Is multimodal occupational therapy in addition to usual care cost-effective in people with thumb carpometacarpal osteoarthritis? A cost-utility analysis of a randomised controlled trial.

Objective: The aim was to evaluate the cost-utility of a 3-month multimodal occupational therapy intervention in addition to usual care in patients with thumb carpometacarpal osteoarthritis (CMC1 OA).

Methods: A cost-utility analysis was performed alongside a multicentre randomised controlled trial including three rheumatology departments in Norway. A total of 180 patients referred to surgical consultation due to CMC1 OA were randomised to either multimodal occupational therapy including patient education, hand exercises, assistive devices and orthoses (n=90), or usual care receiving only information on OA (n=90).

The Measure of Activity Performance of the hand (MAP-Hand) - A reliable and valid questionnaire for use in patients with hand osteoarthritis with specific involvement of the thumb.

Study Design: Cross-sectional methodological study with test-retest design.

Introduction: The Measure of Activity Performance of the Hand (MAP-Hand) is an assessment tool measuring hand-related activity limitations.

Purpose: To assess reliability, validity, and interpretability of the MAP-Hand in patients with hand osteoarthritis with specific involvement of the thumb (CMC1).

Short-Term Effects of Occupational Therapy on Hand Function and Pain in Patients With Carpometacarpal Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial.

Objective: To assess the short-term effects of multimodal occupational therapy on pain and hand function in patients referred for surgical consultation due to first carpometacarpal (CMC1) joint osteoarthritis (OA).

Methods: In this randomized controlled trial, patients with CMC1 joint OA referred for surgical consultation at 3 rheumatology departments were randomized to 3 months multimodal occupational therapy (including patient education, hand exercises, orthoses, and assistive devices) or usual treatment (OA information). Pain was measured on a numeric rating scale from 0 to 10 (0 = no pain).

Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery.

Background: Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery.

Methods: This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation.

The MAP-Hand: Psychometric properties and differences in activity performance between patients with carpometacarpal osteoarthritis and rheumatoid arthritis.

Objective: To assess construct validity (Rasch analyses) of the Measure of Activity Performance of the Hand (MAP-Hand) in people with carpometacarpal osteoarthritis (CMC1 OA), and to explore differences in activity performance between people with CMC1 OA and those with rheumatoid arthritis.

Design: Cross-sectional study.

Subjects: A total of 180 people with CMC1 OA referred for surgical consultation were recruited from rheumatology clinics in Norway, and 340 people with rheumatoid arthritis were recruited from outpatient rheumatology clinics in the UK.

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial.

Objectives: To evaluate whether occupational therapy, provided in the period between referral and surgical consultation, might delay or reduce the need of surgery in thumb carpometacarpal joint (CMCJ) osteoarthritis and to explore predictors for CMCJ surgery.

Methods: This multicentre randomised controlled trial included patients referred for surgical consultation due to CMCJ osteoarthritis. An occupational therapy group received hand osteoarthritis education, assistive devices, CMCJ orthoses and exercises.

Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.

Background: Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations. Evidence-based treatment recommendations state that all patients with hand OA should be offered non-pharmacological treatment. Surgery should be considered only when other treatment has proven insufficient in relieving pain.

Occupational problems and barriers reported by individuals with obesity.

Background: Even if occupational therapists meet many people with obesity in the course of their work, a majority of them do not seem to view weight management as within their area of professional practice.

Aim: To explore the occupational problems and barriers among persons with severe obesity from an occupational therapy perspective.

Materials And Methods: The study used the Canadian Model of Occupation and Engagement (CMOP-E) and Canadian Occupational Performance Measure (COPM) to identify and analyze prioritized occupational performance problems and barriers perceived by 63 individuals with obesity.

Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial.

Background: In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA?

Methods/design: All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate.

Patient education--which parts of the content predict impact on coping skills?

Aims: Studies investigating the effect of patient education usually evaluate whole educational programmes. The aim of this study was to describe the content of several locally developed educational programmes and investigate which parts predicted improved coping skills in the participants.

Method: A prospective observational study investigating the content of several educational programmes and the participants' coping skills 4 months afterwards.

Validity and responsiveness of the Measure of Activity Performance of the Hand (MAP-Hand) in patients with hand osteoarthritis.

Background: The Measure of Activity Performance of the Hand (MAP-Hand) is reliable and valid in patients with rheumatoid arthritis.

Objective: To assess the validity and responsiveness of the MAP-Hand in patients with hand osteoarthritis.

Methods: Patients were recruited from 2 rheumatology centres.

Self-management strategies to support performance of daily activities in hand osteoarthritis.

Aims: The main aim of this study was to explore self-management strategies in persons with hand osteoarthritis (HOA).

Methods: Self-management strategies were explored in semi-structured interviews, in which 125 participants described strategies, use of devices or equipment, and advice they would give to people with HOA concerning how to manage their daily life.

Results: The participants made a total of 483 statements, which were classified into 27 discrete strategies, and thereafter grouped into 13 broader strategies within three categories: general behavioural strategies, HOA-specific behavioural strategies, and cognitive strategies.

Effect of assistive technology in hand osteoarthritis: a randomised controlled trial.

Objective: Hand osteoarthritis (HOA) is a common joint disorder with an expected rise in prevalence due to the increasing ageing population, but with few available effective treatment options. The main aim of this study was to evaluate the effect of assistive technology (AT) in patients with HOA.

Methods: In this observer-blinded, randomised controlled trial, 35 patients with HOA (AT group) received provision of information and AT (assistive devices and splints), while 35 patients received information only (control group).

Bariatric surgery versus lifestyle interventions for morbid obesity--changes in body weight, risk factors and comorbidities at 1 year.

Background: Few studies have looked at non-surgical alternatives for morbid obese patients. This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments.

Methods: Patients with morbid obesity (BMI > 40 or BMI > 35 kg/m(2) plus comorbidities) on waiting list for bariatric surgery, were non-randomly allocated to (A) bariatric surgery or to one of three conservative treatments; (B) residential intermittent program; (C) commercial weight loss camp and (D) hospital outpatient program.