Activity limitations and participation restrictions in women with hand osteoarthritis: patients' descriptions and associations between dimensions of functioning

Hand osteoarthritis – an increasing need for treatment and rehabilitation

PURPOSE OF REVIEW

This review describes advances in our knowledge on the clinical burden of hand osteoarthritis, its relation to radiographic signs of osteoarthritis and potential targets for therapy. Treatments and trial methodology for hand osteoarthritis are critically reviewed.

RECENT FINDINGS

Recent studies have shown that there is an association between radiographic hand osteoarthritis and hand pain, and that symptomatic hand osteoarthritis leads to substantial disability. Some risk factors for hand osteoarthritis have been described but the development of hand osteoarthritis is still unclear. Unfortunately, pharmacological therapies for hand osteoarthritis are lacking and have been investigated little. Only a few studies on other treatment modalities are available. Surgical treatments are not covered in this review.

SUMMARY

Advances have been made in our understanding of symptomatic hand osteoarthritis. Potential targets for therapy are recognized. The challenge for the coming years is to conduct clinical trials of high quality in hand osteoarthritis.

The assessment of disability associated with osteoarthritis

PURPOSE OF REVIEW

Disability (activity limitation) is an important and common health outcome for patients with osteoarthritis, making accurate measures essential. This paper explores self-report measures of activity limitation associated with osteoarthritis and reports on recent conceptual advances that impact on the measurement of activity limitation.

RECENT FINDINGS

The Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36, the most commonly used measures to assess activity limitation, continue to be validated in osteoarthritis. There has been little consensus, however, about which measure to use across different types of osteoarthritis. While new measures have been developed to assess activity limitation, it remains unclear whether or not these are an improvement over existing measures. The International Classification of Functioning, Disability and Health is becoming an important consideration. Commonly used measures do not map directly onto individual constructs of this classification, however a new measure for Japanese people with knee osteoarthritis was developed based on these constructs.

SUMMARY

There have been significant developments in the conceptual approach to measuring activity limitation. Measures are needed that operationalize activity limitation as defined by the International Classification of Functioning, Disability and Health (within or ideally across cultures), providing a common underlying construct for measures and hence facilitating comparability across studies.

The International Classification of Functioning as an explanatory model of health after distal radius fracture: a cohort study

Background

Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health.

Methods

This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome.

Results

Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE.

Conclusion

The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.