In the July issue of BMC Musculoskeletal Disorders http://www.ncbi.nlm.nih.gov/pubmed/21745357 Dr. Dziedzic and his group from Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom discuss their plan to assess self management, joint protection and exercises in hand osteoarthritis: a randomized controlled trial with cost effectiveness analyses.
The main analysis will be on an intention to treat basis and will assess the clinical and cost effectiveness of joint protection and hand exercises for managing hand osteoarthritis (OA). The findings will improve the cost–effective evidence based management of hand OA.
Methods
Participants aged 50 years and over registered at three general practices in North Staffordshire and Cheshire will be mailed a health survey questionnaire (estimated mailing sample n=9,500). Those fulfilling the eligibility criteria on the health survey questionnaire will be invited to attend a clinical assessment to assess for the presence of hand or thumb base OA using the ACR criteria. Eligible participants will be randomised to one of four groups: leaflet and advice; joint protection (looking after your joints); hand exercises; or joint protection and hand exercises combined (estimated n=252). Results The primary outcome measure will be the OARSI/OMERACT responder criteria combining hand pain and disability (measured using the AUSCAN) and global improvement, 6 months post–randomisation. Secondary outcomes will also be collected for example pain, functional limitation and quality of life. Outcomes will be collected at baseline and 3, 6 and 12 months post–randomisation. The main analysis will be on an intention to treat basis and will assess the clinical and cost effectiveness of joint protection and hand exercises for managing hand OA.
The HandTutor is an motion capture glove which together with dedicated rehabilitation software motivates patients to do intensive finger(s) and wrist exercises. It is important that patients suffering form joint degenerative diseases continue to do active exercises in order to reduce the rate of movement and musculoskeletal degeneration. The ArmTutor which allows for customized shoulder and elbow exercises and the LegTutor that allows for customized knee and hip exercises have also been proven to reduce the rate of joint movement degeneration in OA.
The HandTutor, ArmTutor, LegTutor and 3DTutor are used in many clinics in the USA and worldwide with patients are also using these devices in private outpatient clinics and the home environment. Home bound patients can use tele rehabilitation that is supported by physical and occupational therapists.
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