Exercise Management for People with Hand Osteoarthritis: A Mixed Methods Multistrand Study

Abstract

People living with hand osteoarthritis (OA) often experience challenges with performing daily functional tasks due to pain and joint stiffness. Exercises are frequently recommended for hand OA; however, their effects on pain and hand function remain uncertain. Research to determine the optimal exercise programme beneficial for this patient population was warranted. The aim of this PhD was to develop an exercise programme to improve hand pain, function, and quality of life in people with hand OA.

Using mixed methods multistrand research, the aim was addressed in three phases through five studies. Phase-1 comprised two reviews: (1) a systematic review of eight clinical practice guidelines and consensus recommendations on hand OA to provide evidence on contemporary recommended exercises and (2) a scoping review of 33 records to provide evidence on existing hand OA exercises, their development, prescription and adherence strategies. Phase-2 comprised two studies: (1) a qualitative analysis study to understand the views of 10 hand OA patients on an existing hand OA exercise programme and (2) a before and after study to investigate the proof of concept of a rapid-force hand exercise protocol, adapted from the lower limbs, in the hand of 8 healthy volunteers. Findings from Phases 1 and 2 were consolidated in Phase-3, which involved developing a novel hand OA exercise programme, which was tested in 18 adults with hand OA in a proof of concept mixed methods study (Phase-3). Quantitative data were analysed with SPSS statistics and qualitative data with NVivo software using inductive thematic analysis.
The systematic review provided evidence to support the use of strengthening, stretching and joint mobility exercises for hand OA management (Phase-1). These recommendations informed the synthesis of six frequently used exercises from the scoping review: “making O sign”, “making a fist”, finger and thumb stretch, grip strengthening, pinch strengthening, and thumb extension and abduction with elastic band. Based on suggestions from patients in the qualitative study (Phase-2), thumb extension and abduction with elastic bands were excluded from the summary of exercise recommendations due to challenges with pain and difficulty in performing the exercise activity. Findings from the proof of concept study showed positive trends towards the use of rapid-force exercises in the hand which were found to be tolerable and feasible in healthy volunteers. The rapid-force element was combined with the five recommended exercises to develop the Rapid-force Hand Osteoarthritis Exercise (Rapid-HOE) programme. The evidence-based Rapid-HOE programme was found to be feasible, tolerable, and acceptable. This novel programme demonstrated potential for successfully improving hand pain, function, and quality of life in people living hand OA. This thesis has advanced the field of hand OA management and provides a sound basis for a randomised controlled trial to examine the efficacy of the Rapid-HOE programme.

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Identifiers

ORCID for Maria Stokes: orcid.org/0000-0002-4204-0890

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