Task Shifting in the Care for Patients With Hand Osteoarthritis
- Conditions
- Osteoarthritis Both Hands
- Registration Number
- NCT03102788
- Lead Sponsor
- National Resource Center for Rehabilitation in Rheumatology
- 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 400
- Hand osteoarthritis diagnosed by physician in primary care, referred for consultation in specialist health care, and ability to communicate in Norwegian.
- Exclusion criteria were cognitive or mental impairment, possible inflammatory rheumatic disease (SR>40 or CRP>20, or patient confirming having psoriasis during telephone screening).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Number of treatment responders One year Number of treatment responders will be calculated as number of OMERACT/OARSI-responders. This is a composite index that presents the results of changes after treatment in the three domains of pain, function and patient's global assessment as a single variable (responder yes/no).
- Secondary Outcome Measures
Name Time Method Hand stiffness measured on a numeric rating scale One year Hand stiffness will be measured on a numeric rating scale
Disease activity measured on a numeric rating scale One year Disease activity will be measured on a numeric rating scale
Health related quality of life measured by EQ5D One year Health related quality of life will be measured by EQ5D
Grip strength measured by JAMAR dynamometer One year Grip strength will be measured by JAMAR dynamometer
Number of painful finger joints One year Joint count of number of painful finger joints at each hand
Hand pain measured on a numeric rating scale One year Hand pain will be measured on a numeric rating scale
Physical function measured by the Functional Index for Hand OsteoArthritis One year Physical function will be measured by the Functional Index for Hand OsteoArthritis
Activity performance measured by the Measure of Activity Performance of the Hand One year Activity performance will be measured by the Measure of Activity Performance of the Hand
Satisfaction with care measured by PASS-Opp One year Satisfaction with care will be measured by PASS-Opp
Trial Locations
- Locations (3)
Diakonhjemmet Hospital
🇳🇴Oslo, Norway
National resource center for rehabilitation in rheumatology
🇳🇴Oslo, Norway
Martina Hansens Hospital
🇳🇴Sandvika, Norway
Diakonhjemmet Hospital🇳🇴Oslo, Norway