Search

Background: Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations. Evidence-based treatment recommendations state that all patients with hand OA should be offered non-pharmacological treatment. Surgery should be considered only when other treatment has proven insufficient in relieving pain. The purpose of this study was to investigate prior treatment and characteristics of patients referred to specialist health care surgical consultation due to CMCJ OA. The study includes exploring differences in pain and function between referred and non-referred hand, between men and women, and between patients with and without OA affection of other finger joints than CMCJ. Methods: Patients in this cross-sectional study reported prior non-pharmacological treatment for CMCJ OA. Patient demographics, disease and functional variables were assessed based on hand radiographs, patient-reported and observer-based outcome measures. Differences in pain and function between referred and non-referred hand, men and women, and between patients with and without additional affection of finger joints other than CMCJ, were analysed using Paired-samples T-tests, Wilcoxon Signed Rank, or Chi-Square tests. Results: One hundred and eighty patients were included. The mean age was 63 years and 79% were women. Only 21% reported having received non-pharmacological treatment before referral to surgical consultation. The results show a statistically significant worse function for referred hands, women and involvement of additional interphalangeal joints. Most patients reported no pain or mild pain in their referred hand. Conclusions: The results of this study show a non-pharmacological treatment gap in OA care. Most patients report no pain or mild pain, and that they had not received non-pharmacological treatment prior to being referred to CMCJ OA surgical consultation. The results furthermore show that CMCJ OA negatively affects all aspects of function. Strategies need to be developed to improve OA care, including educating general practitioners in evidence-based treatment recommendations and in the assessment of hand pain, and encourage the routine referral of patients with symptomatic hand OA to occupational therapy before considering surgery. This study was conducted with the financial support from The Interregional research funds (HELSEFORSK) via The Research Council of Norway, project number 243758.

To assess the short-term effects of multimodal occupational therapy on pain and hand function in patients referred for surgical consultation due to first carpometacarpal (CMC1) joint osteoarthritis (OA).In this randomized controlled trial, patients with CMC1 joint OA referred for surgical consultation at 3 rheumatology departments were randomized to 3 months multimodal occupational therapy (including patient education, hand exercises, orthoses, and assistive devices) or usual treatment (OA information). Pain was measured on a numeric rating scale from 0 to 10 (0 = no pain). Function included grip and pinch strength (Newtons), range-of-motion (palmar and CMC1 joint abduction [°]; flexion deficit in digits 2-5 [mm]), and self-reported Measure of Activity Performance of the Hand (MAP-Hand; range 1-4, 1 = no activity limitation) and short version of the Disability of the Arm, Shoulder, and Hand (QuickDASH; range 0-100, 0 = no disability). Between-group difference was assessed with follow-up values as dependent variables and group as an independent variable, adjusted for baseline values and time to follow-up.Among 180 patients (mean ± SD age 63 ± 8 years; 81% women), 170 completed the short-term follow-up assessment (3-4 months after baseline). Compared to usual treatment, occupational therapy yielded significantly improved pain at rest (-1.4 [95% confidence interval (95% CI) -0.7, -2.0]; P 0.001), pain following grip strength (-1.1 [-0.5, -1.7]; P = 0.001), grip strength (23.4 [95% CI 7.5, 39.3]; P = 0.004), MAP-Hand score (-0.18 [95% CI -0.09, -0.28]; P = 0.001), and QuickDASH score (-8.1 [95% CI -4.6, -11.5]; P 0.001).The multimodal occupational therapy intervention had significant short-term effects on pain, grip strength, and hand function in patients with CMC1 joint OA.

Background: Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery. Methods: This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question, categorized with the International Classification of Functioning, Disability and Health coding system, and compared to self-reports of pain and function. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0 = not motivated). Factors characterizing patients highly motivated for surgery (NRS ≥ 8) were explored with multivariate regression analyses. Results: The mean age of the participants was 63 years (SD = 7.6), and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use, but these were not reflected in self-reports of pain and function. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with reporting more activity limitations (odds ratio [OR] = 4.00, P = .008), living alone (OR = 3.18, P = .007), and a young age (OR = 0.94, P = .002). Conclusions: Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations for, and goals and motivation for surgery. According to the european league against rheumatism (EULAR) recommendations, previously received conservative and pharmacological treatment should also be evaluated.

