Supporting patients to manage osteoarthritis in the hand

Joint protection education provided by occupational therapists (OTs) is an effective way of supporting older adults with hand osteoarthritis to manage their condition, and provides an effective treatment in the medium term, new research has shown.

The Arthritis Research UK-funded trial from Keele University involved more than 250 people and was published in the Annals of the Rheumatic Diseases online.

However, the study, conducted by a team at the Arthritis Research UK Primary Care Centre at Keele University, failed to show that hand exercises were effective.

Osteoarthritis of the hand is a painful, disabling condition, which significantly restricts daily activities such as dressing and bathing.

"There is limited evidence for effective management of hand osteoarthritis, but we have produced clear evidence about the most clinically effective methods of delivering and supporting self-management at six months for older adults with hand osteoarthritis, "explained study leader Professor Krysia Dziedzic.

"We have shown that support for self-management, through a joint protection education programme delivered by OTs, provides an effective approach."

"Our study also highlights the feasibility of supporting self-management in community settings, and offers strategies to close the gap between what patients should receive, and what therapies are offered," she added.

As part of the trial, 257 people aged over 50 with hand osteoarthritis, from GP practises in central Cheshire and north Staffordshire, were randomised into four groups: joint protection; hand exercises; joint protection and hand exercises combined; and no joint protection or hand exercises. Participants in the last group received written advice only. All groups were given standardised written information on self-management approaches based on Arthritis Research UK booklets.

Joint protection involved practical help and education about how to manage pain during everyday activities, how to change habits, use labour-saving gadgets and avoid lifting heavy objects. Participants were also given home programmes to practise the skills they had been taught, and a weekly activity diary to complete.

At six months, the primary end point, participants who received joint protection were statistically significantly more likely to respond to treatment to those not receiving joint protection (33 per cent compared to 21 per cent). The response was not maintained over 12 months.

There was no statistically significant difference in those receiving hand exercises and those not receiving hand exercises (28 per cent compared to 25 per cent).