Task Shifting in the Care for Patients With Hand Osteoarthritis

Osteoarthritis Both Hands Clinical Trial

Official title:

Task Shifting in the Care for Patients With Hand Osteoarthritis: May the First Consultation in Specialist Health Care be Performed by an Occupational Therapy Specialist?

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03102788
• Other study ID #: Project nr 97001
• Status: Completed
• Phase: N/A
• Start date: September 14, 2017
• Est. completion date: November 14, 2020

Study information

• Verified date: March 2023
• Source: National Resource Center for Rehabilitation in Rheumatology
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The main aim in this randomized controlled trial is to improve access to safe and effective care, professional practice and cost-effective utilisation of health care resources by testing if occupational therapist-led care is as effective and safe as rheumatologist-led care for people with hand osteoarthritis.

Description:

Hand osteoarthritis is one of the most prevalent musculoskeletal conditions in an adult population, and may have large influences on an individual's function, health related quality of life, and participation in the society. In the absence of disease-modifying interventions, occupational therapy, comprising information, hand exercises, assistive devices and orthoses/splints, is considered as core treatment. In Norway, people with hand osteoarthritis are increasingly referred to consultation by a rheumatologist in specialist health care. At the same time a shortage of rheumatologists nationwide is stressing the healthcare system's capacity, and rheumatologists time should therefore primarily be allocated to patients in which early diagnosis and medical treatment are essential.

The World Health Organization recommend task-shifting as one method of strengthening and expanding the health workforce. Such models rely on other healthcare providers in expanded clinical roles, where physiotherapists, nurses or occupational therapists working in collaboration with physicians and other team members have their own patients for whom they provide health care services.

In this randomized controlled trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 400
• Est. completion date: November 14, 2020
• Est. primary completion date: November 14, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• Hand osteoarthritis diagnosed by physician in primary care, referred for consultation in specialist health care, and ability to communicate in Norwegian.

Exclusion Criteria:

• Exclusion criteria were cognitive or mental impairment, possible inflammatory rheumatic disease (SR>40 or CRP>20, or patient confirming having psoriasis during telephone screening).

Related Conditions & MeSH terms

• Osteoarthritis
• Osteoarthritis Both Hands

Intervention

Behavioral:
• Rheumatologist-led care.
Rheumatologist-led care comprises confirmation of diagnosis, information about hand osteoarthritis and symptom modifying medication, and, for some patients, Intra-articular injection of long-acting Corticosteroid. The rheumatologist may also refer participants to occupational therapy if needed.
• Occupational therapist-led care.
Occupational therapist-led care comprises confirmation of diagnosis, information about hand osteoarthritis and symptom modifying medication, teaching of hand exercises and ergonomic working methods, and, for some patients, provision assistive devices and orthoses/splints. The occupational therapist will refer patients to a short rheumatologist consultation if confirmation of diagnosis or intra-articular injections of long-acting Corticosteroid are needed.

Locations

Country	Name	City	State
Norway	Diakonhjemmet Hospital	Oslo
Norway	National resource center for rehabilitation in rheumatology	Oslo
Norway	Martina Hansens Hospital	Sandvika

Sponsors (3)

Lead Sponsor	Collaborator
National Resource Center for Rehabilitation in Rheumatology	Diakonhjemmet Hospital, Martina Hansen Hospital

Country where clinical trial is conducted

Norway, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of treatment responders	Number of treatment responders will be calculated as number of OMERACT/OARSI-responders. This is a composite index that presents the results of changes after treatment in the three domains of pain, function and patient's global assessment as a single variable (responder yes/no).	One year
Secondary	Number of painful finger joints	Joint count of number of painful finger joints at each hand	One year
Secondary	Hand pain measured on a numeric rating scale	Hand pain will be measured on a numeric rating scale	One year
Secondary	Hand stiffness measured on a numeric rating scale	Hand stiffness will be measured on a numeric rating scale	One year
Secondary	Disease activity measured on a numeric rating scale	Disease activity will be measured on a numeric rating scale	One year
Secondary	Physical function measured by the Functional Index for Hand OsteoArthritis	Physical function will be measured by the Functional Index for Hand OsteoArthritis	One year
Secondary	Activity performance measured by the Measure of Activity Performance of the Hand	Activity performance will be measured by the Measure of Activity Performance of the Hand	One year
Secondary	Grip strength measured by JAMAR dynamometer	Grip strength will be measured by JAMAR dynamometer	One year
Secondary	Health related quality of life measured by EQ5D	Health related quality of life will be measured by EQ5D	One year
Secondary	Satisfaction with care measured by PASS-Opp	Satisfaction with care will be measured by PASS-Opp	One year

External Links

•   Published study protocol