Background/Purpose:  Hand Osteoarthritis (hand OA) is highly prevalent among women and men aged 55 and older. It often causes pain, reduced range of motion and grip strength which, in turn, reduce hand function and cause activity limitations in daily life. Effects of structured hand OA programs in primary care settings, including both patient education and exercise, are sparsely reported. The aim of the study is to evaluate the effectiveness of a six-week hand OA primary care program on hand function and activity limitation in individuals with hand OA.

Methods:  Individuals with diagnosed hand OA that began a hand OA program at a primary care unit in southeastern Sweden were enrolled consecutively between 2008 and 2011. In total 64 individuals agreed to participate, of which 15 did not fulfill the program. The remaining 49 (92% female, mean age 69, range 47-89 years) performed the hand OA program starting with a theoretical part with two lectures of 1.5 hours each. The program continued with group based hand exercises including paraffin treatment twice weekly during the six-week period. Outcome measures were the Grip Ability Test (GAT), the Signal of Functional Impairment (SOFI) and the JAMAR (grip strength). To assess activity limitation the Patient Specific Functional Scale (PSFS) and the Quick Disabilities of the Arm, Shoulders and Hand (Quick-DASH) were used. The evaluations were performed at baseline, after three months and after one year by occupational therapists trained in using the study specific outcome measures. The study was conducted in accordance with the ethical principles of the Helsinki declaration.

Results:  The participants and the drop-outs were comparable with the exception that patients in the drop-out group were working to a higher extent (p=0.005). The comparisons based on non-parametric analyses showed that the participants’ hand function, concerning grip strength (JAMAR), range of motion (SOFI – hand) and grip ability (GAT) improved significantly from baseline to the three-month follow-up (p<0.001- 0.011), as well as when comparing baseline with the one year follow-up (p<0.001-0.004). Activity limitations (PSFS and Quick-DASH) also decreased during the same periods (0.001- 0.008 and 0.001- 0.013 respectively).

Conclusion:  The result indicates that a structured hand OA program, including both patient education and hand exercises, is a useful non-pharmacological group treatment in primary care as it improves hand function and activity limitation with a retentive effect up to one year after completion of the intervention.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-a-six-week-hand-osteoarthritis-program-in-a-primary-care-setting/