Hand function in Palestinian people with rheumatoid arthritis: an exploratory mixed methods study

Abstract

Background
Rheumatoid arthritis (RA) is the most prevalent, chronic, inflammatory arthritis and
is a debilitating disease that leads to pain, joint damage, and functional disability.
For those with RA, loss of general functional ability largely depends on hand function.
There is limited research available on hand function and its impact on the daily life
of people with RA in Palestine. This project, therefore, was designed to explore this
subject in-depth, that is to say, hand function and the factors influencing hand
functional disability among Palestinian people with RA.

Methods
An exploratory mixed-methods research design employed in two sequential phases,
was adopted for this PhD project and the International Classification of Functioning,
Disability and Health (ICF) was used as the theoretical framework. This was
underpinned by a pre-study phase, which included a systematic review of the factors
associated with hand functional disability in RA. Phase One (Qualitative) involved
five focus group discussions with 20 Palestinians with RA, who were recruited using
a purposive sampling technique. Focus group data were analysed using a modified
form of content analysis (specifically, the condensation procedure) to identify
concepts of hand functioning important to Palestinians with RA. The findings from
the focus groups were then used to inform the design and conduct the second phase
of this project. Phase Two (Quantitative) was a multicentre, cross-sectional
observational study conducted to examine hand function and related variables
among Palestinian people with RA. The study comprised a convenience sample of
67 patients. The data were collected by both self-reported and clinician assessed objective performance-based measures and analysed statistically using SPSS
software (Statistical Package for Social Sciences version 25).

Results
The systematic review study (pre-study phase) revealed that evidence from the
existing literature was insufficient to advise on the environmental and personal
factors that might influence hand function in RA. In Phase One, the qualitative data
analysed from the focus group interviews revealed 32 hand functioning concepts
considered to be important for Palestinians with RA. Activity and participation
comprised the largest number of concepts (16 concepts), followed by body function
and structure (7 concepts), personal factors (5 concepts), and finally, environmental
factors (4 concepts). The above findings informed the discussion on the appropriate
hand functional outcome measure(s) to use within the Palestinian context and
identified the important personal and environmental variables in relation to hand
function in daily living. The findings from the cross-sectional study in Phase Two
identified that Palestinian patients with RA have reduced grip strength, limited hand
mobility and hand pain remains a problem. Furthermore, hand functional disability
in various levels were detected in 85% of the patients studied. Finally, the bivariate
analyses also revealed that hand functional disability was associated with different
aspects of functional dimensions, which indicated that hand functional disability in
RA is complex.

Conclusions
Findings from this PhD project suggest that hand function problems are prevalent in
Palestinian patients with RA, form an important aspect of their patient experience
and significantly impact their daily lives. In addition, the thesis results also revealed
that hand functional disability is associated with different aspects of functional
dimensions. Future longitudinal research would provide useful data about hand
functional abilities over time and would allow causal factors amenable to change to
be identified.

More information

Identifiers

ORCID for Joanna Adams: orcid.org/0000-0003-1765-7060

ORCID for Ann-Marie Hughes: orcid.org/0000-0002-3958-8206

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