Task Shifting in the Care for Patients With Hand Osteoarthritis
Condition: Osteoarthritis Both Hands
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      The main aim in this randomized controlled trial is to improve access to safe and effective
      care, professional practice and cost-effective utilisation of health care resources by
      testing if occupational therapist-led care is as effective and safe as rheumatologist-led
      care for people with hand osteoarthritis.
    

Detailed description: 
      Hand osteoarthritis is one of the most prevalent musculoskeletal conditions in an adult
      population, and may have large influences on an individual's function, health related quality
      of life, and participation in the society. In the absence of disease-modifying interventions,
      occupational therapy, comprising information, hand exercises, assistive devices and
      orthoses/splints, is considered as core treatment. In Norway, people with hand osteoarthritis
      are increasingly referred to consultation by a rheumatologist in specialist health care. At
      the same time a shortage of rheumatologists nationwide is stressing the healthcare system's
      capacity, and rheumatologists time should therefore primarily be allocated to patients in
      which early diagnosis and medical treatment are essential.

      The World Health Organization recommend task-shifting as one method of strengthening and
      expanding the health workforce. Such models rely on other healthcare providers in expanded
      clinical roles, where physiotherapists, nurses or occupational therapists working in
      collaboration with physicians and other team members have their own patients for whom they
      provide health care services.

      In this randomized controlled 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 specialist, is as safe and effective as the traditional model, where they receive
      their first consultation by a rheumatologist.
    

Intervention name(s): Rheumatologist-led care.; Occupational therapist-led care.
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Rheumatologist-led care comprises confirmation of diagnosis, information about hand osteoarthritis and symptom modifying medication, and, for some patients, Intra-articular injection of long-acting Corticosteroid.
The rheumatologist may also refer participants to occupational therapy if needed.; Occupational therapist-led care comprises confirmation of diagnosis, information about hand osteoarthritis and symptom modifying medication, teaching of hand exercises and ergonomic working methods, and, for some patients, provision assistive devices and orthoses/splints. The occupational therapist will refer patients to a short rheumatologist consultation if confirmation of diagnosis or intra-articular injections of long-acting Corticosteroid are needed.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: In this randomized controlled trial, participants will be allocated to receive their first consultation in specialist health care by either an occupational therapy specialist or a rheumatologist. The occupational therapist may thereafter refer the patient to a consultation with a rheumatologist if necessary, and vice versa.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research