Objective: To assess construct validity (Rasch analyses) of the Measure of Activity Performance of the Hand (MAP-Hand) in people with carpometacarpal osteoarthritis (CMC1 OA), and to explore differences in activity performance between people with CMC1 OA and those with rheumatoid arthritis.\ud Design: Cross-sectional study.\ud Subjects: A total of 180 people with CMC1 OA referred for surgical consultation were recruited from rheumatology clinics in Norway, and 340 people with rheumatoid arthritis were recruited from outpatient rheumatology clinics in the UK.\ud \ud Methods: The MAP-Hand consists of 18 predefined items scored on a 4-point scale from 1 (no difficulty) to 4 (unable to do), from which a mean score is calculated. Construct validity was assessed using Rasch analyses. Differences between the 2 groups were assessed using an independent sample t-test at the group level and differential item functioning (condition\ud as grouping variable) at the item level.\ud Results: Some mis-targeting of data and clusters of dependency were found, but the MAP-Hand scores showed an overall fit to the model. No between group difference in total mean MAP-Hand score was found, but there were significant differences between the 2 groups on item levels.\ud \ud Conclusion: The MAP-Hand showed satisfactory construct validity and could differentiate between\ud people with CMC1 OA and those with rheumatoid arthritis on item levels.

Background:Carpometacarpal osteoarthritis (CMC1 OA) is a subset of hand OA, often leading to pain and functional limitations. The EULAR recommends conservative treatment as first-line management, and a recent study showed significant short-term effect of multimodal occupational therapy on pain and hand function in patients referred to surgical consultation1. However, long-term results are lacking.Objectives:To explore the long-term effect of multimodal occupational therapy on pain and hand function in patients with CMC1 OA, and to assess the differences between those undergoing surgery or not in the two groups.Methods:This project presents secondary analyses of a multicentre RCT. Patients referred by their general practitioner to surgical consultation due to CMC1 OA at three Norwegian hospitals from 2013-2015 were eligible. During the waiting period between referral and surgical consultation, 180 patients were randomized to usual care (information, n=90) or a 3-month multimodal occupational therapy intervention (patient education, hand exercises, orthoses and assistive devices, n=90). Patients were assessed at baseline, and 4 (before surgical consultation), 18 and 24 months. Pain at rest was assessed using a 11-point numeric rating scale, and hand function was self-reported with the MAP-Hand (1-4, 1=no problem). The long-term within- and between-group differences on pain and hand function were assessed using repeated measure ANOVA. Sub-analyses were done among those undergoing surgery or not in the two groups. P-value Results:163 patients (63 (8) years, 81% women) were included in the analyses. Both groups showed a significant reduction in pain and improvement in hand function over time (pAfter 2 years, 22 patients had undergone surgery in the intervention group vs 29 in the control group. No significant difference over time were found in pain or hand function between those undergoing surgery or not in the two groups. However, at the time of the surgical consultation, significantly higher pain (Figure 1) and poorer hand function were reported among those later undergoing surgery in the control group (p≤0.001). Surgery did not lead to further improvement in pain and hand function in the intervention group.Figure 1.Between-group difference on pain over a 2-year period. The control group is marked in light grey and the intervention group in black. Those who underwent surgery are marked with dotted lines, while those who did not are marked with solid lines (n=163)Conclusion:The results showed that the positive effect of multimodal occupational therapy on pain and hand function persisted over the 2-year period, however, no significant between-groups difference over time was found. No significant between-group differences were found when dividing into sub-groups, however, those later undergoing surgery in the control group scored significantly worse on pain and hand function at the time of surgical consultation. The results may imply that patients who would benefit from surgery were identified, and that surgery does not give an additional benefit in patients who have received multimodal occupational therapy. This needs to be further investigated.References:[1]Tveter AT, Østerås N, Nossum R, Eide REM, Klokkeide Å, Hoegh Matre K, et al. Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: secondary analyses from a randomized controlled trial. Arthritis care & research. 2020:10.1002/acr.24543Acknowledgements:We would like to acknowledge Øyvor Andreassen for her contribution throughout the project as a patient representative.Disclosure of Interests:None declared

