Feasibility of a Cross-sectorial Management Program in Hand Osteoarthritis

Background Osteoarthritis (OA) occurs after the age of 40 and increases with age causing pain and stiffness mostly in knees, hands, and hips. Globally nearly 600 million people are affected and it is estimated to increase to 642 million in 2050 due to growth and ageing populations. Hand OA is the second most common OA subtype, and clinically hand OA can be seen with three clinically patterns, First were the distal and proximal interphalangeal joints are affected, secondly including the thumb base, or thirdly in a combination of the two before mentioned.

People with hand OA reports difficulties in relation to performance of Activities of Daily Living (ADL). More specifically, they report using extra time and/or effort and occasionally also need of help to manage daily life. ADL task performance problems may be in relation to personal ADL (PADL) tasks carried out every day such as bathing, dressing, and eating or instrumental ADL (IADL) tasks carried out on a weekly basis such as cleaning, cooking, and shopping. When people with hand OA are observed using standardized ADL assessment tool, the overall ADL motor ability also indicates clumsiness and use of extra effort for the population. When comparing the mean of ADL motor ability with other age-related healthy adults, people with hand OA have a lower ADL motor ability.

In 2020 OA was the top-ten leading cause of disability for older adults (>70 years). The increasing OA population presenting with decreased ADL ability will lead to a greater burden on the health care system. According to the 2018 EULAR recommendations, people with hand OA should be offered multidisciplinary and multimodal treatment approaches. In relation to non-pharmacological treatment education, training, home modifications, assistive devices, and splints to reduce symptoms and improve overall functioning and quality of life are recommended. Several of these treatment modalities may be employed by occupational therapists to improve ADL ability including education, home modifications, assistive devices, and splinting. Still, when exploring current practice of referring people with disabilities due to hand OA for occupational therapy among Danish general practitioners, only one were referred. Moreover, a literature review indicated a lack of an evidence-based occupational therapy program addressing decreased ADL ability among people with hand OA. Previous interventions studies involving people with hand OA have often focused on improving body functions (e.g. muscle strength) through exercises. This approach is based on the assumption that improved body function will lead to increased ability to perform ADL. Research, however, indicates that improved body function not necessarily translate into improved ADL ability. Rather, existing research support, that interventions focusing on ADL also has an effect on improvement of ADL ability for people with chronic condition.

To support the referral of people with hand OA to evidence-based occupational therapy addressing decreased ADL ability, a cross-sectorial management program for people with hand OA, named HANDY, was developed. The HANDY program includes procedures for needs evaluation and referral, and a group-based occupational therapy program. The development was based on the United Kingdom's Medical Research Councils recommendations. A core element is involvement of stakeholders. Therefore, the research group has worked closely with GPs, OTs, people with hand OA and specialist within rheumatology. Through a co-productional process the HANDY program was developed based on theories, research evidence, current best practice and the preferences of people with hand OA. The aim of this study is to evaluate the feasibility of the HANDY program.

Methods Aims The overall aim is to investigate the feasibility of the cross-sectorial management program, HANDY, for people with hand OA (v. 1.0) in terms of content and delivery of needs evaluation, referral procedures, the occupational therapy intervention, and the cross-sectorial collaboration.