TORONTO — A multimodal, non-pharmacologic intervention involving four strategies was associated with improved pain and functioning in a cohort of patients with hand OA, according to findings presented here.
Ann Tveter, MD, of the National Advisory Unit on Rehabilitation in Rheumatology at Diakonhjemmet Hospital in Oslo, Norway, suggested that previous research has shown the efficacy of occupational therapy intervention programs in this patient population. “Our study will contribute to this knowledge gap by showing that multimodal, non-pharmacological treatment is effective with regard to pain and function in these patients,” she said.
Tveter and colleagues conducted a randomized, controlled trial in 90 patients and 90 controls. Participants in the intervention group were taught exercises that aimed to improve grip and pinch strength, along with mobility, stability and stretching. Study protocols called for exercises to be performed three times a week for 3 months, with a 2-year follow-up period.
The participants were also provided with two orthoses to wear in the day or night. “Patients were instructed to use the orthoses as much as possible,” Tveter said.
In addition, participants in the active treatment group received a diary to record their progress, while controls were given educational materials on hand OA only. The study ran from baseline to the time when patients were referred to surgical consultation.
Using the 10-point numerical rating scale (NRS), results showed that the intervention group improved pain at rest compared to controls (-1.4; P < .001). Similarly, the intervention group also showed improvement in grip strength (-1.1; P < .001) and pinch strength (-0.8; P < .001) compared to controls.
“The intervention group showed a significant improvement for all three measures, while the control group did not, or even did a bit worse,” Tveter said.
For self-reported outcomes, grip strength (P = .002) but not pinch strength (P = .06) showed a significant improvement among participants in the intervention group compared with controls. “We saw a significant between-group improvement for both measures,” Tveter said.
Regarding function, the intervention group bested controls in terms of MAP-Hand (-0.18 points; P < .001) and QuickDASH (-8.1 points; P < .001). “MAP-Hand measures activity performance of the hand, and QuickDASH assesses disability-related activities,” Tveter said.
“No between group difference was found for any of the range of motion measures,” Tveter added. “Possibly because range of motion was not particularly impaired at baseline.”
Regarding adverse events, eight patients reported minor discomfort using day or night orthoses, and eight patients reported some pain during exercises.
Tveter reported that 64% of participants in the intervention group adhered to three out of four of the strategies. Adherence to the exercise regimen was 82%, 61% to the use of day orthoses, 54% to the use of night orthoses, and 69% to the use of assisted devices.
“A multimodal occupational therapy intervention had significant short-term effect on pain, grip strength, and function in patients referred to surgical consultation,” Tveter concluded. —by Rob Volansky
Tveter A, et al. Abstract #87. Presented at: OARSI 2019 World Congress on Osteoarthritis; May 2-5; Toronto, Canada.
Disclosure: Tveter reports no relevant financial disclosures.