ObjectivesTo evaluate whether occupational therapy, provided in the period between referral and surgical consultation, might delay or reduce the need of surgery in thumb carpometacarpal joint (CMCJ) osteoarthritis and to explore predictors for CMCJ surgery.MethodsThis multicentre randomised controlled trial included patients referred for surgical consultation due to CMCJ osteoarthritis. An occupational therapy group received hand osteoarthritis education, assistive devices, CMCJ orthoses and exercises. A control group received only hand osteoarthritis information. Primary outcome was the proportion of patients that had received CMCJ surgery after 2 years. We examined the primary outcome and predictors for surgery with regression models, and time to surgery with the log-rank test and cox regression analyses.ResultsOf 221 patients screened for eligibility, 180 were randomised. Information on the primary outcome was collected from medical records for all included patients. Surgery was performed on 22 patients (24%) that had received occupational therapy and 29 (32%) control patients (OR 0.56, 95% CI 0.26 to 1.21; p=0.14). Median time to surgery was 350 days (IQR 210–540) in the occupational therapy group and 296 days (IQR 188–428) in the control group (p=0.13). Previous non-pharmacological treatment (OR 2.72, 95% CI 1.14 to 6.50) and higher motivation for surgery (OR 1.25, 95% CI 1.09 to 1.43) were significant predictors for CMCJ surgery.ConclusionsOccupational therapy showed a small non-significant tendency to delay and reduce the need for surgery in CMCJ osteoarthritis. Previous non-pharmacological treatment and higher motivation for surgery were significant predictors for surgery.

b Study Design Cross-sectional methodological study with test-retest design. Introduction The Measure of Activity Performance of the Hand (MAP-Hand) is an assessment tool measuring hand-related activity limitations. Purpose To assess reliability, validity, and interpretability of the MAP-Hand in patients with hand osteoarthritis with specific involvement of the thumb (CMC1). Methods One hundred-and-eighty patients referred to surgical consultation for hand osteoarthritis affecting the CMC1 were included in the evaluation of validity and interpretability. Among these, 59 stable patients were included in reliability analyses, completing the questionnaire twice with a 2-week retest interval. The MAP-Hand has 18 predefined and 5 optional patient-specific items, scored on a 4-point scale (1 = no difficulty to 4 = not able to do). Relative (ICC2.1) and absolute (SDC95%ind) reliability were calculated. An ICC of >0.70 was considered acceptable. Nine (75%) or more of 12 predetermined hypotheses had to be confirmed for acceptable construct validity. Interpretability was assessed using floor and ceiling effects and considered present if 15% scored at eitherend of the scale. Results Mean (SD) age was 63 (8) years, and most patients were women (79%). The mean total score of predefined items showed acceptable reliability (ICC2.1 0.74, SDC95%ind 0.60) and construct validity. The mean total score of the patient-specific items did not reach acceptable reliability. Ceiling effect was found for the predefined items. Discussion and Conclusions We found that the mean total score of the predefined items on MAP-Hand had acceptable reliability and construct validity but a ceiling effect in patients with hand osteoarthritis with CMC1 affection.

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 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 QuickDASH) and grip strength, with the intervention group showing greater improvement (p Conclusion Occupational therapy had significant positive short-term effects on pain and function in patients referred to surgical consultation for CMC1 OA. Disclosure of Interests None declared

