Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial

Gravås, Else Marit Holen; Østerås, Nina; Nossum, Randi; Eide, Ruth Else Mehl; Klokkeide, Åse; Matre, Karin Hoegh; Olsén, Monika Fagevik; Andreassen, Øyvor; Haugen, I.K.; Tveter, Anne Therese; Kjeken, Ingvild

doi:10.1136/rmdopen-2019-001046

Cited by 19 publications

(40 citation statements)

References 43 publications

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“…Moreover, long-term outcomes after non-operative treatment of painful TMC-OA have not been reported (23). Low quality studies suggest that hand exercise may have a mild positive effect on hand pain, function and finger joint stiffness in the short term (23), however, an occupational therapy regimen has not been shown to significantly delay or reduce the rate of surgery (24). As a growing number of patients, even with few or mild symptoms, are seeking expert opinion on TMC-OA treatment (13,14,25), high-quality research is warranted to aid decision making between non-operative and operative treatment in order to avoid surgical over-treatment.…”

Section: Discussionmentioning

confidence: 99%

Substantial Increase in the Incidence of Surgery for Osteoarthritis of the Base of the Thumb Between 1997 and 2019 in Finland

MYOHANEN

Waris

Nordback

et al. 2022

In Vivo

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Background/Aim: Osteoarthritis (OA) at the trapeziometacarpal joint (TMC) is common. However, no published data on the TMC-OA surgery incidence exist. The aim of this study was to evaluate the incidence and trends of TMC-OA surgical treatment. Patients and Methods: A nationwide hospital discharge register-based study was conducted among patients surgically treated for TMC-OA in Finland between 1997 and 2019. Results: A total of 8,728 surgeries were performed. The annual surgery incidence increased 10-fold from 1997 to 2019. The incidence was higher in women and increased the most in the age groups of 50-59 and 60-69 years. TMC resection arthroplasty with or without ligament reconstruction and/or tendon interposition accounted for 91% of all surgeries. Conclusion: The increase in the surgical procedure rates is substantial. It is not explained by advancements in surgical treatment or by the ageing population. The indications for surgery appear to have become broader.Osteoarthritis (OA) of the trapeziometacarpal joint (TMC) at the base of the thumb is one of the most common degenerative diseases. Female gender and heredity are known risk factors for hand OA (1). Moreover, the prevalence of TMC-OA increases with age (2-5). Up to 44% of Caucasian men and 57% of women >60 years of age have been reported to have signs of radiographic TMC-OA, whereas 3.7% of men and 9.3% of women suffered from symptomatic TMC-OA leading to pain, weakness, and disability (5).If non-operative measures fail to treat pain adequately in patients with TMC-OA, operative intervention is considered (6). Trapeziectomy, described by Gervis in 1949 ( 7), is still the gold-standard surgical procedure for TMC-OA. Several different modifications of this procedure have been described, which combine e.g., ligament reconstruction, tendon interposition (LRTI), or both (8-10). Various interposition implants and total joint replacement designs have also been described (11). Arthrodesis is considered an option for patients with isolated TMC-OA (12).While a major increase in hand-OA prevalence seems unlikely, a study by Wildin et al. showed that the number of patients seeing a surgeon for hand OA has almost tripled in 10 years from 13 to 34/100000 (13). In a Scandinavian study, more than 1 in 20 elderly women consulted a physician for TMC-OA (14). However, no national-level epidemiological studies on surgical treatment of TMC-OA have been previously reported. Thus, the purpose of this study was to investigate the incidence and trends of surgical treatment of TMC-OA in Finland between 1997 and This article is freely accessible online.

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Section: Discussionmentioning

confidence: 99%

Substantial Increase in the Incidence of Surgery for Osteoarthritis of the Base of the Thumb Between 1997 and 2019 in Finland

MYOHANEN

Waris

Nordback

et al. 2022

In Vivo

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“…The second reason is that the value of non-operative treatments for TMC osteoarthritis remains unclear and, at present, there is no widely agreed or standardized protocol for non-operative treatment. Gravas et al. (2019) reported that an occupational therapy regime did not significantly delay or reduce the rate of surgery.…”

Section: When Should Patients Be Offered Surgical Treatment?mentioning

confidence: 99%

“…However, this may not always be the case. One study reported that 68% of patients referred for consideration of surgery did not undergo surgery during the following 2 years (Gravas et al., 2019), and I am unaware of any studies that have reported the long-term outcome of painful TMC osteoarthritis that is not treated surgically. In my experience, I have found it sensible to delay surgery for at least 3–6 months after the onset of intolerable pain, or even longer.…”

Section: When Should Patients Be Offered Surgical Treatment?mentioning

confidence: 99%

Trapeziometacarpal joint arthritis: a personal approach to its treatment

Davis

2020

J Hand Surg Eur Vol

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Many hand surgeons have fixed beliefs on how trapeziometcarapl (TMC) osteoarthritis should be treated. However, not all hand surgeons share the same fixed beliefs, so different factions of hand surgeons can hold contradictory beliefs. Many retain their fixed beliefs, rather than reconsidering them, when the best available evidence challenges them. The problem causing this heterogeneity of fixed beliefs is the lack of high-quality evidence that can withstand critical appraisal and cannot be ignored or simply dismissed by those with rigid contradictory beliefs. This article examines some of the dogmas surrounding the treatment of TMC osteoarthritis.

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“…O’Brien et al concluded that receiving non-operative treatment by an OT was the only significant predictor for not requiring surgery among 224 patients referred to a hand surgeon for common hand conditions, such as hand OA [ 23 ]. In a recent randomized controlled trial (RCT), occupational therapy in the waiting period to surgical consultation led to improved function after three months [ 24 ] and less surgery after two years in patients with CMC1 OA [ 25 ]. Furthermore, in an ethnographic study exploring the practice in OT-led hand clinics, the authors conclude that the therapists’ occupational perspective on assessing and addressing activity and participation is as an important and added bonus [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

Kjeken

Bergsmark

Haugen

et al. 2021

BMC Musculoskelet Disord

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Background Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions: What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline? Methods Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. Discussion The findings will improve access to evidence-based management of people with hand OA. Trial registration ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.

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Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial

Cited by 19 publications

References 43 publications

Substantial Increase in the Incidence of Surgery for Osteoarthritis of the Base of the Thumb Between 1997 and 2019 in Finland

Substantial Increase in the Incidence of Surgery for Osteoarthritis of the Base of the Thumb Between 1997 and 2019 in Finland

Trapeziometacarpal joint arthritis: a personal approach to its treatment

Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

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