OP0273-HPR NON-INFERIOR OUTCOMES IN OCCUPATIONAL-LED COMPARED TO RHEUMATOLOGIST-LED CARE FOR HAND OSTEOARTHRITIS: EVIDENCE FROM A NON-INFERIORITY RANDOMIZED CONTROLLED TRIAL
Authors: U. Olsen, I. Kjeken, K. Bergsmark, B. Christensen, I. Haugen, T. Hennig, M. Hermann-Eriksen, Å. Hove, A. Prøven, T. A. Sjøvold, A. T. Tveter, A. Polster
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Hand osteoarthritis (OA) is a prevalent disease, severely affecting hand function and quality of life. Traditional management often involves rheumatologist-led care, but task allocation to occupational therapists (OTs) is suggested to ensure sustainable healthcare services in the future. However, a research gap exists in determining whether a shift from a rheumatologist-led to an OT-led care model is non-inferior regarding patient outcomes and satisfaction. <h3>Objectives:</h3> Evaluate if clinical outcomes and satisfaction in OT-led care are non-inferior to the outcomes in rheumatologist-led care for patients with hand OA. <h3>Methods:</h3> This is a secondary analysis of results from a randomized controlled non-inferiority multi-center trial, comparing an OT-led care model to a rheumatologist-led care model in patients with hand OA. Following international recommendations, both groups underwent a clinical examination and received standard information. This included details on pharmacological treatment and referrals to other relevant procedures or professions. Additionally, depending on patients' symptoms and reported issues, rheumatologist-led care included intra-articular injections of glucocorticoids, whereas OT-led care included information on ergonomic working methods and use of assistive devices, instruction in hand exercises, and provision of thumb orthoses. Outcomes included hand stiffness, pain in activity, painful finger joints, activity performance, grip strength and satisfaction with care, collected at baseline and 6 months. Mean differences with 95% confidence intervals were used to evaluate differences between the two groups for baseline variables and outcomes after 6 months. <h3>Results:</h3> Out of 570 screened patients, 397 were randomized, with 193 analysed in the OT-led group and 186 in the rheumatologist-led group at six months. The participants, primarily female (81%) with a mean age of 64 years, were comparable in terms of demographic and clinical characteristics at baseline. Both groups exhibited a marginal trend of improvement in all outcomes. Analyses indicated that the OT-led group`s outcomes were non-inferior to those of the rheumatologist-led group in all measured outcomes, with a trend towards slightly better outcomes in the OT-led group (Figure 1). <h3>Conclusion:</h3> Our results demonstrate that OT-led care for hand osteoarthritis is non-inferior to rheumatologist-led care in improving clinical outcomes and patient satisfaction. These findings underscore that a care model provided by OTs might be a viable alternative for hand OA management, suggesting its potential to ease healthcare burdens and enhance patient care accessibility. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>