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Development of a care pathway for patients with hand osteoarthritis

Development of a course of treatment for patients with hand osteoarthritis

Project Manager
Occupational therapist | PhD

Professor Ingvild Kjeken

Project employee
Researcher

Unni Olsen

PhD fellow
Physical therapist

Hege Johanne Magnussen


MSc Health Psychology, University of Nottingham

Silje Zink

ABOUT THE PROJECT

People with hand osteoarthritis are a large and growing group of patients at 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 in the use of assistive devices and ergonomic work techniques, while those with advanced osteoarthritis in the thumb's root joint should be offered surgery. Recent studies show that occupational therapy for hand osteoarthritis is effective in terms of reduced pain and fatigue, and improved hand strength and activity performance.

The traditional treatment course 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 for outpatient assessment in the specialist health service. This assessment is usually carried out by a rheumatologist, who often refers the patient to an occupational therapist for further measures.

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

The project includes three sub-studies:

Participants in the first substudy (led by Professor Ingvild Kjeken) were people with hand osteoarthritis who were randomly assigned to have an initial consultation with either a rheumatologist (control group) or an occupational therapy specialist (intervention group). Those who were randomized to a rheumatologist received information about the disease and medication use, and steroid treatment if needed. Those who were randomized to occupational therapy received information about the disease and medication use, and instruction in hand exercises and ergonomic work methods. Those who needed it also received customized orthoses and guidance in the use of assistive devices. Based on the assessment of the rheumatologist and occupational therapist, patients in both groups could be referred further, i.e. the rheumatologist could refer further to an occupational therapist, and the occupational therapist could refer further to a rheumatologist if needed for clarification of diagnosis or steroid treatment.

Participants in substudy two (led by Professor Marte Feiring) were interviewed about the content, roles and responsibilities in the current course of care for patients with hand osteoarthritis, what they think is a desired course, and what contributes to roles and tasks being moved between providers and levels in the health service. In addition, we have analyzed the content of GPs' medical records and referrals to specialist health services for patients with hand osteoarthritis.

Together with knowledge from previous research, the results from the two sub-studies have formed the basis for developing a proposal for a new treatment course for patients with hand osteoarthritis (sub-study three, led by Professor Anne Therese Tveter). Here, an expert group with user representatives, clinicians and researchers participated in a controlled voting process (Delphi process) to develop proposals for a new course and strategies for implementing this course.

WHO HAS BEEN WITH?

Patients over the age of 18 with hand osteoarthritis, who were referred for treatment at Diakonhjemmet Hospital or Martina Hansens Hospital, participated in the first part of the study.

The second sub-study involved rheumatologists, occupational therapists, and patients with hand osteoarthritis at Diakonhjemmet Hospital, Martina Hansens Hospital, Lillehammer Rheumatism Hospital, and St. Olavs Hospital.

In the third sub-study, national and international experts on hand osteoarthritis participated; user advocates, clinicians and researchers.

Recruitment of participants for all sub-studies has been completed.

The results of the project are being analyzed continuously and published in English-language scientific journals. Below are links to English summaries of the four articles published so far.

PUBLICATIONS