Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis

Abstract

Aims: The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. Methods: An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. Results: The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. Conclusions: A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

Key words::

• evidence-based practice
• functional assessment
• rheumatology
• occupational therapy

Acknowledgements

The author would like to thank all the occupational therapists in the rheumatology network who participated in the process of developing and validating the recommendations, and especially the occupational therapists who arranged the meetings in 2009 and 2010; Siri Darre, Randi Nossum, Merethe Hermann and Solvår Lillemo. The author also gives great thanks to Ida Dørstad for data entry and assistance, to Hilde Iren Flaatten for library assistance, and to Solvår Lillemo and Rikke Moe, who helped review the literature.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.