Clinical trial NCT03102788: Task Shifting in the Care for Patients With Hand Osteoarthritis
Official title: Task Shifting in the Care for Patients With Hand Osteoarthritis: May the First Consultation in Specialist Health Care be Performed by an Occupational Therapy Specialist?
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Osteoarthritis Both Hands
Lead sponsor: National Resource Center for Rehabilitation in Rheumatology
Sponsor class: OTHER
Collaborators: name: Diakonhjemmet Hospital
name: Martina Hansen Hospital
First posted: 2017-04-06
Enrollment: 400
Sex: ALL
Minimum age (years): 18
Maximum age (years): 100
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
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.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Hand osteoarthritis diagnosed by physician in primary care, referred for consultation in specialist health care, and ability to communicate in Norwegian.

Exclusion Criteria:

* Exclusion criteria were cognitive or mental impairment, possible inflammatory rheumatic disease (SR\>40 or CRP\>20, or patient confirming having psoriasis during telephone screening).

Primary outcomes:
measure: Number of treatment responders
timeFrame: One year
Secondary outcomes:
measure: Number of painful finger joints
timeFrame: One year
measure: Hand pain measured on a numeric rating scale
timeFrame: One year
measure: Hand stiffness measured on a numeric rating scale
timeFrame: One year
measure: Disease activity measured on a numeric rating scale
timeFrame: One year
measure: Physical function measured by the Functional Index for Hand OsteoArthritis
timeFrame: One year
measure: Activity performance measured by the Measure of Activity Performance of the Hand
timeFrame: One year
measure: Grip strength measured by JAMAR dynamometer
timeFrame: One year
measure: Health related quality of life measured by EQ5D
timeFrame: One year
measure: Satisfaction with care measured by PASS-Opp
timeFrame: One year
Other outcomes:
Locations:
city: Oslo
country: Norway
facility: Diakonhjemmet Hospital
city: Oslo
country: Norway
facility: National resource center for rehabilitation in rheumatology
city: Sandvika
country: Norway
facility: Martina Hansens Hospital
Study officials:
affiliation: Research director, Diakohjemmet Hospital
name: Tore K Kvien, PhD
role: STUDY_DIRECTOR
References:
citation: Kjeken I, Bergsmark K, Haugen IK, Hennig T, Hermann-Eriksen M, Hornburg VT, Hove A, Proven A, Sjovold TA, Slatkowsky-Christensen B. Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial. BMC Musculoskelet Disord. 2021 Feb 16;22(1):194. doi: 10.1186/s12891-021-04019-9.