Strategies for Patients With Osteoarthritis, by Using Assistive Technology and Exercises.
Condition: Osteoarthritis Hand
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      Introduction: Osteoarthritis is a disabling disease that can affect 6% to 12% of the adult
      population and more than a third of people over 65 years of age. Considering osteoarthritis
      of hands, existing research about the therapeutic treatment advocates actions such as (1)
      joint protection, (2) assistive technology and (3) exercises, however, doubts persist as to
      their effects. Objective: To verify the functional and analgesic effect of joint protection
      and energy conservation techniques, assistive technology (orthotics and adaptations) and
      exercises in the treatment of patients with osteoarthritis of the hands. Method: An
      epidemiological study in which a total sample of patients with knee osteoarthritis will
      receive joint protection and energy conservation guidelines. Subsequently, the sample will be
      divided into two groups, group 1 with radiological signs that suggest osteoarthritis of the
      hands and 2 with patients with radiological signs and symptoms of osteoarthritis of the
      hands, who present greater functional limitations in the daily life, being eligible for
      treatment of Rehabilitation, in which will be used orthosis aiming at the relief of pain,
      stabilization of the affected joints and the prevention of grievance of deformities and
      orientations of exercises to maintain muscle strength. Participants will be followed up for
      two years, evaluated with the Disabilities of the Arm, Shoulder and Hand questionnaire
      (DASH), Stanford Health Assessment Questionnaire (HAQ), palmar grip strength measured with
      Jamar dynamometer, key pinch strength, three point pinch strength and pulp pinch strength
      measured with B & L Pinch-gauge dynamometer. The groups will be divided between 1 and 2, the
      group 1 will be composed of patients who will only perform the orientations informed in the
      theoretical and practical classes, while the group 2, besides the orientations will receive
      orthoses with models such as volar hand rest splints, short thumb stabilization splints, and
      volar finger splints with nocturnal support, aiming at the relief of the pain, stabilization
      of the affected joints and the prevention of the appearance / aggravation of deformities.
      Exercise guidelines for maintenance of muscle strength for thumb and fingers will be
      performed on patients who present significant improvement of pain.
    

Detailed description: 
      Participants

      Were included 200 patients in the group of Bone Metabolic Diseases of the Institute of
      Orthopedics and Traumatology of the Faculty of Medicine of the University of São Paulo
      (FMUSP). Were included patients aged between 40 and 80 years, with involvement of
      osteoarthritis (OA) in the knees and of these, a sample of patients with involvement of the
      first carpometacarpal, metacarpophalangeal or interphalangeal joint of the thumb and the
      proximal or distal interphalangeal joint of fingers with from I to III degrees of
      classification of Kelgreen and Lawrence (KL).

      For the calculation of the sample size, a pilot test was performed with 15 subjects and
      assumed: alpha of 5%, beta of 20% (power = 80%) and difference between the groups of 10%
      referring to the scores at each scale . With these data, a minimum of 200 individuals was
      calculated.

      Intervention

      Participants are patients in an OA treatment program in the Bone Metabolic Diseases group of
      the Orthopedics and Traumatology Institute of the Faculty of Medicine of the University of
      São Paulo (FMUSP).

      These patients were evaluated for their ability to perform functional activities and
      anthropometric parameters of upper limbs. The Disability of the Arm, Shoulder and Hand
      (DASH), the Stanford Health Assessment Questionnaire (HAQ), questionnaires were applied, as
      well as grip strength measured with Jamar® dynamometer, key pinch, three point pinch, and a
      pulp pinch measured with B & L Pinch-gauge® dynamometer.

      The force was established after arithmetic average of 3 trials. The tests were performed
      bilaterally. The presence of deformities has also been reported.

      The total sample was divided into two groups. Both received guidelines on joint protection
      and energy conservation, including theoretical and practical classes aimed at protecting all
      joints that may be affected by OA.

      Theoretical classes were carried out through slide presentation with concepts of joint
      protection, conservation of energy, organization of time, organization of the home and work
      environment and organization of daily routine. Printed information material was also
      provided.

      The practical classes were carried out in a simulated house, mounted in two rooms of
      infirmary, suggesting all the environments of a conventional house. Adaptations made by
      therapists and commercials and conventional objects used in daily living activities were used
      for the guidelines described above.

      The groups were divided between 1 and 2, which was group 1 with patients who presented
      osteoarthritis in the knees, without specific complaints of hand, but with radiographic
      findings and group 2 was characterized by patients with radiographic signs and symptoms of
      hands that presented larger functional limitations in the daily routine or that were eligible
      for rehabilitation treatment using orthosis models such as resting hand volar splints, thumb
      stabilization splints or finger volar splints with nocturnal support, aiming at the relief of
      the pain, stabilization of the affected joints and the prevention of the
      appearance/aggravation of deformities. Exercise guidelines for maintenance of muscle strength
      for thumb and fingers were performed in patients who presented significant improvement of
      pain.

      Patients returned for reevaluation at 12 and 24 months after the initial evaluation.

      Study Design

      Prospective, analytical, experimental, case control study with mixed data collection
      (prospective and retrospective).

      Statistical Analysis

      The following variables were considered as dependent variables: HAQ, DASH (general questions,
      symptons and functions in athletes, performing artists and workers) and dynamometry (manual
      grip, key pinch, three point pinch and pulp pinch strenght) for the right and left hands. The
      dependent variables were submitted to ANOVA with factor 2 (Intervention: ortesis, exercises
      and orientation; orientation) by 8 (group of orientation: 8 different groups of orientation)
      by 3 (Moment of evaluation: 1- first evaluation [initial], 2- second evaluation [after 1
      year], 3- third evaluation [after 2 years]) with repeated measures in the last factor. In
      order to compare the pain scores in the evaluation moments, the Friedman test was used for
      the three questions of the DASH's pain module, in a separated moment. Post-hoc comparisons
      were carried out using Tukey-HSD test (p<0.05).
    

Intervention name(s): Orthosis Exercises Orientation; Orientation
Intervention type(s): Device; Behavioral
Intervention description(s): Use of orthosis, exercises and orientation for home.; Orientation for home.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: osteoarthritis; hand deformities; hand strength; assistive technology; exercise; health education