SAN DIEGO – Hand osteoarthritis causes patients a wide range of daily problems, but popular functional assessment questionnaires may miss many of them, Norwegian researchers have found.
In response to a survey question, 211 Norwegians with hand osteoarthritis (OA) listed 311 tasks their OA made more challenging. Wringing out cloths and opening jars was a struggle for more than half. A third or more said buttoning and unbuttoning clothes were hard, as was carrying suitcases and other heavy objects. More than 20% reported having a hard time peeling raw vegetables.
Those items are among the nine tasks asked about on the widely used hand OA questionnaire, the Australian/Canadian (AUSCAN) Hand Osteoarthritis Index, said lead investigator Linda Fernandes, Ph.D., a physiotherapist at Diakonhjemmet Hospital in Oslo.
However, more than half of the Norwegian sample had a hard time opening bottles, too. About a third said writing by hand and slicing bread were tough. About 20% or more said knitting, putting on socks, vacuuming, carrying shopping bags, zipping pants, and wiping down floors, among other chores, were problems, and some patients listed those items as priorities. None are on the AUSCAN, she said at the World Congress on Osteoarthritis, sponsored by the Osteoarthritis Research Society International.
Patients also did not mention problems putting on jewelry; opening doors and turning on faucets weren’t problems either, likely because doors in Scandinavia have turning handles, not doorknobs, and most sinks have a single lever to control hot and cold water. All three items are on the AUSCAN, Dr. Fernandes said.
"The outcome measures we have today," which also include Dreiser’s Functional Index, "are all expert opinion–based questionnaires. They haven’t really asked the patients themselves" about their daily struggles, she said.
She and her colleagues are using their findings to develop what they hope will be a more comprehensive questionnaire, but they declined to give details pending publication.
In the meantime, physicians might learn more about the challenges their OA patients face by going beyond current questionnaires; the study suggests additional things about which to ask. For many chores, there are tools to help, such as lid handles to open jars. Grip-strength exercises and range of motion exercises, especially for the thumb, may also help, Dr. Fernandes said.
In general, patients said they were still able to perform the tasks they listed, just not as well as before. Pain or fear of it might have had something to do with the problems, she said.
The study included 201 women and 10 men recruited consecutively as they presented to rheumatology clinics in Oslo and Trondheim. They were 63 years old on average, with a mean disease duration of 12.5 years and 8.6 affected joints; 64% had a comorbidity, 49% were employed.
The Norwegian Occupational Therapy Association and the Oslo Rheumatism Association paid for the study. Dr. Fernandes said she has no disclosures.