Background The 2018 update of the EULAR recommendations for the management of hand osteoarthritis (OA) states that every patient with hand OA should be offered patient education, hand exercises and provision of assistive devices. Orthoses should be considered for symptom relief in patients with thumb carpometacarpal (CMC1) OA. Surgery should only be considered when other treatment modalities have not been sufficiently effective in relieving pain (1). Objectives The main aim was to evaluate whether occupational therapy in the waiting period prior to surgical consultation can reduce or delay the need for surgery in CMC1 OA. A secondary aim was to explore potential predictors for CMC1 surgery. Methods This is a multicentre parallel-group randomized controlled trial including patients referred by their general practitioner for surgical consultation due to CMC1 OA at three Norwegian departments of rheumatology. After baseline assessments, participants were randomized into an occupational therapy group or a control group and reassessed after 4, 18 and 24 months. Both groups received written and oral information on hand OA. In addition, the occupational therapy group received a hand exercise program, day and night orthoses, assistive devices and a treatment diary. Intention-to-treat analyses were conducted fitting multivariate logistic regression analyses to compare the proportion of participants in the two groups who had received CMC1 surgery after two years. Time to surgery was examined in a Kaplan-Meier survival plot, whereas crude and adjusted logistic regression analyses were performed to investigate predictors for CMC1 surgery using a predefined set of covariates of demographic and clinical variables. Results Of 214 patients screened for eligibility, 180 (84%) were randomized. The mean age was 63 years (SD 7.6) and 79% were women. Eighty-four (93%) participants in the occupational therapy group and 82 (91%) in the control group completed 24 months follow-up assessments. Fifty-eight (64%) participants in the occupation therapy group were categorized as having high treatment adherence. Twenty-two (24%) participants in the occupational therapy group and 31 (34%) in the control group received surgery before the two year follow-up. The odds for receiving surgery were 50 percent lower in the occupational therapy group (p=0.10). Median time to surgery was 349 days (IQR 210 to 540) in the occupational therapy group and 267 days (IQR 181 to 406) in the control group (p=0.07). Previous non-pharmacological treatment (OR 2.70, 95% CI 1.16 to 6.27) and higher motivation for surgery (OR 1.22, 95% CI 1.07 to 1.38) were significant predictors for CMC1 surgery Conclusion In participants receiving occupational therapy there was a clear, but not statistically significant trend towards reduction and delay in CMC1 surgery as compared to the control group. Previously received non-pharmacological treatment and higher motivation for surgery significantly predicted surgery. The results support that patients with CMC1 OA should be referred to occupational therapy before surgery is considered. Reference [1] Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2019;78(1):16-24. Disclosure of Interests: Else Marit H. Gravas: None declared, Nina Osteras: None declared, Randi Nossum: None declared, Ruth Else Mehl Eide: None declared, Ase Klokkeide: None declared, Karin Hoegh Matre: None declared, Monika Olsen: None declared, Oyvor Andreassen: None declared, Ida Kristin Haugen Grant/research support from: ADVANCE research grant from Pfizer, Consultant for: Advisory board Abbvie, Anne Therese Tveter: None declared, Ingvild Kjeken: None declared

Background:Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations, but for which there is yet no cure. Evidence-based treatment recommendations state that all patients with hand OA should be offered patient education, hand exercises, and provision of assistive devices and orthoses. Pharmacological therapy is recommended as a symptom relieving supplement. The main indication for CMCJ surgery is pain and poor function, and such surgery should be considered only when other treatment has proven insufficient in relieving pain (1). Previous research has shown that high motivation is a significant predictor for deciding to undergo CMCJ surgery (2), but there is little knowledge regarding which factors that motivates patients for undergoing such surgery.Objectives:The objective of this study was to explore patient goals and motivation for surgery, and factors characterizing patients highly motivated for surgery.Methods:This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question and analysed by linking the content of each goal to domains in the International Classification of Functioning, Disability and Health coding system. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0=no motivation). Activity limitations was self-reported using the Measure of Activity Performance of the Hand (MAP-Hand, score 1 to 4, 1=no activity problems) and the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; score 0-100, 0=no disability). Factors that characterized patients highly motivated for surgery (NRS≥8) were explored with multivariate regression analyses.Results:Mean age of participants was 63 years (SD 7.6) and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with more activity limitations (MAP-Hand; (OR 4.00, p=0.008)), living alone (OR 3.18, p=0.007) and a young age (OR 0.94, p=0.002).Conclusion:Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations and motivation and goals for surgery. According to the EULAR recommendations, previously received conservative and pharmacological treatment should also be evaluated.References:[1] Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.” Ann Rheum Dis. 0; 1-9[2] Gravas, E. M. H., et al. (2019). “Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.” BMC Musculoskelet Disord 20(1): 180.Disclosure of Interests:None declared

