Osteoarthritis of the hand: a modifiable disease

The effects of age and sex on hand movement structure

The aim was to investigate the effects of age and sex on hand function and ascertain age-related changes (magnitude and rate) by assessing a broad range of functional tasks with the dominant and non-dominant hands. A representative sample of 635 adults (114 males and 491 females) aged 50 years and over completed motor performance series of the Vienna Test System Parametric and non-parametric analysis and simple linear regression was used to examine the relationships. Significant relationships were observed between task performance and age and sex, although the contributions of both factors differed by varying degree. Compared with males, the females performed significantly better than males in the majority of tests, particularly with the dominant hand, although greater age-related reductions were observed in performance. Among the skills quantifying hand function, age accounted for the most variance in hand and finger dexterity.

Effectiveness of a fine motor skills rehabilitation program on upper limb disability, manual dexterity, pinch strength, range of fingers motion, performance in activities of daily living, functional independency, and general self-efficacy in hand osteoarthritis: A randomized clinical trial

STUDY DESIGN

A randomized clinical trial.

INTRODUCTION

Rehabilitation treatments for improving fine motor skills (FMS) in hand osteoarthritis (HOA) have not been well explored yet.

PURPOSE OF THE STUDY

To assess the effectiveness of a rehabilitation program on upper limb disability, independence of activities of daily living (ADLs), fine motor abilities, functional independency, and general self-efficacy in older adults with HOA.

METHODS

About 45 adults (74-86 years) with HOA were assigned to an experimental group for completing an FMS intervention or a control group receiving conventional occupational therapy. Both interventions were performed 3 times/wk, 45 minutes each session, during 8 weeks. Upper limb disability, performance in ADLs, pinch strength, manual dexterity, range of fingers motion, functional independency, and general self-efficacy were assessed at baseline, immediately after treatment, and after 2 months of follow-up.

RESULTS

FMS group showed significant improvements with a small effect size on manual dexterity (P ≤ .034; d ≥ 0.48) and a moderate-high effect on range of index (P ≤ .018; d ≥ 0.58) and thumb (P ≤ .027; d ≥ 0.39) motion. The control group showed a significant worse range of motion over time in some joints at the index (P ≤ .037; d ≥ 0.36) finger and thumb (P ≤ .017; d ≥ 0.55).

CONCLUSIONS

A rehabilitation intervention for FMS may improve manual dexterity and range of fingers motion in HOA, but its effects on upper limb disability, performance in ADLs, pinch strength, functionality, and self-efficacy remain uncertain. Specific interventions of the hand are needed to prevent a worsening in range of finger motion.

LEVEL OF EVIDENCE

1b.

Orthotic considerations for dense connective tissue and articular cartilage--the need for optimal movement and stress

Orthotic intervention is an essential component of hand rehabilitation, addressing biological factors that affect activity and participation. Functional, pain-free joint mobility requires skeletal stability, healthy articular cartilage, and appropriate extensibility of periarticular dense connective tissues (DCTs). This article addresses basic science underlying clinical reasoning when considering orthoses to maintain or restore structural integrity, mobility and function of DCT structures, and articular cartilage. However, these tissues often have different and sometimes conflicting requirements for the maintenance and restoration of integrity and health. The duration of immobilization, especially at end range, should be carefully considered, as it impairs nutrition of tissues and adversely compresses articular cartilage, causing injury that may not be reversible. Immobilization also reduces extensibility of DCT. Thus, an intermittent orthotic wearing schedule is suggested, allowing movement wherever possible to promote tissue health. To optimize benefits and minimize harmful effects of orthotic intervention, further research on physiological responses of human tissues to immobilization and tension is needed.

Hand osteoarthritis

This short report presents a view of osteoarthritis (OA) as cumulative microtrauma mediated by physical activity. The view, grounded in principles of hand pathomechanics, places physical activity at the centre of the process through which problems in the joint (originating from many possible sources) result in a cascade of symptoms and hand impairments. The view points towards opportunities to expand treatment options and improve treatment outcomes for patients with hand OA.

Methodological issues arising from a pilot RCT investigating the effectiveness of joint protection

Aims:

This article describes the difficulties encountered when attempting to evaluate the addition of joint protection education to an exercise programme in the treatment of patients with osteoarthritis (OA) of the hand. This involved a pilot study for a randomized controlled trial, which was carried out in order to inform the design of future studies.

Methods:

Subjects were recruited from rheumatology and orthopaedic out-patient clinics in a district general hospital for a 6 month period in 2006. They were assessed at baseline and 12 weeks after intervention. There were 2 intervention groups: one receiving exercise therapy and formal joint protection education from an occupational therapist over 2 sessions, supplemented with a joint protection information booklet, and the control group which received exercise therapy and informal joint protection advice. The primary outcome measures were pain and hand function measured using the hand pain visual analogue scale and the Cochin Hand Functional Disability Scale. Six patients were recruited with OA of the hand (mean age 59.2 years and mean disease duration 8.9 years) with three randomized to the intervention group, and three to the control group.

Findings:

There were methodological issues arising from the study, including sample recruitment issues, time scale, limited participant numbers and ethical constraints. No statistically valid data was gained to ascertain whether exercise therapy was more effective when given in conjunction with joint protection advice than without.

Conclusions:

Although some results were achieved that suggested there were improvements in the measures of perceived hand pain, health status, grip strength and pinch grip, these were not statistically meaningful. The improvements were greater in the control group, which received exercise therapy without joint protection advice. Hand function was reduced in both intervention groups. The reasons for this could not be answered in this study. A larger study would need to be undertaken in order to gain statistically valid data to evaluate the effectiveness of joint protection advice for people with OA hand.

The aging hand

Hand function decreases with age in both men and women, especially after the age of 65 years. A review is presented of anatomical and physiological changes in the aging hand. The age-related changes in prehension patterns (grip and pinch strength) and hand dexterity in the elderly population are considered. Deterioration in hand function in the elderly population is, to a large degree, secondary to age-related degenerative changes in the musculoskeletal, vascular, and nervous systems. Deterioration of hand function in elderly adults is a combination of local structural changes (joints, muscle, tendon, bone, nerve and receptors, blood supply, skin, and fingernails) and more distant changes in neural control. These age-related changes are often accompanied by underlying pathological conditions (osteoporosis, osteoarthritis, rheumatic arthritis, and Parkinson's disease) that are common in the elderly population. Assessment of hand function and prehension patterns is needed in order to determine specific treatment approaches.