Can lessons in joint protection help patients with hand osteoarthritis?

This study investigated the clinical effectiveness of hand exercise and joint protection sessions for adults with hand osteoarthritis.

Osteoarthritis mainly affects older or overweight adults and is the most common form of arthritis in the United States. It is also the leading cause of disability in older adults, with the hand being one of the most frequently affected sites. Symptoms of osteoarthritis generally involve joint pain during or after movement.

One strategy for treating patients with osteoarthritis has been the development of community-based self-management programs. These are cost-effective, but there is limited research investigating whether they are effective for managing patients with hand osteoarthritis.

This study included 257 patients over the age of 50, with hand osteoarthritis. Patients were divided into 4 groups. Group 1 received leaflets and advice on how to manage their arthritis, but did not receive any occupational therapy sessions (65 patients). Group 2 received joint protection lessons (62 patients). Patients from group 3 received hand exercise sessions (65 patients). Patients from group 4 received both joint protection and the hand exercise sessions (65 patients). Joint protection and hand exercises were delivered by 9 occupational therapists, over 4 group sessions. Patient outcomes were collected at 3, 6, and 12 months.

The joint protection intervention included the following guidelines: distributing the weight of what you lift over several joints (such as, spreading the load over two hands), avoiding putting strain on the thumb and repetitive thumb movements, avoiding prolonged grips in one position, using as large a grip as possible, reducing the effort needed to do a task (such as, using labor-saving gadgets; avoiding lifting heavy objects, and reducing the weight of what you lift).

The hand exercise intervention included the following exercises: stretching exercises, wrist flexion and extension, radial finger walking, making an ‘O’ with the thumb and index finger, using an elastic band to provide resistance to thumb extension, Play-Doh rolling, squeezing and pinching, and holding a 0.5–0.75 kg weight while doing wrist exercises.

After 6 months 33% of patients receiving joint protection group had responded to their treatment, significantly more than the 21% of patients not receiving joint protection. After 6 months 28% of patients receiving hand exercises had responded compared to 25% of patients not receiving hand exercises.

Patients receiving joint protection also had significant improvements in pain self-efficacy (improved confidence in performing activities while in pain) at 3, 6 and 12 months. There were no reported side effects of the treatment strategy for any of the groups. 

The authors concluded that occupational therapists can support self-management and that joint protection is an effective intervention in older adults with hand osteoarthritis. 

These were occupational therapist guided sessions. Please talk to a doctor if you think you could benefit from similar joint protection sessions.