Full Length ArticleIncorporation of occupational based intervention into joint protection education for individuals with thumb carpometacarpal osteoarthritis: A case series
Introduction
The integration of occupation-based interventions (OBI) into the outpatient therapy treatment of orthopedic hand and upper limb disorders is slowly emerging in both the literature and clinic-based setting.1, 2, 3, 4 This paradigm shift may in part be due to the renewed emphasis on activity and participation and health (function) versus disability found in the updated framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF).5 While the usefulness of OBI is gaining a bit of traction in the clinical setting as an intervention,1,4 there is not a clear understanding of the role of performing OBI inside the clinic as a component of home program instruction and patient education.
By and large, in hand therapy practice, the importance of routine home program instruction is well identified 6, 7, 8 and there are studies evaluating methods to improve carry over, outcomes, patient engagement and satisfaction.9, 10, 11 Research has suggested that impactful treatment of hand therapy diagnoses such as osteoarthritis (OA) at the carpometacarpal (CMC) joint of the thumb can occur in an average of less than 2 skilled therapy sessions.12 A large component of patient education for individuals who have symptomatic thumb CMC OA is to avoid the key pinch which promotes a stressful load to the thumb CMC joint and instead encourage the use of the stable “c” posture in which the dorsal ligaments of the joint become taut and thereby more supportive and the joint is in a closed packed/more stable position.12, 13, 14, 15 Hand therapists are tasked with educating patients with thumb CMC joint OA on the importance of using healthy thumb postures during their occupational task performance.12 The importance of patient education and instruction cannot be understated when discussing joint posture and joint protection. Understanding and acknowledging the value of OBI to outcomes is likewise an important factor. This case series was designed to investigate if OBI instruction inside the clinic was useful as an educational tool for individuals with thumb CMC joint arthritis.
Section snippets
Purpose
The purpose of this case series is to 1) investigate the perceived experience of patients attending outpatient hand therapy for symptomatic thumb CMC joint OA when they engaged in OBI to practice joint protection techniques and 2) examine impact on pain and self-reported functional status when OBI is included with common non-surgical thumb CMC joint OA interventions.
Study design and participants
This study is a small case series with IRB permission sought and garnered prior to initiation. A convenience sample of 3 patients were recruited from 2 outpatient orthopedic hand therapy clinics. It is identified that case series have relatively low numbers of participants and the specific number of patients, the temporal direction of follow-up or even the definition by case/exposure are not differentiating characteristics of case report/series.16 Although a case series is identified as a lower
Results
Three patients with thumb CMC joint OA were included in this study: 2 female and 1male. The mean age was 69.33 years old (range 66-71) and all patients were right hand dominant with the involved side being varied; 1right, one left and 1bilateral. Refer to Table 1 for baseline characteristics. The patients attended an average of 3.3 visits (SD 1.5) and averaged 46.0 minutes each session (SD 4.4).
Discussion
The purpose of this study was to understand if OBI's are useful as an in-person educational method for individuals with a diagnosis of thumb CMC joint OA. All participants in this study were educated on joint protection techniques for their thumb CMC OA diagnosis with the incorporation of performance of occupations inside the clinic during skilled hand therapy. All participants reported satisfaction with the inclusion of OBI in their treatment and experienced a decrease in pain and an
Limitations
The small sample size is a limitation of this study along with the fact that the data collection occurred at only 2clinics using a convenience sample, thus decreasing the generalizability of the results. The satisfaction questionnaire was a 3 question self-designed measure, therefore is not a validated tool and may not capture all areas related to patient satisfaction. A case series is unable to provide information on relationships or causation in outcomes. In addition, the hand therapists
Conclusion
Although no causal relationships can be assumed in this case series, performance of occupational based activities in the clinic during patient education for thumb CMC OA joint protection techniques was found to be satisfying to the participants in this study. All participants had an improvement in pain and function according to the TDX when OBI was incorporated into home exercise education. Hand therapists should consider adding OBI performance as a component of patient education on joint
Quiz: # 876
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.
The study design was
- a.
RCTs
- b.
case study
- c.
retrospective cohort
- d.
case series
- a.
- # 2.
Pain improved by approximately
- a.
35%
- b.
10%
- c.
17%
- d.
20%
- a.
- # 3.
Patient satisfaction was determined by use of
- a.
a 3-question satisfaction survey
- b.
the QuickDash
- c.
patient interviews
- d.
therapist interviews
- a.
- # 4.
Functional status was determined by the
- a.
DASH
- a.
References (41)
- et al.
A systematic review of the benefits of occupation-based intervention for patients with upper extremity musculoskeletal disorders
J Hand Ther
(2019) - et al.
Comparison of therapeutic activities with therapeutic exercises in the rehabilitation of young adult patients with hand injuries
J Hand Surg
(2007) - et al.
The relationship between adherence to hand therapy and short-term outcome after distal radius fracture
J Hand Ther
(2005) - et al.
Client preferences and perceptions regarding a written home exercise program or video self-modeling: a cross-sectional study
J Hand Ther
(2020) - et al.
Use of mobile applications in hand therapy
J Hand Ther
(2020) - et al.
Thumb carpometacarpal osteoarthritis: a musculoskeletal physiotherapy perspective
J Bodyw Mov Ther
(2019) - et al.
Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review
J Pain Symptom Manage
(2011) - et al.
Minimally clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale
Eur J Pain
(2004) - et al.
A systematic review of conservative interventions for osteoarthritis of the hand
J Hand Ther
(2010) - et al.
An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale- a randomized controlled trial
J Hand Ther
(2020)
The use of occupation-based assessments and intervention in the hand therapy setting- a survey
J Hand Ther
Becoming occupation-based: a case study
Occup Ther Health Care
The 2019 practice analysis of hand therapy and the use of orthoses by certified hand therapists [e-pub ahead of print April 14, 2021]
J Hand Ther
International Classification of Functioning, Disability and Health: ICF
Therapist-supervised hand therapy versus home therapy with therapist instruction following distal radius fracture
J Hand Surg Am
The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review
Br Med Bull
Effect of smartphone application-supported self-rehabilitation for frozen shoulder: a prospective randomized control study
Clin Rehabil
Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: a retrospective study
J Hand Ther
The effect of an exercise program in patients with thumb base osteoarthritis: a prospective cohort study with propensity score matching [Unpublished Master's Thesis]
The Anatomical Basis of Clinical Practice
Cited by (1)
The biomechanics of osteoarthritis in the hand: Implications and prospects for hand therapy
2022, Journal of Hand TherapyCitation Excerpt :In many studies, the JP program is integrated with hand flexibility and strength exercises, so the effect of JP alone is difficult to evaluate. In general studies of JP interventions and programs have been limited with most reporting low-to-moderate quality evidence related to pain and function with few evaluating biomechanical outcomes.75–78 A few key biomechanical principles utilized by most JPP are worth noting.
Conflicts of interest: The authors have no conflicts of interest related to this manuscript.