denmark ( n = 1) 24 and Canada ( n = 1) 33 .…”

“…24 Study participants presented with various upper limb conditions, as shown in Table 1. Most studies included in the review originated in high income countries, namely the USA ( n = 6) 9,27,28,30–32 , Denmark ( n = 1) 24 and Canada ( n = 1) 33 . The remaining four studies originated in low and middle income countries, namely Malaysia ( n = 1) 1 , Iran ( n = 1) 25 and South Africa ( n = 2) 26,29 .…”

“…Three studies made use of meaningful activities, which were based on the COPM semi-structured interview. 24,25,31 Others determined the clients’ occupational profile through interview and gave the client the opportunity to choose their activity. 26,32 It was noted that consultation with the client, facilitated by the COPM, resulted in a positive outcome of splinting for CMCJ osteoarthritis, especially after initial splinting (as decided by the therapist) did not offer adequate pain relief.…”

“…The three RCTs 1,24,25 commenced OBI using specific time frames, varying from four to 10 weeks, based on their respective trial periods. All three studies made use of OBI from the onset of therapy.…”