Exercises for hand osteoarthritis: a systematic review of clinical practice guidelines and consensus recommendations

Abstract

Background: Individuals with hand osteoarthritis (OA) often experience hand pain, joint stiffness and reduced grip strength, which affect performance of everyday functional tasks. There is a need to evaluate evidence-based rehabilitation strategies that aim to lessen the burden and improve the quality of life of people living with hand OA.

Objectives: Our objectives were to (1) identify guidelines and consensus recommendations on hand OA management to ascertain whether hand exercises are recommended as part of best practice; (2) identify the type and dosage of exercises recommended regarding frequency, intensity and duration and (3) provide a summary of exercise recommendations for the management of hand OA.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and was registered on Prospero (CRD42018086440). Seven published databases and 20 grey literature sources were searched (January 1997–January2019). Quality assessment was conducted with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument and, using a narrative approach, evidence was synthesized based on the levels of evidence and strength of recommendations.

Results: Eight guidelines and consensus recommendations were identified and included. Evidence from seven guidelines was rated between fair to high quality. Five out of seven guidelines recommended exercises for the management of hand OA. Limited information on exercise dosage (frequency, intensity and duration) was reported. Three strong and two weak recommendations for using different hand exercises were proposed in this systematic review.

Conclusion: Available guidelines and consensus recommendations on hand OA recommend exercises as part of current best practice for hand OA management. There is strong evidence to support the recommendation of strengthening, stretching and joint mobility exercises for the management of the hand OA. These recommended exercises, however, lacked specific details regarding the type and dosage (frequency, intensity and time) for optimal uptake, which therefore need to be established through research.

Keywords:

• Exercises
• guidelines
• hand osteoarthritis
• recommendations

Acknowledgements

The reviewers thank Paula Sands (PS) of the Health Services Library, University of Southampton for her immense support in searching the literature.

Disclosure statement

Reviewers report no conflict of interest.

Funding

The authors received no financial support for the review, authorship or publication of this article. The first reviewer, BS, is however, a Commonwealth Scholar, funded by the UK government to pursue doctoral studies.

Appendix A. CINAHL search strategy.

Appendix B. MEDLINE (Ebsco host) search strategy.

Appendix C. AMED.

Appendix D. Cochrane library.

Appendix E. Web of Science.

Appendix F. PEDro.

Additional information

Funding

The authors received no financial support for the review, authorship or publication of this article. The first reviewer, BS, is however, a Commonwealth Scholar, funded by the UK government to pursue doctoral studies.

Notes on contributors

Beatrice E. A. Sankah

Beatrice E.A. Sankah MSc, BSc. PhD student, School of Health Sciences, University of Southampton, UK (Orcid ID: http://orcid.org/0000-00024934-6091).

Beatrice is a physiotherapist and her PhD research is aimed at developing an exercise programme to improve hand function and quality of life in people with hand osteoarthritis. Her research interest includes the development, implementation and evaluation of interventions to improve function in adults with orthopaedic and musculoskeletal disorders.

Maria Stokes

Maria Stokes PhD, FCSP. Professor of Musculoskeletal Rehabilitation, School of Health Sciences, University of Southampton, UK (Orcid ID: http://orcid.org/0000-0002-4204-0890).

Maria leads the Active Living Research Group in the School of Health Sciences, University of Southampton. She is a physiotherapist by background, with a PhD in neuromuscular physiology. Her research focuses on active living (in adolescents to older people) and healthy ageing, spanning the activity spectrum from elite sport to frailty, including deconditioning in astronauts. Her research involves understanding physiological and biomechanical mechanisms of musculoskeletal dysfunction to inform targeted neuromuscular exercise programmes to protect joints from injury and osteoarthritis.

Jo Adams

Jo Adams PhD, MSc. DipCOT. Professor of Musculoskeletal Health, School of Health Sciences, University of Southampton, UK (Orcid ID: https://orcid.org/0000-0003-1765-7060).

Jo's research interests focus on optimising self-management strategies for people living with musculoskeletal disorders. All of Jo's research is linked to engaging patient and public partners in helping identify research questions that matter most to them. Jo's research programmes benefit from interdisciplinary collaboration and has integrated both quantitative and qualitative approaches across health and social care.