EXERCISES FOR HAND OSTEOARTHRITIS: A SYSTEMATIC REVIEW OF CLINICAL PRACTICE GUIDELINES AND CONSENSUS RECOMMENDATIONS

B. Sankah^1,2, M. Stokes^1,2, J. Adams^1,2

Background: Individuals with Hand Osteoarthritis (OA) often experience hand pain, joint stiffness and reduced grip strength, which affect performance of everyday functional tasks. There is a need to evaluate evidence-based rehabilitation strategies that aim to lessen the burden and improve the quality of life of people living with hand OA.

Purpose: Our objectives were to
(1) identify guidelines and consensus recommendations on hand OA management to ascertain whether hand exercises are recommended as part of best practice;
(2) identify the type and dosage of exercises recommended regarding frequency, intensity and duration and
(3) provide a summary of exercise recommendations for the management of hand OA.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and was registered on Prospero (CRD42018086440). Seven published databases and 20 grey literature sources were searched (January 1997–January2019). Quality assessment was conducted with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument and, using a narrative approach, evidence was synthesized based on the levels of evidence and strength of recommendations.

Results: Eight guidelines and consensus recommendations were identified and included. Evidence from seven guidelines was rated between fair to high quality. Five out of seven guidelines recommended exercises for the management of hand OA. Limited information on exercise dosage (frequency, intensity and duration) was reported. Three strong and two weak recommendations for using different hand exercises were proposed in this systematic review.

Conclusion(s): Available guidelines and consensus recommendations on hand OA recommend exercises as part of current best practice for hand OA management. There is strong evidence to support the recommendation of strengthening, stretching and joint mobility exercises for the management of the hand OA. These recommended exercises, however, lacked specific details regarding the type and dosage (frequency, intensity and time) for optimal uptake, which therefore need to be established through research.

Implications: Implications for Clinical Practice
1. Patients and clinicians can use strengthening, stretching and joint mobility exercises as either home-based or supervised weekly sessions.
2. Policy makers can adopt these recommendations in their institutions, providing time for staff training
Implications for Research.
The lack of specific details regarding the type, frequency, intensity and duration of the recommended exercises needs to be established.

Funding, acknowledgements: This systematic Review is part of the first author's PhD study, which is funded by the Commonwealth Scholarships Commission, UK

Keywords: Hand Osteoarthritis, Exercises, Guidelines

Topic: Rheumatology

Did this work require ethics approval? No

Institution: University of Southampton

Committee: Faculty of Environmental and Life Sciences Ethics Committee Committee

Reason: Etics approval was not required as this was a systematic review of already published literature