Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study

Gravås, Else Marit Holen; Tveter, Anne Therese; Nossum, Randi; Eide, Ruth Else Mehl; Klokkeide, Åse; Matre, Karin Hoegh; Olsén, Monika Fagevik; Andreassen, Øyvor; Østerås, Nina; Haugen, I.K.; Kjeken, Ingvild

doi:10.1186/s12891-019-2567-3

Cited by 24 publications

(19 citation statements)

References 44 publications

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“…That a substantial number of those who would benefit do not access health care has recently been confirmed in CMC1 joint OA (50) and previously in hand (40) and general OA (45). We endorse the findings of previous studies that there is a need, on the part of both patients and clinicians, to dispel the belief that OA problems are an inevitable part of aging (40,47).…”

Section: Discussionmentioning

confidence: 77%

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Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study

Bűhler

Chapple

Stebbings

et al. 2021

Arthritis Care & Research

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Objective First carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets. Methods In this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face‐to‐face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact Model was employed to help with interpretation of the results. Results Five interrelated levels of health impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and an altered sense of self. Constant pain and pain at night were key symptoms that were associated with impact at the other levels. Conclusion Constant pain, pain at night, functional capacity, medication burden, emotional impact, and sense of self are important outcomes and treatment targets in people with CMC1 joint OA.

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Section: Discussionmentioning

confidence: 77%

“…In hand OA, this unmet need has been linked to clinical uncertainty and a lack of high‐quality evidence for therapeutic options (30). Earlier access to evidence‐based information, advice, and nonpharmacologic and nonsurgical interventions, in primary care or via public information platforms and agencies, would help address this gap (50).…”

Section: Discussionmentioning

confidence: 99%

Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study

Bűhler

Chapple

Stebbings

et al. 2021

Arthritis Care & Research

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“…Rhizarthrosis is a common and burdensome condition that causes substantial morbidity, disability, frequent ambulant health care visits, and hospitalization [5,14]. Conservative therapies are needed because prevalence rates for osteoarthritis are rising and conservative treatment options have been scientifically underexplored [6,19,46]. Therapeutic exercise and manual hand therapy and their combination have been reported as effective methods to improve pain and function in short-term follow-up in OAT patients [20,29,47].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, conservative options should be considered first [18]. Consequently, there is a need for conservative therapies such as specific hand therapies that may reduce OAT symptoms, improve the patient's quality of life, and, at best, delay disease progression [19]. It is unclear which conservative measures, if any, are most effective [20].…”

Section: Introductionmentioning

confidence: 99%

Study of Medical Ultrasound for Rhizarthrosis (SUR): study protocol for a randomized controlled single-center pilot-trial

Böck

Eisenschenk

Lorenzen

et al. 2020

Trials

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Background: Rhizarthrosis (trapeziometacarpal osteoarthritis) is the second most common site of osteoarthritis in the hand affecting 10-30% of adults over the age of 50. Up to four times as many women as men have rhizarthrosis. Clinical symptoms include functional disability of the thumb, pain, joint swelling, and reduced strength. The first carpometacarpal joint is pivotal in the opposition of the thumb and allows a high degree in flexibility to humans. Current therapies focus mainly on surgical strategies, which should be considered in advanced, therapy-resistant stages to relieve pain and improve function. However, conservative treatment methods are urgently required in presurgical stages. The efficacy of conservative treatment options for rhizarthrosis, which are intended to preserve function, joint integrity and to relieve pain, has not been adequately studied. In the clinical study protocol presented here, we investigate the efficacy of multimodal hand therapy versus therapeutic ultrasound versus combination therapy with both hand therapy and therapeutic ultrasound. Methods: This study is a single-center, randomized, controlled, parallel-group pilot trial. One hundred fifty patients with rhizarthrosis and current disease activity will be randomized to one of three conservative interventions over 6 months. Interventions are (1) multimodal hand therapy (2) therapeutic ultrasound, and (3) combination therapy with both hand therapy and ultrasound therapy. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score after 6 months. Secondary endpoints are changes in pain, quality of life, disability progression, and changes of hand function. Safety will also be assessed. Discussion: Clinical data suggest that multimodal hand therapy may improve functionality and reduce pain in rhizarthrosis. Clinical data regarding therapeutic ultrasound are not available. Clinical evidence is lacking. This study is the first clinical study investigating the effects of multimodal hand therapy in direct comparison to therapeutic ultrasound and to a combination therapy with both hand therapy and ultrasound therapy for rhizarthrosis.

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“…Recent research shows that the quality of primary care services in general is sub-optimal for this patient group [ 11 ], and in particular, people with hand OA have poor access to recommended treatment both in primary and secondary care [ 12 ]. This is supported by contemporary results from a Norwegian trial, where only 21% of patients had received recommended non-pharmacological treatment before being referred from their general practitioner (GP) to surgical consultation due to CMC1 OA [ 13 ]. Thus, patients with hand OA are currently not receiving the recommended intervention options and are increasingly referred to consultation by a rheumatologist in specialist care.…”

Section: Introductionmentioning

confidence: 95%

Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

Kjeken

Bergsmark

Haugen

et al. 2021

BMC Musculoskelet Disord

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Background Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions: What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline? Methods Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. Discussion The findings will improve access to evidence-based management of people with hand OA. Trial registration ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.

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Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study

Cited by 24 publications

References 44 publications

Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study

Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study

Study of Medical Ultrasound for Rhizarthrosis (SUR): study protocol for a randomized controlled single-center pilot-trial

Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

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