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C. Srikesavan1, B. Dean2, F. Toye3, A. Bolt4, N. Thurley5
1University of Oxford, Nuffield Department of Orthopaedics and Musculoskeletal Sciences, Oxford, United Kingdom, 2University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, 3Oxford University Hospitals NHS Trust, Physiotherapy Research Unit, Oxford, United Kingdom, 4Pulvertaft Hand Centre, Derby, United Kingdom, 5University of Oxford, Bodleian Health Care Libraries, Oxford, United Kingdom
Background: Osteoarthritis (OA) is the most prevalent joint disease causing significant disability and economic burden worldwide. The hand joints are one of the common sites to be affected by OA. It is characterised by chronic joint pain, stiffness and functional impairments leading to reduced participation and overall quality of life.
Purpose: To systematically review the qualitative literature on the perceptions and experiences of people living with hand osteoarthritis (HOA), carers and therapists relating to quality of life, treatments and services available.
Methods: We conducted a review of qualitative research in HOA using a comprehensive search strategy developed in collaboration with a health sciences librarian. The protocol was registered on the PROSPERO database (CRD42019153378). A qualitative meta-synthesis was undertaken in three steps:
1) a systematic search of the literature on MEDLINE, Embase and CINAHL electronic databases for qualitative studies including people with HOA,
2) a critical evaluation of the methodological quality of the included studies using the Critical Appraisal Skills Programme (CASP) checklistand,
3) meta-synthesis of the findings from the selected studies. The confidence in each of the themes was assessed using the four components of the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation- Confidence in the Evidence from Reviews of Qualitative research).
1) a systematic search of the literature on MEDLINE, Embase and CINAHL electronic databases for qualitative studies including people with HOA,
2) a critical evaluation of the methodological quality of the included studies using the Critical Appraisal Skills Programme (CASP) checklistand,
3) meta-synthesis of the findings from the selected studies. The confidence in each of the themes was assessed using the four components of the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation- Confidence in the Evidence from Reviews of Qualitative research).
Results: From a total of 807 records, 11 relevant studies were identified. Eleven full-text articles from seven studies on people with HOA from New Zealand, Denmark, Norway, United Kingdom, United States of America, Singapore and multiple European countries were included (288 women and 39 men, average age 63 years). Four key themes emerged:
1) my hands are painful all the time
2) It stops me doing everyday things
3) It stops me doing things I value and
4) How I help myself cope.
The quality of evidence was moderate for all themes except for a lack of rich descriptive data on pain leading to low quality of evidence. The main reasons for downgrading were the limited number of articles and concerns about relevance as most studies were from Europe and the United Kingdom with 90% female participants recruited from hospital settings. We found three studies involving clinicians (surgeons, physiotherapists and occupational therapists) that explored different aspects of managing site-specific thumb carpometacarpal joint osteoarthritis;and another on occupational therapy practice of HOA in general. There were no qualitative studies that involved carers of people with HOA.
1) my hands are painful all the time
2) It stops me doing everyday things
3) It stops me doing things I value and
4) How I help myself cope.
The quality of evidence was moderate for all themes except for a lack of rich descriptive data on pain leading to low quality of evidence. The main reasons for downgrading were the limited number of articles and concerns about relevance as most studies were from Europe and the United Kingdom with 90% female participants recruited from hospital settings. We found three studies involving clinicians (surgeons, physiotherapists and occupational therapists) that explored different aspects of managing site-specific thumb carpometacarpal joint osteoarthritis;and another on occupational therapy practice of HOA in general. There were no qualitative studies that involved carers of people with HOA.
Conclusions: Our synthesised findings from seven studies involving people with HOA highlighted the impact of HOA on physical, functional and psychological domains thereby reducing their quality of life and how various strategies were used to cope with pain and disability.
Implications: Healthcare professionals involved in HOA care must acknowledge, assess, and address the psychological challenges due to HOA. Positive psychological interventions such as mind-body therapies alongside standard care would support optimal holistic care in this population. Furthermore, personalised support and information about effective use of coping strategies as part of self-management programmes would be helpful.
Funding acknowledgements: Benjamin Dean discloses receipt of financial support for research, authorship, and publication from British Medical Association Doris Hiller grant.
Keywords:
Hand osteoarthritis
Qualitative synthesis
Pain
Hand osteoarthritis
Qualitative synthesis
Pain
Topics:
Musculoskeletal: upper limb
Disability & rehabilitation
Rheumatology
Musculoskeletal: upper limb
Disability & rehabilitation
Rheumatology
Did this work require ethics approval? No
Reason: This is a qualitative evidence synthesis and hence ethics approval is not required.
All authors, affiliations and abstracts have been published as submitted.
