People with hand osteoarthritis are a large and growing group of patients in rheumatology outpatient clinics. There is currently no cure for hand osteoarthritis and drug treatment is mainly symptomatic. Other recommended treatment is occupational therapy, which includes information, hand training, fitting of support splints and guidance on the use of assistive devices and ergonomic work techniques, while those with advanced osteoarthritis of the thumb root joint should be offered surgery. Recent studies show that occupational therapy for hand osteoarthritis is effective in reducing pain and fatigue, and improving hand strength and activity performance.
The traditional course of treatment for patients with hand osteoarthritis in Norway is that they are diagnosed by a general practitioner in the municipal health service, who in some cases refers the patient for outpatient assessment in the specialist health service. This assessment is usually performed by a rheumatologist, who often refers the patient to an occupational therapist for further intervention.
Many rheumatology departments in Norway have waiting lists, partly due to a shortage of rheumatologists. The main goal of this project is to develop a new, safe and feasible patient pathway for patients with hand osteoarthritis.
The project comprises three sub-studies:
Patients over 18 years of age with hand osteoarthritis who have been referred for treatment at Diakonhjemmet Hospital or Martina Hansen Hospital are eligible for the first part of the study.
The second part of the study involves rheumatologists, occupational therapists, and patients with hand osteoarthritis at Diakonhjemmet Hospital, Martina Hansen's Hospital, Lillehammer Rheumatism Hospital and St. Olav's Hospital.
The third part of the study involves national and international experts in hand osteoarthritis.
Recruitment of participants for all sub-studies has been completed.
Participants in the first part of the study are people with hand osteoarthritis who are randomized to have their first consultation with either a rheumatologist (control group) or an occupational therapy specialist (intervention group). Those randomized to the rheumatologist receive information about the disease and medication use, and steroid treatment if needed. Those randomized to occupational therapy will receive information about the disease and drug use, and instruction in hand exercises and ergonomic work methods. Those who need it will also receive customized orthoses and guidance in the use of assistive devices. Based on the rheumatologist's and occupational therapist's assessment, patients in both groups can be referred further, i.e. the rheumatologist can refer to the occupational therapist, and the occupational therapist can refer to the rheumatologist if there is a need for clarification of the diagnosis or steroid treatment.
Participants in sub-study two are interviewed about the content, roles and responsibilities in the current care pathway for patients with hand osteoarthritis, what they think is a desired pathway, and what contributes to shifting roles and tasks between practitioners and levels in the health service. In addition, the content of GPs' medical records and referrals to the specialist health service for patients with hand osteoarthritis are analyzed.
In sub-study three, an expert group of user representatives, clinicians and researchers participate in a guided voting process (Delphi process) to develop proposals for a new pathway and strategies for implementing this pathway.