Defining Optimal NHS Occupational Therapy Treatment, individualised splint and placebo splint for patients with thumb base OA: a Delphi study
Boucas, S & Hislop, K & Dziedzic, K & Arden, N & Burridge, J & Hammond, A & Al, e 2013, 'Defining Optimal NHS Occupational Therapy Treatment, individualised splint and placebo splint for patients with thumb base OA: a Delphi study', Rheumatology.
The OTTER (OsTeoarthritis Thumb ThERapy) trial is a 2-year development study for a full RCT into the clinical and cost effectiveness of an occupational therapy and splint intervention for thumb base OA. A Delphi study was conducted to obtain a consensus opinion of both patients with thumb base OA and AHPs about the most appropriate NHS OT programme, splint and placebo splint intervention to use in the RCT. The findings from the consensus study will inform the full trial, and define the three components of the trial interventions. The Delphi panel consisted of 63 AHPs experienced in treating adults with thumb base OA, and 7 patients with thumb base OA. The panel were asked to rate how much they agreed or disagreed about what optimal NHS OT care for thumb base OA should include; which trial splint design options should be included; what should be included in the design of an appropriate placebo splint; and what outcome measures to use. The Delphi study comprised 3 rounds. In Round 1, a 38-item questionnaire was used consisting of closed questions and some open questions to allow for additional comments for the panel’s consideration. A 7-point Likert scale was used. Rounds 2 and 3 consisted of closed questions only.
Results:The response rate for Round 1 was 49.21% for AHPs and 85.71% for patients; Round 2 87.10% AHPs and 83.33% patients; and Round 3 96.30% AHPs and 100% patients. The Delphi study provided consensus between AHPs and patients on the optimal NHS treatment for thumb base OA. This included: Education about General OA and Hand OA; Joint Protection General and Hand Specific; Advice on Hand Exercise; Splint Assessment and Provision; Aids and Equipment for Hands; Fatigue Management and Pacing; Activities of Daily Living; Hobbies; Pain Assessment and Management; Prognosis Advice; and Subjective Verbal Functional Assessment. Agreement regarding thumb base splint options were: a short splint distal to wrist; a hard thermoplastic splint; a soft splint; an off-the-shelf commercial splint; and a therapist manufactured splint. Agreement regarding outcome measurement for thumb base OA included: hand pain, hand mobility, hand function, hand impairment, quality of life, satisfaction, aesthetics, and adherence/non-adherence.
Conclusions:In order to develop a standardized package of care for delivery within a multi-centre AHP RCT, it is imperative to gain the consensus of clinicians and patients about what is important to include in an optimal NHS OT consultation. There are differences in the provision of NHS care and OT consultation for people with thumb base OA across the UK. This Delphi study provides clinician and patient agreement on the optimal components of national OT intervention, splinting and placebo splint design options that reflect optimal NHS intervention and are feasible to provide throughout the UK within national OT departments for use in the OTTER trial RCT.
Rheumatology, 52(Suppl 1), pp.i105-(132).