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Task slippage in hand osteoarthritis

Development of a course of treatment for patients with hand osteoarthritis

Project Manager
Post doc
PhD fellow

ABOUT THE PROJECT

People with hand osteoarthritis are a large and growing patient group at rheumatology outpatient clinics. There is currently no cure for hand osteoarthritis, and drug treatment is mainly symptomatic relief. Other recommended treatment is occupational therapy, which includes information, hand training, adaptation of support rails and guidance in the use of aids and ergonomic work techniques, while those with advanced arthrosis in the root joint of the thumb should be offered surgery. Recent studies show that occupational therapy for hand osteoarthritis has an effect in the form of reduced pain and fatigue, and improved hand strength and performance of activities.

The traditional course of treatment for patients with hand osteoarthritis in Norway is that they are diagnosed by a GP in the municipal health service, who in some cases refers the patient on to outpatient assessment in the specialist health service. This assessment is usually carried out by a rheumatologist, who often refers the patient on to an occupational therapist for further measures.

Many rheumatology departments in Norway have waiting lists, partly because there are too few rheumatologists. The main aim of this project is to develop a new, safe and feasible patient course for patients with hand osteoarthritis.

The project comprises three sub-studies:

  • In the first part of the study (led by Professor Ingvild Kjeken), we investigate whether an occupational therapist-led course in the specialist healthcare service is as safe, effective and cost-effective as a rheumatologist-led course with regard to treatment response and patient satisfaction.
  • In the second part of the study (led by Professor Marte Feiring), we interview patients and healthcare personnel about the current course of patients with hand osteoarthritis, and what contributes to responsibilities, roles and tasks being shifted between practitioners and levels in the healthcare service.
  • Together with knowledge from previous research, the results from the two sub-studies will form the basis for developing a proposal for a new course of treatment for patients with hand osteoarthritis (sub-study three, led by senior researcher Anne Therese Tveter). Through a controlled voting process in an expert group with user representatives, practitioners and researchers, the group must agree on how such a procedure should be designed, and which strategies should be used to introduce the procedure in the health service.

WHO CAN JOIN?

Patients over 18 years of age with hand osteoarthritis, who are referred for treatment at Diakonhjemmet hospital or Martina Hansens Hospital can take part in the first part of the study.

In the second part of the study, rheumatologists, occupational therapists and patients with hand osteoarthritis at Diakonhjemmet Hospital, Martina Hansens Hospital, Rheumatism Hospital Lillehammer and St. Olavs Hospital participate.

In the third part of the study, national and international experts on hand osteoarthritis participate.

Recruitment of participants for all sub-studies has ended.

WHAT DOES THE STUDY INCLUDE?

Participants in the first part of the study are people with hand osteoarthritis who are randomly assigned to have a first consultation with either a rheumatologist (control group) or an occupational therapy specialist (intervention group). Those who are randomized to a rheumatologist receive information about the disease and drug use, and steroid treatment if necessary. Those who are randomized to occupational therapy receive information about the disease and drug use, and instruction in hand exercises and ergonomic work methods. Those who need it will also receive adapted orthoses, and guidance in the use of aids. Based on the rheumatologist's and the occupational therapist's assessment, patients in both groups can be referred on, that is, the rheumatologist can refer on to an occupational therapist, and the occupational therapist can refer on to a rheumatologist if clarification of diagnosis or steroid treatment is needed.

Participants in part-study two are interviewed about content, roles and responsibilities in the current course for patients with hand osteoarthritis, what they think is a desired course, and about what contributes to roles and tasks being moved between practitioners and levels in the health service. In addition, the content of GP medical records and referrals to the specialist health service of patients with hand osteoarthritis are analysed.

In part-study three, an expert group with user representatives, clinicians and researchers participates in a controlled voting process (Delphi process) to prepare proposals for a new course and strategies for implementing this course.