Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
Arthritis Res Ther. 2018 Nov 9;20(1):253. doi: 10.1186/s13075-018-1747-0.
Evidence for non-pharmacological interventions in hand osteoarthritis is promising but still scarce. Combined interventions are most likely to best cover the clinical needs of patients with hand osteoarthritis (OA). The aim of this study was to evaluate the effect of a combined, interdisciplinary intervention feasible in both primary and specialist care compared to routine care plus placebo in patients with hand OA.
This was a randomised, controlled 2-month trial with a blinded assessor. In the combined-intervention group, rheumatology-trained health professionals from different disciplines delivered a one-session individual intervention with detailed information on functioning, activities of daily living, physical activity, nutrition, assistive devices, instructions on pain management and exercises. Telephone follow up was performed after 4 weeks. The primary outcome was grip strength after 8 weeks. Secondary outcomes were self-reported pain, satisfaction with treatment, health status, two of the Jebsen-Taylor Hand Function subtests and the total score of the Australian/Canadian Hand Osteoarthritis Index (AUSCAN). Statistical significance was calculated by Student's t test or the Mann-Whitney U test depending on data distribution. Binominal logistic regression models were fitted, with the primary outcome being the dependent and the group allocation being the independent variable.
There were 151 participating patients (74 in the combined-intervention and 77 in the routine-care-plus-placebo group) with 2-month follow-up attendance of 84% (n = 128). Grip strength significantly increased in the combined-intervention group and decreased in the routine-care group (dominant hand, mean 0.03 bar (SD 0.11) versus - 0.03 (SD 0.13), p value = 0.001, baseline corrected values) after 8 weeks.
The combined one-session individual intervention significantly improved grip strength and self-reported satisfaction with treatment in patients with hand OA. It can be delivered by different rheumatology-trained health professionals and is thus also feasible in primary care.
ISRCTN registry, ISRCTN62513257 . Registered on 17 May 2012.
非药物干预对手部骨关节炎的疗效证据令人鼓舞，但仍然有限。联合干预最有可能满足手部骨关节炎（OA）患者的临床需求。本研究旨在评估一种可行的联合、跨学科干预措施在初级保健和专科护理中的效果，与手部 OA 患者的常规护理加安慰剂相比。
这是一项随机对照 2 个月试验，采用盲法评估。在联合干预组中，来自不同学科的接受过风湿病培训的卫生专业人员提供了一次单独的干预，详细介绍了功能、日常生活活动、体育活动、营养、辅助设备、疼痛管理和锻炼方面的信息。4 周后进行电话随访。主要结局为 8 周后握力。次要结局为自我报告疼痛、治疗满意度、健康状况、Jebsen-Taylor 手部功能测试中的两项和澳大利亚/加拿大手部骨关节炎指数（AUSCAN）的总评分。根据数据分布，通过学生 t 检验或曼-惠特尼 U 检验计算统计显著性。拟合二项逻辑回归模型，以主要结局为因变量，组分配为自变量。
共有 151 名参与患者（联合干预组 74 名，常规护理加安慰剂组 77 名），2 个月随访率为 84%（n=128）。8 周后，联合干预组握力显著增加，常规护理组握力下降（优势手，平均 0.03 巴（SD 0.11）与-0.03（SD 0.13），p 值=0.001，基线校正值）。
联合单次个体干预显著改善手部 OA 患者的握力和自我报告的治疗满意度。它可以由不同的接受过风湿病培训的卫生专业人员提供，因此也可以在初级保健中实施。
ISRCTN 注册，ISRCTN62513257。于 2012 年 5 月 17 日注册。
