Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Orthopaedic Surgery, Odense University Hospital, Odense C, Denmark; Department of Rehabilitation, Odense University Hospital, Odense C, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Rehabilitation, Odense University Hospital, Odense C, Denmark; Health Sciences Research Center, University College Lillebaelt, Odense M, Denmark.
J Hand Ther. 2020 Oct-Dec;33(4):455-469. doi: 10.1016/j.jht.2019.12.009. Epub 2020 Mar 7.
A nonblinded randomized controlled trial.
Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC).
To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects.
A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI) or a physical exercise-based occupation-focused intervention. The primary outcome, functioning, was measured using the Disability of the Arm, Shoulder and Hand questionnaire. Primary endpoint was at three months. Patients were followed up for a year.
No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times.
OBI as delivered in this study was not superior to physical exercise-based occupation-focused intervention in this patient group. However, in taking a client-centered approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice.
一项非盲随机对照试验。
以作业为基础的干预措施在活动受限的患者中优于基于体育锻炼的干预措施。然而，只有少数研究检查了手部相关疾病患者的效果。患者的恢复情况存在异质性，这可能是由于个人因素，如感知凝聚力（SOC）。
调查手部相关疾病患者进行以作业为基础的干预的有效性，以及 SOC 是否可以预示预期效果。
共有 504 名患者分为三个 SOC 组，然后随机分为以作业为基础的干预组，包括体育锻炼（OBI）或基于体育锻炼的作业为重点的干预组。主要结局是使用手臂、肩部和手部残疾问卷测量功能。主要终点为三个月。患者随访一年。
主要结局分析未发现显著差异。然而，接受 OBI 的患者在一个、两个月和三个月随访时，对职业表现的满意度有统计学上显著和更大的变化。在所有时间点，SOC 较弱的患者功能和健康相关生活质量均低于其他组。
本研究中提供的 OBI 并不优于该患者群体的基于体育锻炼的作业为重点的干预。然而，在采取以客户为中心的方法时，我们建议根据个人需求进行 OBI，因为患者在对其职业表现的满意度方面有统计学上更大的评分变化。显然，SOC 较弱的患者功能水平较低。这一知识应指导临床实践。