Background:Patient education, hand exercises, and use of assistive devices and orthoses are regarded as first-line treatment for patients with hand osteoarthritis (OA) (1), however there is limited evidence for the cost-effectiveness of such treatment.Objectives:The objective of this study is to assess the cost-utility of a multimodal occupational therapy treatment delivered in the waiting period before surgical consultation in patients with thumb base OA compared to usual care.Methods:This study presents an economic evaluation assessing the difference in health care use and quality-of-life during a 24-month period in a Norwegian multicenter randomized controlled trial. All patients referred to surgical consultation due to thumb base OA at three departments of rheumatology between 2013 and 2015 were eligible for inclusion. In total, 180 patients were included and randomized to a control group or a multimodal occupational therapy group (90 patients in each group). During the waiting period between referral and actual surgical consultation, the control group continued with usual care which was staying on the waiting list and receiving information on hand OA. The intervention group got information on hand OA, ergonomic principles and use of assistive devices, and they were instructed in home-based hand exercises and received a day and a night orthosis. The intervention group was instructed to use the orthoses and assistive devices as much as possible and perform home exercises three times per week for 12 weeks. The patients were assessed at baseline and after 4, 18 and 24 months. The within-trial economic analysis reports the incremental cost-effectiveness ratio (ICER) reflecting the between-group difference in incremental cost per adjusted life years (QALY) over 24 months. A generic health-related quality of life questionnaire, the EuroQol 5 Dimension, was used to calculate the QALYs at baseline, 4, 18 and 24 months. Costs were collected from different sources, taking a health care perspective; The occupation therapist reported the number of consultations related to the intervention; surgical procedure and post-operative follow-up were collected from patients’ journals; and additional consumption of primary and specialist health care was self-reported by the patient. Sensitivity analyses were performed. The results are presented in a cost-effectiveness plane using bootstrapping. Willingness-to-pay threshold is set to be € 27 500 linked to the severity of this condition.Results:The mean age of the included patients was 63 years (SD 7.6) and 79% were women. There was a total between-group difference in QALYs of 0.07 utilities after 24 months, in favour of the intervention group. Operations constituted the main costs with 22 operations in the intervention group compared to 33 in the control group. The between-group difference in costs due to health care consumption was estimated to € 500 in favour of the intervention group (Figure 1).Conclusion:The results in this within-trial analysis indicate that multimodal occupational therapy in the waiting period before surgical consultation compared to usual care is a cost-effective alternative taking a health care perspective.References:[1]Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.”Ann Rheum Dis.Disclosure of Interests:None declared

Background Carpometacarpal osteoarthritis (CMC-OA) is a common joint condition, with a prevalence of 13% in people aged 41 to 50 years, increasing to 68% in people between 71 and 80 years. In the absence of disease-modifying interventions, non-pharmacological approaches are considered as core treatments for hand OA, while surgery is recommended for those with severe CMC-OA. Objectives To describe function and previous treatment in patients referred for surgical consultation due to CMC-OA. Methods Individuals referred for surgical consultation due to their CMC-OA at three Norwegian departments of rheumatology were invited to participate. Those who agreed attended a clinical assessment and reported their symptoms, disability and function using validated outcome measures including the Quick-Dash (0–100, 0=no disability) and the MAPHand (1–4, 1=no limitations). Results A total of 180 patients (mean age 63, range: 45 to 82; 79% women) were included. Thirty-six percent were referred for right hand, 43% for left hand, and 21% for bilateral surgery. Concerning previous treatment for hand OA, 21% (78% women) had received hand surgery, 22% (81% women) physical or occupational therapy, and 11% (95% women) had consulted a rheumatologist. Women consistently reported higher pain levels compared to men, had more finger joints with bony enlargements and significantly lower grip and pinch strength in both hands (Table). They also reported significantly more disability and activity limitations at Quick Dash; 38.6 versus 30.4, (p=0.006) and MAPHand; 2.0 versus 1.7 (p Conclusions Among patients referred for surgical consultation due to CMC-OA, women self-reported lower hand function and scored poorer than men in observer based assessments. Even if conservative treatment is recommended before referral for surgery, only a few participants had received such treatment for their hand OA. Disclosure of Interest None declared

Background In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients’ motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA? Methods/Design All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years. Discussion The findings will improve the evidence-based management of HOA. Trial registration identifier NCT01794754. First registrated February 15th 2013.

