Self management, joint protection and exercises in hand osteoarthritis: a randomised controlled trial with cost effectiveness analyses

Dziedzic, Krysia S.; Hill, Susan; Nicholls, Elaine; Hammond, Alison; Myers, Helen; Whitehurst, Tracy; Bailey, Jo; Clements, Charlotte; Whitehurst, David G. T.; Jowett, Sue; Handy, June; Hughes, Rhian W.; Thomas, Elaine; Hay, Elaine M.
January 2011
BMC Musculoskeletal Disorders;2011, Vol. 12 Issue 1, p156
Academic Journal
Background: There is limited evidence for the clinical and cost effectiveness of occupational therapy (OT) approaches in the management of hand osteoarthritis (OA). Joint protection and hand exercises have been proposed by European guidelines, however the clinical and cost effectiveness of each intervention is unknown. This multicentre two-by-two factorial randomised controlled trial aims to address the following questions: • Is joint protection delivered by an OT more effective in reducing hand pain and disability than no joint protection in people with hand OA in primary care? • Are hand exercises delivered by an OT more effective in reducing hand pain and disability than no hand exercises in people with hand OA in primary care? • Which of the four management approaches explored within the study (leaflet and advice, joint protection, hand exercise, or joint protection and hand exercise combined) provides the most cost-effective use of health care resources Methods/Design: Participants aged 50 years and over registered at three general practices in North Staffordshire and Cheshire will be mailed a health survey questionnaire (estimated mailing sample n = 9,500). Those fulfilling the eligibility criteria on the health survey questionnaire will be invited to attend a clinical assessment to assess for the presence of hand or thumb base OA using the ACR criteria. Eligible participants will be randomised to one of four groups: leaflet and advice; joint protection (looking after your joints); hand exercises; or joint protection and hand exercises combined (estimated n = 252). The primary outcome measure will be the OARSI/OMERACT responder criteria combining hand pain and disability (measured using the AUSCAN) and global improvement, 6 months post-randomisation. Secondary outcomes will also be collected for example pain, functional limitation and quality of life. Outcomes will be collected at baseline and 3, 6 and 12 months post-randomisation. The main analysis will be on an intention to treat basis and will assess the clinical and cost effectiveness of joint protection and hand exercises for managing hand OA. Discussion: The findings will improve the cost-effective evidence based management of hand OA. Trial registration: identifier: ISRCTN33870549


Related Articles

  • Effectiveness and cost-effectiveness of a multidisciplinary intervention programme to prevent new falls and functional decline among elderly persons at risk: design of a replicated randomised controlled trial [ISRCTN64716113]. Hendriks, Marike R. C.; van Haastregt, Jolanda C. M.; Diederiks, Joseph P. M.; Evers, Silvia M. A. A.; Crebolder, Harry F. J. M.; van Eijk, Jacques Th. M. // BMC Public Health;2005, Vol. 5 Issue 1, p6 

    Background: Falls are common among community-dwelling elderly people and can have a considerable impact on quality of life and healthcare costs. People who have sustained a fall are at greater risk of falling again. We replicated a British randomised controlled trial which demonstrated the...

  • Higher Direct Medical Costs Associated With Physical Inactivity. Pratt, Michael; Macera, Carolina A. // Physician & Sportsmedicine;Oct2000, Vol. 28 Issue 10, p63 

    Describes the direct medical expenditures associated with physical inactivity in the United States. Finding that an increase in participation in regular moderate physical activity among inactive Americans over the age of 15 might reduce annual national medical costs by billions of dollars.

  • Are occupational therapy interventions for service users with mental health problems cost-effective? Morley, Mary; Smyth, Genevieve // British Journal of Occupational Therapy;Oct2013, Vol. 76 Issue 10, p470 

    The current financial climate in health and social care is challenging: occupational therapists who work in mental health services need urgently to demonstrate clinical effectiveness and value for money in comparison to other interventions. In doing so they will help to ensure that service users...

  • Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. Graff, Maud J.L.; Adang, Eddy M.M.; Vernooij-Dassen, Myrra J.M.; Dekker, Joost; Jönsson, L.; Thijssen, Marjolein; Hoefnagels, Willibrord H.L.; Rikkert, Marcel G.M. Olde // BMJ: British Medical Journal (International Edition);1/19/2008, Vol. 336 Issue 7636, p134 

    Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. Design Cost effectiveness study alongside a single blind randomised controlled trial. Setting Memory...

  • strong dominance.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p2224 

    An encyclopedia entry for "strong dominance," which refers to any strategy in health care management that provides a more effective and less costly solution to a problem, is presented.

  • Reply to Paltiel et al. Schneider, Karen; Gray, Richard T.; Wilson, David P. // Clinical Infectious Diseases;Jul2014, Vol. 59 Issue 1, p141 

    A response from the author of the article "Applied methods of cost effectiveness analysis in health care" in a 2011 issue is presented.

  • Cost-Cutting Counsel. Goldman, Jay P. // School Administrator;Jan2009, Vol. 66 Issue 1, p5 

    The article discusses the article "Trimming Costs in Personnel and Health Care," by Ron Valenti, which appears in this issue.

  • Cost-Effectiveness and coverage policy. Brown, Elizabeth // Physician Executive;May/Jun1999, Vol. 25 Issue 3, p75 

    Focuses on using cost-effectiveness analyses in the application of medical coverage policy. Focus of cost containment efforts; Challenges in implementing cost-effectiveness as a coverage criteria; Methodology for cost-effectiveness analyses.

  • Hospitals Collaborate to Provide Quality, Cost-Effective Care.  // Business NH Magazine;Jun2011, Vol. 28 Issue 6, p10 

    The article reports that five hospitals in New Hampshire including Elliot Hospital, Concord Hospital, and Douglass Hopital, have come together to lead the transformation of health care delivery in the communities they each serve through improvements in quality, cost effectiveness and access to care.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics