The clinical effectiveness of joint protection education and exercises in hand osteoarthritis (OA)

Dziedzic, K, Nicholls, E, Hill, S, Hammond, A ORCID:, Jowett, S, Oppong, R and Hay, EM 2012, The clinical effectiveness of joint protection education and exercises in hand osteoarthritis (OA) , in: 2012 World Congress on Osteoarthritis, 26th-29th April 2012, Barcelona, Spain.

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Purpose: This multicentre 2x2 factorial randomised controlled trial compared; the effectiveness of joint protection education with no joint protection; and the effectiveness of hand exercises with no exercises. Methods: Participants aged 50 years and over from 5 general practices in North Staffordshire and Cheshire, UK, were mailed a screening questionnaire (n¼12,297). Those fulfilling the trial eligibility criteria were invited to attend a clinical assessment for a further eligibility screen for the presence of hand or thumb base OA (ACR clinical criteria). Participants giving informed consent were randomised (with allocation concealment) using computer generated permuted blocks stratified by GP practice, to one of four treatment interventions (leaflet and advice alone; joint protection education; hand exercises; or joint protection education and hand exercises combined). Participants with inflammatory arthritis were excluded. The interventions were delivered by occupational therapists (OTs) to groups of 4-6 participants in 4 sessions over 4 weeks. The primary outcome measure was the OARSI/ OMERACT responder criteria combining hand pain and disability (measured using the AUSCAN) and global improvement at 6 months post-randomisation (primary end point). Secondary outcomes included grip strength, arthritis self-efficacy for pain and EUROQoL EQ-5D. Outcomes were collected blind to treatment allocation and were measured at 0, 3, 6 and 12 months. The main analysis was on an intention to treat basis after adjusting for key baseline covariates and imputation of missing data. Results: Of 257 participants randomised (mean age (SD) 66 (9.1) yrs; Female 66%) there was 85% follow up at 6m (n¼212) (90% at 3m; 85% at 12m). Recruitmentwas balanced across the groups (no joint protection n ¼ 130, joint protection n ¼ 127; no hand exercises n ¼ 127, hand exercises n ¼ 130). Of those randomised to OT classes, 72% attended at least 3 sessions. At 6m, 32% were classed as responders to joint protection and 19% to no joint protection (p¼0.02); 28% were responders to hand exercises and 22% to no hand exercises (n.s.). There were no statistically significant differences in responder criteria at 3m or 12m. There were no consistently statistically significant differences in any of the secondary outcome measures at any time point, with the exception of self-efficacy for pain where differences favoured joint protection compared with no joint protection (3m, p¼0.01; 6m, p¼0.008; 12m, p¼0.06). No adverse treatment events were reported. Conclusion: A four-week programme of joint protection provided for older adults with hand OA afforded improvements in symptoms at 6-months only and self-efficacy at each follow-up time-point. However, no affect on symptoms was seen for the hand exercise programme. The cost effectiveness of these interventions can now be determined and findings will add to the current evidence base for supporting self-management of hand OA. ISRCTN 33870549 Funded by the Arthritis Research UK

Item Type: Conference or Workshop Item (Poster)
Schools: Schools > School of Health and Society > Centre for Health Sciences Research
Journal or Publication Title: Osteoarthritis and Cartilage
Publisher: Elsevier
ISSN: 1063-4584
Related URLs:
Funders: Arthrits Research UK
Depositing User: Professor Alison Hammond
Date Deposited: 21 Sep 2020 08:18
Last Modified: 16 Feb 2022 05:42

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