Hand osteoarthritis (HOA) is a common joint disorder with an expected rise in prevalence due to the increasing ageing population, but with few available effective treatment options. The main aim of this study was to evaluate the effect of assistive technology (AT) in patients with HOA.In this observer-blinded, randomised controlled trial, 35 patients with HOA (AT group) received provision of information and AT (assistive devices and splints), while 35 patients received information only (control group). Primary outcomes were activity performance and satisfaction with performance, measured by the Canadian occupational performance measure (COPM) on a 1-10 scale. Secondary outcomes included measures of disease activity, pain, fatigue and function. Outcome assessments were made at 3 months follow-up.Of 70 participants randomised, 66 participants completed all assessments. Provision of AT was associated with improvement in the COPM performance score (mean difference (95% CI) in change scores 1.8 (1.1 to 2.6) and in the satisfaction score (1.7 (0.7 to 2.6)), indicating a moderate to large treatment effect (effect sizes 0.9). There was a significant improvement in the Australian/Canadian hand index function score in the AT group after 3 months (-0.4, p0.001), and an adjusted mean difference between groups of -0.3 (p=0.06, effect size -0.5). No other differences were found in the secondary outcomes. Self-reported AT usage rate in the AT group was 92%, and participants rated their comfort with AT usage as high.Use of AT is well tolerated and significantly improves activity performance and satisfaction with performance in patients with HOA. The trial is registered in the ISRCTN register (ISRCTN40357804).

Few studies have looked at non-surgical alternatives for morbid obese patients. This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments. Patients with morbid obesity (BMI > 40 or BMI > 35 kg/m2 plus comorbidities) on waiting list for bariatric surgery, were non-randomly allocated to (A) bariatric surgery or to one of three conservative treatments; (B) residential intermittent program; (C) commercial weight loss camp and (D) hospital outpatient program. Body weight, risk factors and comorbidities were assessed at baseline and 1 year. Of 206 participants, 179 completed the study. All treatments resulted in significant weight loss, but bariatric surgery (40 ± 14 kg, 31 ± 9%) led to the largest weight loss (P

Aims: Studies investigating the effect of patient education usually evaluate whole educational programmes. The aim of this study was to describe the content of several locally developed educational programmes and investigate which parts predicted improved coping skills in the participants. Method: A prospective observational study investigating the content of several educational programmes and the participants’ coping skills 4 months afterwards. Results: The content of 35 different educational programmes was described. The programmes lasted on average 12 hours. The main focus was increased knowledge about the disease and improved coping skills. Programmes developed locally and tailored to the specific participant group in collaboration between services users and health professionals led to improved coping skills. The participants’ level of activity was the strongest predictor for improved coping skills (adjOR = 4.1 (95% CI 1.5–11.2) p = 0.007). Conclusions: The group process during patient education might be more important for improving coping skills than the content of the programme. Future patient education programmes should focus on group processes and improving participants’ activity.

Background The Measure of Activity Performance of the Hand (MAP-Hand) is reliable and valid in patients with rheumatoid arthritis. Objective To assess the validity and responsiveness of the MAP-Hand in patients with hand osteoarthritis. Methods Patients were recruited from 2 rheumatology centres. The internal consistency of the MAP-Hand was assessed by Cronbach's α. Content validity was evaluated based on patient interviews. Construct validity and responsiveness were based on predefined hypotheses of correlation between the MAP-Hand and concurrent measures. Results Ten men and 201 women, mean age 62.8 years (standard deviation (SD) 6.8) and disease duration 12.5 (SD 7.5) years were included. A Cronbach's α of 0.86 was determined. All 18 items in the MAP-Hand were described in the interviews. Sixty-seven percent of the correlation coefficients for baseline scores and 75% for change scores were in correspondence with the predefined hypotheses. A high correlation was found between the MAP-Hand and the Australian/Canadian Hand Osteoarthritis Index function score at baseline (rho = 0.76). A moderate correlation was found for change scores (rho = 0.52). Conclusion The content of the MAP-Hand adequately reflects described activity limitations in patients with hand osteoarthritis. The results suggest that the MAP-Hand has adequate internal consistency and responsiveness. Before the MAP-Hand is used in patients with hand osteoarthritis, evaluations of reliability and further construct validity are warranted.