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Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial
  1. Else Marit Holen Gravås1,
  2. Nina Østerås1,
  3. Randi Nossum2,
  4. Ruth Else Mehl Eide3,
  5. Åse Klokkeide4,
  6. Karin Hoegh Matre3,
  7. Monika Olsen4,
  8. Oyvor Andreassen5,
  9. Ida K Haugen6,
  10. Anne Therese Tveter1 and
  11. Ingvild Kjeken1
  1. 1National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Clinical Services, Saint Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
  3. 3Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
  4. 4Department of Rheumatology, Haugesund Sanitary Association Rheumatism Hospital, Haugesund, Norway
  5. 5Patient panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  6. 6Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  1. Correspondence to Professor Ingvild Kjeken; Ingvild.Kjeken{at}


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. A control group received only hand osteoarthritis information. Primary outcome was the proportion of patients that had received CMCJ surgery after 2 years. We examined the primary outcome and predictors for surgery with regression models, and time to surgery with the log-rank test and cox regression analyses.

Results Of 221 patients screened for eligibility, 180 were randomised. Information on the primary outcome was collected from medical records for all included patients. Surgery was performed on 22 patients (24%) that had received occupational therapy and 29 (32%) control patients (OR 0.56, 95% CI 0.26 to 1.21; p=0.14). Median time to surgery was 350 days (IQR 210–540) in the occupational therapy group and 296 days (IQR 188–428) in the control group (p=0.13). Previous non-pharmacological treatment (OR 2.72, 95% CI 1.14 to 6.50) and higher motivation for surgery (OR 1.25, 95% CI 1.09 to 1.43) were significant predictors for CMCJ surgery.

Conclusions Occupational therapy showed a small non-significant tendency to delay and reduce the need for surgery in CMCJ osteoarthritis. Previous non-pharmacological treatment and higher motivation for surgery were significant predictors for surgery.

  • hand osteoarthritis
  • treatment
  • occupational therapy
  • orthopaedicsurgery

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  • Contributors RN and IK conceived the project. IK is the principal investigator, the procedure of funding for the project and supervised coordinator of the trial. RN, REME and ÅK were the local study coordinators at the participating hospitals. IK, RN, REME, ÅK and ØA planned the study and IK developed the research design. RN, REME, ÅK, KHM and MO did the data collection. EMHG, NØ, ATT, IKH and IK performed the analyses and all authors discussed and interpreted the data. EMHG, NØ, ATT, IKH and IK drafted the article, revised it critically for important intellectual content and approved the final version for publication. All authors have read and approved the final manuscript.

  • Funding This study was conducted with the financial support from The Interregional research funds (HELSEFORSK) via The Research Council of Norway, project number 243758. The funding body had no participation in the design of the study, data collection, data analysis and interpretation and writing the manuscript.

  • Disclaimer A patient research partner (ØA) was involved in all stages of the study. She participated in the project group in developing research questions, designing the interventions, and discussing and publishing the results.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Regional Committees for Medical Research Ethics approved the study. Ref. no: 2012/2265/REK South East Norway. Written informed consent was obtained from all participants included in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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