No evidence for the effectiveness of a multidisciplinary group based treatment program in patients with osteoarthritis of hands on the short term; results of a randomized controlled trial.

Objective: To examine the efficacy of a multidisciplinary non-pharmacological intervention in patients with hand osteoarthritis (OA).
Method: Parallel group randomized controlled trial was performed in three participating rheumatology outpatient clinics in the Netherlands. Block randomization was performed using a computer generated permuted block scheme (blocks of four). An independent person randomly assigned 151 participants with clinical hand OA to four sessions of multidisciplinary non-pharmacological treatment, or 30 min education followed by 3 months waiting time. Participants and therapists were not blinded to the assigned intervention. The research assistant who assessed all outcomes was blinded to the assigned intervention. Subscale limitations in activities of the Australian Canadian Osteoarthritis Hand Index (AUSCAN) and OARSI responder criteria (primary outcomes) and secondary outcome measures, were assessed at baseline and 12 weeks. Linear or logistic regression analyses were used, where appropriate, with the outcome as dependent and the intervention group as independent variable. The analyses were adjusted for baseline values.
Results: At 3 months no significant and no relevant differences were observed between the experimental (n = 76) and control group (n = 75) in any of the primary or secondary outcome measures. In both groups about one-third of patients were classified as responder.
Conclusion: There is insufficient evidence to confirm a clinically relevant treatment effect on the short term, between patients who followed a multidisciplinary treatment program and those who received only written information. Since hand OA causes a range of impairments and limitations in activities, programs with more guidance to formulate and implement individually tailored treatment plans could be probably more effective. Furthermore, more research is needed on the efficacy of single treatment elements. (Dutch Trial Register trial number NTR1191).
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