Short‐Term Effects of Occupational Therapy on Hand Function and Pain in Patients With Carpometacarpal Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial

Abstract

Objective. To assess the short-term effects of multimodal occupational therapy on pain and hand function in patients referred for surgical consultation due to first carpometacarpal (CMC1) joint osteoarthritis (OA).Methods. In this randomized controlled trial, patients with CMC1 joint OA referred for surgical consultation at 3 rheumatology departments were randomized to 3 months multimodal occupational therapy (including patient education, hand exercises, orthoses, and assistive devices) or usual treatment (OA information). Pain was measured on a numeric rating scale from 0 to 10 (0 = no pain). Function included grip and pinch strength (Newtons), range-of-motion (palmar and CMC1 joint abduction [ ]; flexion deficit in digits 2-5 [mm]), and self-reported Measure of Activity Performance of the Hand (MAP-Hand; range 1-4, 1 = no activity limitation) and short version of the Disability of the Arm, Shoulder, and Hand (QuickDASH; range 0-100, 0 = no disability). Between-group difference was assessed with follow-up values as dependent variables and group as an independent variable, adjusted for baseline values and time to follow-up.Results. Among 180 patients (mean AE SD age 63 AE 8 years; 81% women), 170 completed the short-term followup assessment (3-4 months after baseline). Compared to usual treatment, occupational therapy yielded significantly improved pain at rest (−1.4 [95% confidence interval (95% CI) −0.7, −2.0]; P < 0.001), pain following grip strength (−1.1 [−0.5, −1.7]; P = 0.001), grip strength (23.4 [95% CI 7.5, 39.3]; P = 0.004), MAP-Hand score (−0.18 [95% CI −0.09, −0.28]; P = 0.001), and QuickDASH score (−8.1 [95% CI −4.6, −11.5]; P < 0.001).Conclusion. The multimodal occupational therapy intervention had significant short-term effects on pain, grip strength, and hand function in patients with CMC1 joint OA.ClinicalTrials.gov identifier: NCT01794754.

Digitally delivered education and exercises for patients with hand osteoarthritis—An observational study

“…Tveter et al. (2022), using the Measure of Activity Performance of the Hand (MAP‐Hand) and the short version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), showed higher patient disability than the population investigated in our study. In addition, the use of orthosis and topical medication in their studies may partly explain the better outcome.…”

“…Deveza et al (2021), who also assessed hand function with FIHOA, included patients with more severe disease burden, having a baseline mean FIHOA of 10.7 compared to 5.9 among participants included in the present study. Tveter et al (2022), using the Measure of Activity Performance of the Hand (MAP-Hand) and the short version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), showed higher patient disability than the population investigated in our study. In addition, the use of orthosis and topical medication in their studies may partly explain the better outcome.…”

“…In the present study, there were no meaningful clinical or statistical improvements in hand function, which is in line with the mobile app‐delivered arm in an RCT (Rodríguez Sánchez‐Laulhé et al., 2023). On the contrary, face‐to‐face treatments (Deveza et al., 2021, S. 20; Tveter et al., 2022) showed hand function improvement. However, there were differences regarding intervention and assessment between our and the latter studies.…”

“…Hand OA is a common condition affecting 50% of women and 25% of men (Y. Zhang & Jordan, 2010). The first‐line treatment for people with hand OA, that is, exercise and education, has shown beneficial effects on pain (Kloppenburg et al., 2019; Kolasinski et al., 2020; Kroon et al., 2018), function and finger stiffness (Beasley et al., 2019; Deveza et al., 2021; Tveter et al., 2022; Østerås et al., 2017) and is well tolerated by patients (Hennig et al., 2015). However, only one out of five patients with thumb base OA receives first‐line treatment before being referred for surgical consultation in specialist health care (Gravås et al., 2019).…”

Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial

“…Pharmacological therapy is recommended as a symptom relieving supplemental intervention, whereas surgery should only be considered when other treatments have failed to provide sufficient pain relief 7. The multimodal intervention is shown to have a statistically significant beneficial short-term effect on pain8 9 and hand function9 compared with or in addition to usual care. However, there is an evidence-to-practice gap regarding this first-line multimodal intervention, with only 20% reporting to have received this treatment before being referred to surgical consultation 10.…”