GHANAIAN PATIENTS' AND CLINICIANS’ PERSPECTIVES OF HAND OSTEOARTHRITIS AND ITS ASSESSMENT: A PATIENT PUBLIC INVOLVEMENT PROJECT

B.E.A. Sankah^1,2, M. Stokes^1,2, A.I. Bello³, J. Adams^1,2

Background: People living with hand Osteoarthritis (OA) often experience challenges in performing daily functional tasks due to pain and joint stiffness. Recognized as a global public health concern, research to understand its epidemiology, diagnosis and management is recommended. There is much to know about hand OA in some western countries but less in ethnically diverse populations and geographical locations such as Ghana. The need to explore the feasibility of investigating the condition in Ghana using the Patient and Public Involvement (PPI) approach was warranted. Whilst PPI is routine practice in some western countries, it is unpopular and not a component of clinical research in Ghana. A PPI consultation was therefore needed to generate preliminary research ideas on hand OA within the Ghanaian context.

Purpose: To consult with people with hand OA and clinicians to
1) explore their perspectives on hand OA and
2) generate ideas and set future research plans regarding the profiling, diagnosis and assessment of hand OA in Ghana

Methods: This PPI project was conducted and reported following the GRIPP2-LF (Guidance for Reporting Involvement of Patients and the Public -long form) checklist. Initial contact was made with the Ghana Physiotherapy Association who recruited physiotherapists with specialized skills in hand care (n=2), and a rheumatologist for the project. These physiotherapists subsequently helped recruit patients (n=4) for the discussions which took place in two teaching hospitals in Ghana. The PPI project partners were engaged in discussions (≤1hour) using semi-structured topic guides. Whilst notes were taken, discussions were also audio recorded to corroborate the information gathered. These were transcribed and analysed thematically.  

Results: Six major themes surrounding the perception of hand OA were identified. These were poor public awareness of the disease, missed diagnosis by the experts, delayed referrals to physiotherapy services, the need for training of physiotherapists on hand OA assessments, improved health literacy amongst patients, and the need for research about the condition. Insights from all PPI partners suggested the need for public engagement activities to create awareness about hand OA both outside and within the clinical field as most physiotherapists and other clinicians know little about the condition and often misdiagnosed and delayed its management. Patient PPI partners also identified barriers and facilitators to the proposed research ideas and suggested some innovative recruitment strategies and practical ways of undertaking future research within the Ghanaian context. Whilst the rheumatologist PPI partner believed the condition was less common in Africa and had limited research potentials, the patient and physiotherapist partners recognized the urgent need for training and research on hand OA assessments due to the dearth of information available.

Conclusion(s): Insights from this foremost PPI project in Ghana on hand OA highlighted the lack of awareness of the disease amongst patients and clinicians, and the huge research gap regarding its assessment, which must be addressed with research.

Implications: The training of Ghanaian physiotherapists and other clinicians on the identification and assessment of hand OA through workshops are required.
Feasibility studies on assessment methods to inform future prevalence studies on hand OA in Ghana is warranted.

Funding, acknowledgements: Global Research Initiative Scheme Grant, University of Southampton, UK

Keywords: Hand osteoarthritis, Patient Public Involvement, Ghana

Topic: Rheumatology

Did this work require ethics approval? No

Institution: University of Southampton

Committee: School of Health Sciences, University of Southampton

Reason: This is a Patient and Public Involvement consultation project, as such clinical research ethics approval is not required.