OP0161 HPR SHORT-TERM EFFECT OF OCCUPATIONAL THERAPY INTERVENTION ON HAND FUNCTION AND PAIN IN PATIENTS WITH THUMB BASE OSTEOARTHRITIS – SECONDARY ANALYSES OF A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Carpometacarpal joint osteoarthritis (CMC1 OA) is a subset of hand osteoarthritis (HOA), presenting symptoms of pain and functional limitations. No cure for OA exists, and the EULAR recommendations highlight conservative treatment as first-line treatment for patients with HOA. Although several studies have assessed the effect of different treatments on pain and function in patients with HOA, there is a lack of high quality studies assessing these effects in patients with CMC1 OA. A recent systematic review showed that multimodal treatments (i. e. patient education, exercises, orthoses) improved pain but not function; however, the two studies included had short intervention periods and small samples. Thus, additional studies are warranted. Objectives: To assess the short-term effect of a 3-month multimodal occupational therapy intervention on pain and function in patients referred to surgical consultation for CMC1 OA. Methods: This study presents secondary analyses of a multicenter randomized controlled trial. Patients referred to surgical consultation due to CMC1 OA at three departments of rheumatology in Norway between 2013 and 2015 were considered eligible if they could speak Norwegian and did not have cognitive dysfunction. During the waiting period between referral and actual surgical consultation, the 180 included patients were randomized to either usual care (information about hand OA) or multimodal occupational therapy consisting of patient education, hand exercises, orthoses and assistive devices. Patients were instructed in conducting hand exercises three times per week for 12 weeks. They were given both day and night orthoses and were instructed to use them as much as possible. They were also given five commonly used assistive devices for use at home. The patients answered questionnaires and were assessed at baseline and in conjunction with the surgical consultation (follow-up). Pain at rest and during pinch- and grip strength was self-reported on a 10-point numeric rating scale. Function was self-reported in MAP-Hand (1-4, 1= no problems) and QuickDASH (0-100, 0=no disability) and measured as grip- and pinch strength (% of reference values) and range of motion (flexion deficit 2.-5. finger, palmar abduction and abduction in the CMC1). Within-group difference from baseline to follow-up was analyzed with paired sample t-test, while between-group difference at follow-up was estimated with multiple linear regression, adjusting for baseline value and time to follow-up. Due to multiple analyses of secondary outcomes, the p-value was set to p<0.01. Results: The 180 included patients' mean (SD) age was 63 (8) years and most were women (81%). At baseline, there were no significant differences between groups in any of the included variables. Most patients reported mild pain (NRS median 3) and moderate disability. Thirty-six had additional affection of interphalangeal joints. At follow-up, the control group showed no improvements, while the intervention group showed significant improvement in all pain and functional measures, except flexion deficit. When adjusting for baseline value and time to follow- up, there were significant differences between the two groups at follow-up for pain at rest, pain following grip, self-reported function (MAP-Hand and Quick- DASH) and grip strength, with the intervention group showing greater improvement (p<0.01). Conclusion: Occupational therapy had significant positive short-term effects on pain and function in patients referred to surgical consultation for CMC1 OA.