Base of thumb osteoarthritis in UK interface services—a cohort and survey-based study to assess current practice

Abstract

Aim Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life, while little is known about structure and pathways of interface services. Our aim was to assess disease burden, referral pathways, service structure and management pathways in UK interface services. Patients & Methods A structured questionnaire was carried out with a participating clinician at each centre to detail the local guidelines and management of BTOA. Five patients referred with BTOA were prospectively identified in each of 32 United Kingdom (UK) interface centres. Results Most centres (72%) had a local guideline and a standardised treatment regime consisting of education (100%), joint protection (100%), range of motion exercises (84%), strengthening exercises (88%), splintage (100%) and use of assistive devices (78%). No centre routinely offered a steroid injection at the first appointment and no centre had a specific threshold for offering an injection. Injection delivery was variable. Most patients had not been referred previously (82%). Most patients used analgesia (72%) but a minority of patients had been treated with a splint (46%), therapy (43%) and steroid injection (27%) prior to their latest attendance. Conclusion Most BTOA patients newly referred to interface services have been treated with analgesics and have not received comprehensive multimodal intervention. The management of BTOA at interface services is standardised in terms of education, splintage and therapy. However, there is a lack of standardisation in terms of both the threshold for, timing and mode of delivery of injection therapy.

A qualitative study exploring clinicians’ views on clinical trials in thumb carpometacarpal joint osteoarthritis

“…The interview schedule was developed based on a previous work that has described the CMCJ OA care pathways in the UK. 4 It covered five topics of interest relating to general management approach, the role of exercise, surgery and steroid injection, and clinical trial design ( Table III ). All participants provided verbal consent before the start of each interview.…”

“…[1][2][3] The majority of thumb CMCJ OA pain is managed in primary care settings or by referral to musculoskeletal services, which are largely run by physiotherapists or occupational therapists. 4 Therapybased interventions vary and often include patient education, analgesia, exercises, joint protection, assistive devices, splints, and steroid injections. 4,5 Our previous work has demonstrated that this treatment appears fairly common across the UK, although there are variations regarding the use of steroid injections.…”

“…4 Therapybased interventions vary and often include patient education, analgesia, exercises, joint protection, assistive devices, splints, and steroid injections. 4,5 Our previous work has demonstrated that this treatment appears fairly common across the UK, although there are variations regarding the use of steroid injections. 4 There is a limited qualitative research exploring the impact of thumb CMCJ OA.…”

“…4,5 Our previous work has demonstrated that this treatment appears fairly common across the UK, although there are variations regarding the use of steroid injections. 4 There is a limited qualitative research exploring the impact of thumb CMCJ OA. [6][7][8] A small number of qualitative studies have been carried out relating to therapists' perceptions of CMCJ OA: these studies have focused on joint instability 9 and referral process, assessment, and effectiveness of particular interventions.…”

“… 4 , 5 Our previous work has demonstrated that this treatment appears fairly common across the UK, although there are variations regarding the use of steroid injections. 4 …”