Self-management approaches for osteoarthritis in the hand : a 2x2 factorial randomised trial

Dziedzic, K; Nicholls, E; Hill, S; Hammond, A; Handy, J; Thomas, E; Hay, E

Abstract

Background: Osteoarthritis is the leading cause of
disability in older adults. Evidence of effectiveness for
self-management of hand osteoarthritis is lacking.

Methods: In this randomised, factorial trial, we
evaluated the effectiveness of joint protection versus no
joint protection, and hand exercise versus no hand
exercise in adults, 50 years of age or older, with hand
osteoarthritis. Following a population survey (n=12 297),
eligible individuals were randomly assigned (1:1:1:1) to:
leaflet and advice; joint protection; hand exercise; joint
protection plus hand exercise. Joint protection and hand
exercises were delivered by nine occupational therapists,
over four group sessions. The primary outcome was the
OARSI/OMERACT responder criteria at 6 months.
Outcomes were collected blind to allocation (3, 6,
12 m). Analysis was by intention to treat.

Results: Of 257 participants randomised (65:62:65:65)
(mean age (SD) 66 years (9.1); female 66%) follow-up
was 85% at 6 m (n=212). Baseline characteristics and
loss to follow-up were similar between groups. There
were no reported treatment side effects. At 6 m 33%
assigned joint protection were responders compared with
21% with no joint protection ( p=0.03). Of those
assigned hand exercises, 28% were responders
compared with 25% with no exercises (n.s.). Differences
in secondary outcomes were not statistically significant,
except for improvement in pain self-efficacy with joint
protection (3 m p=0.002; 6 m p=0.001; 12 m p=0.03).

Conclusions: These findings show that occupational
therapists can support self-management in older adults
with hand osteoarthritis, and that joint protection
provides an effective intervention for medium term
outcome. (Funded by the Arthritis Research UK ISRCTN
33870549).

Citation

Dziedzic, K., Nicholls, E., Hill, S., Hammond, A., Handy, J., Thomas, E., & Hay, E. (2015). Self-management approaches for osteoarthritis in the hand : a 2x2 factorial randomised trial. Annals of the Rheumatic Diseases, 74(1), 108-118. https://doi.org/10.1136/annrheumdis-2013-203938

• Journal Article Type: Article
• Acceptance Date: Sep 17, 2013
• Online Publication Date: Oct 9, 2013
• Publication Date: Jan 1, 2015
• Deposit Date: Feb 17, 2015
• Publicly Available Date: Mar 27, 2017
• Journal: Annals of the Rheumatic Diseases (ARD)
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 1
• Pages: 108-118
• DOI: https://doi.org/10.1136/annrheumdis-2013-203938
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2013-203938
• Related Public URLs: http://ard.bmj.com/