Journal Article (Refereed)
Self management, joint protection and exercises in hand osteoarthritis: a randomised controlled trial with cost effectiveness analyses
Dziedzic, K & Hill, S & Nicholls, E & Hammond, A & Myers, H & Whitehurst, T & Bailey, J & Clements, C & Whitehurst, D & Handy, J & Jowett, S & Hughes, R & Thomas, E & Hay, E 2011, 'Self management, joint protection and exercises in hand osteoarthritis: a randomised controlled trial with cost effectiveness analyses', BMC Musculoskeletal Disorders, 12(156).
Background: There is limited evidence for the clinical and cost effectiveness of occupational therapy (OT)
approaches in the management of hand osteoarthritis (OA). Joint protection and hand exercises have been
proposed by European guidelines, however the clinical and cost effectiveness of each intervention is unknown.
This multicentre two-by-two factorial randomised controlled trial aims to address the following questions:
• Is joint protection delivered by an OT more effective in reducing hand pain and disability than no joint
protection in people with hand OA in primary care?
• Are hand exercises delivered by an OT more effective in reducing hand pain and disability than no hand
exercises in people with hand OA in primary care?
• Which of the four management approaches explored within the study (leaflet and advice, joint protection, hand
exercise, or joint protection and hand exercise combined) provides the most cost-effective use of health care
Methods/Design: Participants aged 50 years and over registered at three general practices in North Staffordshire
and Cheshire will be mailed a health survey questionnaire (estimated mailing sample n = 9,500). Those fulfilling the
eligibility criteria on the health survey questionnaire will be invited to attend a clinical assessment to assess for the
presence of hand or thumb base OA using the ACR criteria. Eligible participants will be randomised to one of four
groups: leaflet and advice; joint protection (looking after your joints); hand exercises; or joint protection and hand
exercises combined (estimated n = 252). The primary outcome measure will be the OARSI/OMERACT responder
criteria combining hand pain and disability (measured using the AUSCAN) and global improvement, 6 months
post-randomisation. Secondary outcomes will also be collected for example pain, functional limitation and quality
of life. Outcomes will be collected at baseline and 3, 6 and 12 months post-randomisation. The main analysis will
be on an intention to treat basis and will assess the clinical and cost effectiveness of joint protection and hand
exercises for managing hand OA.
Discussion: The findings will improve the cost-effective evidence based management of hand OA.
BMC Musculoskeletal Disorders