RT Journal Article
SR Electronic
T1 OP0160 HPR DOES OCCUPATIONAL THERAPY DELAY OR REDUCE THE PROPORTION OF PATIENTS WHO RECEIVES THUMB CARPOMETACARPAL SURGERY? A RANDOMIZED CONTROLLED TRIAL
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 155
OP 155
DO 10.1136/annrheumdis-2019-eular.986
VO 78
IS Suppl 2
A1 Else Marit H. Gravås
A1 Nina Østerås
A1 Randi Nossum
A1 Ruth Else Mehl Eide
A1 Åse Klokkeide
A1 Karin Hoegh Matre
A1 Monika Olsen
A1 Øyvor Andreassen
A1 Ida Kristin Haugen
A1 Anne Therese Tveter
A1 Ingvild Kjeken
YR 2019
UL http://ard.bmj.com/content/78/Suppl_2/155.1.abstract
AB 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 surgeryConclusion 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. Gravås: None declared, Nina Østerås: None declared, Randi Nossum: None declared, Ruth Else Mehl Eide: None declared, Åse Klokkeide: None declared, Karin Hoegh Matre: None declared, Monika Olsen: None declared, Øyvor 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