Occupational-Based Activities in Patient Education Useful for Those With Thumb OA

Individuals with thumb carpometacarpal (CMC) joint osteoarthritis (OA) have reported satisfaction with the incorporation of an occupational-based intervention (OBI) as part of patient education on joint protection techniques, according to findings from a case series published in Journal of Hand Therapy.

The aims of the study included to investigate the perceived experience of patients who attended outpatient hand therapy for symptomatic thumb CMC joint OA when they engaged in OBIs to practice joint protection techniques, and to examine the impact on self-reported functional status and pain when OBI was included along with common nonsurgical thumb CMC joint OA interventions.

A convenience sample of 3 patients (3 women) were enrolled in the study from 2 outpatient orthopedic hand therapy clinics. The mean participant age was 69.33 years (range, 66.0-71.0 years). Treatment and collection of data took place between August 2021 and November 2021. Inclusion criteria were diagnosis of thumb CMC joint OA confirmed clinically or radiographically by a hand surgeon; referral to skilled therapy for evaluation; and age 18 years and older.

Participants’ initial evaluation addressed the common areas related to body structure and functions, including grip and pinch strength, range of motion, pain, and sensation. The occupation-based portion of the evaluation was captured via an interview process – activity and participation limitations, along with environmental factors – that permitted a better understanding of any personal barriers. Occupational performance was assessed using a patient-reported outcomes – Thumb Disability Examination (TDX). Pain was evaluated by pain intensity during activity, based on the Numerical Pain Rating Scale (NPRS).

All participants received verbal education on joint protection techniques with an emphasis on the following: avoiding the use of a lateral pinch when able; using a stable “c” pinch when pinching posture is necessary; using larger joints as opposed to loading smaller joints; and using 2 hands instead of 1 whenever possible. Participants were provided with written instructions on the use of these joint techniques for household management tasks, all of which were discussed between the patient and the hand therapist before the supervised performance of the functional tasks in the clinic.

Participants were asked to complete 4 functional tasks, including washing, rinsing, and drying dishes; maneuvering a laundry basket; lifting and moving pots and pans; and pouring water from a pitcher, while receiving skilled treatment in the clinic. A treating therapist demonstrated the 4 tasks for the participant using good joint protection techniques, then had the participants perform the tasks with verbal and tactile cuing, as needed, until they were able to perform the tasks independently with good joint protection.

A 3-item questionnaire of patient satisfaction was developed to better understand the participant experience of the combined activity performance with the simultaneous verbal instruction. Two of the questions examined level of agreement with certain statements and the third question was open-ended in nature. The TDX, which determines functional performance included 20 questions that were divided into 3 sections, which were based on different domains specifically related to the thumb and daily activities.

Results of the study showed that patients expressed satisfaction with the inclusion of the performance of occupations in their joint protection education in the clinic. All participants selected “strongly agree” to questions 1 and 2 on the satisfaction survey. On the NPRS, pain with activity was 5.7 per 10, on average, at baseline, which decreased by an average of 1.7 per 10 at the 4-week follow-up. The TDX score improved for all participants from baseline to 4-week follow-up, with an average decrease in TDX score of 10.04 (range, 7.50-13.86).

A key limitation of the current study was its small sample size, as well as the fact that data collection occurred at only 2 clinics via use of a convenience sample, thus decreasing the generalizability of the results. Because the satisfaction questionnaire was a 3-question self-designed measure, it may not be a validated tool and may not have captured all of the areas associated with patient satisfaction.

According to the researchers, “Hand therapists should consider adding [OBI] performance as a component of patient education on joint protection for individuals with thumb CMC joint [OA].”

Reference

Naughton N, Algar L.Incorporation of occupational based intervention into joint protection education for individuals with thumb carpometacarpal osteoarthritis: a case series. J Hand Ther. Published online August 28, 2022. doi:10.1016/j.jht.2022.07.011