FRI0623-HPR HEALTHCARE RESOURCE USE IN PATIENTS WITH TRAPEZIOMETACARPAL OSTEOARTHRITIS

Background:

Trapeziometacarpal osteoarthritis (TMO) is one of the most debilitating forms of hand osteoarthritis (OA). According to the recent EULAR guidelines1, 2and a systematic review,3the efficacy of topical/oral non-steroid anti-inflammatory drugs (NSAIDs), orthoses, hand exercises, and psychosocial interventions for hand OA or TMO are supported by scientific evidence. Cortisone injections and acetaminophen are generally not recommended.1, 3Besides, TMO management is suboptimal: only 21% of patients receive rehabilitative interventions prior to referral to hand surgeons.4

Objectives:

We aimed at documenting the types of treatment TMO patients employ and their healthcare resource use.

Methods:

A total of 227 TMO patients recruited from 16 healthcare institutions completed a questionnaire about 1) received interventions, 2) analgesic strategies, and 3) healthcare professional consultations.

Results:

Acetaminophen (64.3% of the participants), oral NSAIDs (31.7%), topical NSAIDs (11.9%), and nutraceuticals (7.9%) were the most commonly used medications. More than 70% of the participants reported having received cortisone injection(s) (72.5%) and orthosis (75.7%). More than half employed hand exercises, massage and heat/cold application. Relaxation/respiration, meditation, distraction, assistive devices, and joint protection principles were used by smaller percentages of participants (13.0-30.9%). Patients with TMO reported having consulted various types of healthcare professionals: family physicians, plastic/orthopaedic surgeons, radiologists-interventionists, rheumatologists, physiatrists, occupational/physical therapists, osteopaths, chiropractors, pharmacists, and acupuncturists. Only 4.8% of the participants reported having received psychosocial interventions.

Conclusion:

TMO patients use numerous types of modalities to relieve their pain. Provision of evidence-based interventions tailored to their needs is clearly needed.

References:

[1] Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis.Annals of the rheumatic diseases.2019;78:16-24.

[2] Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis.Annals of the rheumatic diseases.2018;77:797-807.

[3] Hamasaki T, Laprise S, Harris PG, et al. Efficacy of non-surgical interventions for trapeziometacarpal (thumb base) osteoarthritis: A systematic review.Arthritis Care & Research.2019; In press (https://doi.org/10.1002/acr.24084).

[4] Gravås EMH, Tveter AT, Nossum R, et al. Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.BMC musculoskeletal disorders.2019;20:180-180.

Acknowledgments:

This study was supported by a discretionary fund of the Centre de recherche du CHUM (CRCHUM) to Choinière and from the

Multidisciplinary Council of the CHUM. Hamasaki was supported by a Doctoral training award of the Fonds de recherche du Québec—Santé, a doctoral scholarship from the CHUM Foundation to Harris (Hand Surgery Branch) and from Choinière’s internal funds of the CRCHUM.

Disclosure of Interests:

None declared

FRI0608-HPR SEVERITY AND PREDICTORS OF PAIN INTENSITY AND HAND DISABILITY IN PATIENTS WITH TRAPEZIOMETACARPAL OSTEOARTHRITIS

Background:

Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis.1It limits thumb mobility,2reduces hand functions, and manual activities.1Yet, no study has exhaustively documented the characteristics of this pathology using a biopsychosocial approach (e.g., pain, disability, psychological well-being, pain-related catastrophic thinking, quality of life). Furthermore, radiographic TMO severity and symptomatology are only weakly to moderately correlated.3, 4The extent to which biopsychosocial factors (e.g., pain duration, depression, education) contribute to interindividual variability in TMO pain and hand disability merits further investigation.

Objectives:

This study aimed at 1) describing the pain experience of patients with trapeziometacarpal osteoarthritis (TMO) from a biopsychosocial perspective, and 2) identifying predictors of their pain intensity and hand disability.

Methods:

A total of 227 TMO patients recruited from 16 healthcare institutions completed validated questionnaires assessing their biopsychosocial characteristics. The associations of pain severity and hand disability with various biopsychosocial characteristics were analyzed by linear regression.

Results:

The participants’ mean age was 62.6 ± 8.5 years and 78% were women. Their mean pain intensity on the average in the last seven days was 5.8 ± 2.1 while their hand disability scores averaged 45.4 ± 18.8 on the QuickDASH. In terms of health-related quality of life, the participants’ scores on the physical and mental summary scales of the SF-12v2 were 41.0 ± 9.4 and 48.7 ± 9.7 respectively. Results of the multivariable linear regression analyses revealed that age, living condition, pain frequency, pain-related catastrophic thinking, and depression levels accounted for 43.3% of the variance in pain intensity while age, sex, pain intensity, pain-related catastrophic thinking, depression, level of education, employment status and living condition accounted for 60.6% of the variance in hand function.

