Task Shifting in the Care for Patients With Hand Osteoarthritis: May the First Consultation in Specialist Health Care be Performed by an Occupational Therapy Specialist?
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Osteoarthritis Both Hands
- Sponsor
- National Resource Center for Rehabilitation in Rheumatology
- Enrollment
- 400
- Locations
- 3
- Primary Endpoint
- Number of treatment responders
- Status
- Completed
- Last Updated
- last year
Overview
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.
Investigators
Ingvild Kjeken
Professor
National Resource Center for Rehabilitation in Rheumatology
Eligibility Criteria
Inclusion Criteria
- •Hand osteoarthritis diagnosed by physician in primary care, referred for consultation in specialist health care, and ability to communicate in Norwegian.
Exclusion Criteria
- •Exclusion criteria were cognitive or mental impairment, possible inflammatory rheumatic disease (SR\>40 or CRP\>20, or patient confirming having psoriasis during telephone screening).
Outcomes
Primary Outcomes
Number of treatment responders
Time Frame: 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 Outcomes
- Hand stiffness measured on a numeric rating scale(One year)
- Disease activity measured on a numeric rating scale(One year)
- Health related quality of life measured by EQ5D(One year)
- Grip strength measured by JAMAR dynamometer(One year)
- Number of painful finger joints(One year)
- Hand pain measured on a numeric rating scale(One year)
- Physical function measured by the Functional Index for Hand OsteoArthritis(One year)
- Activity performance measured by the Measure of Activity Performance of the Hand(One year)
- Satisfaction with care measured by PASS-Opp(One year)