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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

Post doc

PhD fellow
Physical therapist

Hege Johanne Magnussen


MSc Health Psychology, University of Nottingham

Silje Zink

ABOUT THE PROJECT, WHICH IS COMPLETED

People with hand osteoarthritis represent a large and growing patient group in rheumatology outpatient clinics. There is yet no cure for hand osteoarthritis, and pharmaceutical treatment is primarily aimed at symptom relief. Other recommended treatments include occupational therapy, which involves providing information, hand exercises, thumb orthoses, and guidance on the use of assistive devices and ergonomic work techniques. For those with advanced osteoarthritis in the thumb base joint, surgical intervention may be offered. Recent studies show that occupational therapy for hand osteoarthritis is effective in reducing pain and fatigue, as well as improving hand strength and activity performance.

The traditional pathway patients with hand osteoarthritis in Norway is that they are diagnosed by a general practitioner in primary health care, who increasingly refers the patient on to outpatient assessment in specialist health care. 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 (WP1 led by Professor Ingvild Kjeken), we evaluate if occupational therapist-led care is as safe, effective and cost-effective as rheumatologist-led care for patients with HOA with regard to treatment response and patient satisfaction. In the second part of the study (WP2 led by Professor Marte Feiring), we interview patients, rheumatologists and occupational therapists involved in HOA care to gain a full understanding of current HOA pathways, and the context and determinants for shifting tasks between professions and health care levels. In WP 3, led by senior researcher Anne Therese Tveter), previous research and the results WP 1 and 2 will form the basis for developing new HOA care pathway and strategies for implementation of the pathway.

Together with knowledge from previous research, the results from the two sub-studies have formed the basis for developing a proposal for a new course of treatment 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 prepare proposals for a new course and strategies for implementing this course.

WHO HAS ATTENDED?

Patients over 18 years of age with hand osteoarthritis, who were referred for treatment at Diakonhjemmet hospital or Martina Hansens Hospital have participated 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. Olav's Hospital.

In the third part of the study, national and international experts on hand osteoarthritis participated; user assistants, clinicians and researchers.

Recruitment of participants for all partial studies has ended.

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

PUBLICATIONS