Conclusion:

This comprehensive study showed that patients with TMO experience pain of moderate to severe intensity which can affect various aspects of their daily living and their physical health-related quality of life. Greater tendency to catastrophize in the face of pain and higher depression levels were associated with more severe pain suggesting that psychological interventions aiming at reducing these factors could be beneficial for some patients with TMO.

References:

[1] Bijsterbosch J, Visser W, Kroon HM, Stamm T, Meulenbelt I, Huizinga TW, Kloppenburg M. Thumb base involvement in symptomatic hand osteoarthritis is associated with more pain and functional disability.Annals of the rheumatic diseases.2010;69:585-587.

[2] Gehrmann SV, Tang J, Li ZM, Goitz RJ, Windolf J, Kaufmann RA. Motion deficit of the thumb in CMC joint arthritis.Journal of hand surgery.2010;35:1449-1453.

[3] Botha-Scheepers S, Riyazi N, Watt I, Rosendaal FR, Slagboom E, Bellamy N, Breedveld FC, Kloppenburg M. Progression of hand osteoarthritis over 2 years: a clinical and radiological follow-up study.Annals of the rheumatic diseases.2009;68:1260-1264.

[4] Hwang RW, Ring D. Pain and disability related to osteoarthrosis of the trapeziometacarpal joint.J Hand Microsurg.2011;3:63-65.

Acknowledgments:

This study was supported by a discretionary fund of the Centre de recherche du CHUM (CRCHUM) to Choinière and from the Multidisciplinary Council of the CHUM. Hamasaki was supported by a Doctoral training award of the Fonds de recherche du Québec—Santé, a doctoral scholarship from the CHUM Foundation to Harris (Hand Surgery Branch) and from Choinière’s internal funds of the CRCHUM.

Disclosure of Interests:

None declared

Feasibility and reliability of Doppler flow recordings in the fetal aortic isthmus: a multicenter evaluation

OBJECTIVES

To evaluate the performance of three different centers with respect to their ability to identify the fetal aortic isthmus (AoI) adequately and place a Doppler sample volume in the AoI correctly, and to address the reproducibility of the isthmic flow index (IFI) calculated from Doppler waveforms recorded in the three centers.

METHODS

The three collaborating centers sent several ultrasonographic recordings taken at random over a 6-week period to the Saint-Justine Fetal Cardiology Unit (StJ-FCU). A performance quotient ((number of total readings - number of unsatisfactory results)/number of total readings) was calculated for each center by each of three judges, who were experienced fetal cardiologists, to assess the ability of each center to identify the isthmus and to place the Doppler sample volume (DSV) adequately. Intraclass correlation coefficients (ICC) were computed to quantify the variability of IFI measurements ((systolic + diastolic)/systolic flow velocity integrals).

RESULTS

Fifty-five recordings were available for this study. Concerning isthmus identification, there was 100% agreement between the three judges from StJ-FCU and the performance quotients of Centers A, B and C were: 0.90, 0.95 and 1.00, respectively. For DSV positioning, agreement between the judges varied; for Judge 1 vs. Judge 2, kappa = 0.836 (95% CI, 0.651-1.000); for Judge 1 vs. Judge 3, kappa = 0.773 (95% CI, 0.557-1.000); for Judge 2 vs. Judge 3, kappa = 0.941 (95% CI, 0.805-1.000). The performance quotients of the three centers for DSV positioning were consistently lower than were those for identification of the isthmus, being 0.85, 0.76 and 0.92, respectively. The ICC between the first and second measurements of the IFI by Rater 1 was 0.96 (95% CI, 0.93-0.98, P < 0.001) and that between Raters 1 and 2 was 0.97 (95% CI, 0.95-0.99, P < 0.001).

CONCLUSION

Adequate imaging of the fetal AoI can be achieved easily by a trained sonographer, while DSV positioning is challenging. The intra- and interrater variability of the IFI are low.

[Prosecution of psychiatric patients: elements of reflections and practical applications.]

Among possible solutions in response to violent behaviours of psychiatric patients, prosecution might not be an alternative as well-known. This measure may be potentially beneficial for patients. How can prosecution be chosen as an option when faced with violent patients? When this option is considered, how should it be applied and what are the different steps to follow? To answer these questions, it appeared essential to first proceed to a comprehensive reflection on the recourse of sanction in psychiatry. We then describe advantages and disadvantages of the judicial process. Finally, we illustrate applications as they were conceived and elaborated at the Clinique de dangerosité de l'Institut Philippe Pinel de Montréal.