Hand osteoarthritis rehabilitation practices in South Africa

Abstract

Background: Best-evidence recommendations guide the non-pharmacological management of patients diagnosed with hand osteoarthritis (OA) to manage function, quality of life, and pain based on the European League Against Rheumatism (EULAR) in their updated guidelines and recommendations. The current management approaches and use of these recommendations by occupational therapists and physiotherapists in South Africa for this condition have not yet been investigated. This study investigated the knowledge, patient load, and management practices used by occupational therapists and physiotherapists in South Africa, for individuals diagnosed with hand OA. Methods: This quantitative, cross-sectional study, included 34 postgraduate occupational therapists and physiotherapists in public and private sectors in South Africa. Participants completed the questionnaire after providing informed consent on the first question of a Research Electronic Data Capture (REDCap) questionnaire. The questionnaire data were exported to Excel and analysed using descriptive statistics in STATA. Results: Participants included 19 occupational therapists and 15 physiotherapists, 31 of whom were females. More occupational therapists obtained education in hand rehabilitation from accredited continuing education courses and reported more referrals and a higher patient load. Both occupational therapists and physiotherapists followed EULAR guidelines with a high percentage of occupational therapists providing intervention using splinting, activity modification, grip adjustment in activities of daily living, and exercise. Physiotherapists managed hand OA with exercise, pain education and joint mobilisations. Both professions provide education and home care programmes for patients with hand OA. Assessments for quality of life, and standardised outcome measures were infrequently used with limited referral of patients to a varied multidisciplinary team. Conclusion: Best-evidence practice for hand OA according to international EULAR guidelines and recommendations were implemented by a higher percentage of occupational therapists. Implications for practice: Best-evidence hand OA management recommendations are advocated and implemented by occupational therapists and physiotherapists in South Africa but further research on context specific intervention is required. Standardised hand function and quality of life assessments should be included in management approaches. Interdisciplinary practices, where the strengths of both occupational therapists and physiotherapists are highlighted, benefit individuals diagnosed with hand OA