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TOPLINE:

Occupational therapists matched rheumatologists in providing safe, effective care for hand osteoarthritis (OA).

METHODOLOGY:

• About 374 patients (mean age, 63.6 years; 80.7% women) in Norway with hand OA were randomly assigned to care by occupational therapists (n = 188) or rheumatologists (n = 186) between September 2017 and October 2019.
• Occupational therapists provided ergonomic techniques, assistive devices, hand exercises, and thumb orthoses; rheumatologists offered intra-articular glucocorticoid injections.
• The primary outcome was response to treatment at 6 months based on OMERACT-OARSI criteria, focusing on changes in hand pain, hand function, and disease activity.
• Economic analysis was performed by the Norwegian healthcare system to evaluate cost-effectiveness, with 6- and 12-month follow-up.

TAKEAWAY:

• At 6 months, 28.4% of participants in the rheumatologist-led group and 28.6% in the occupational therapist-led group met the response criteria (odds ratio, 1.01; 95% CI, 0.63-1.62).
• Occupational therapist-led care was non-inferior to rheumatologist-led care, with a response rate difference of 0.2% (95% CI, -9.6 to 9.8).
• No severe adverse events were reported, and patient satisfaction was high, with no significant differences in stiffness, pain, and grip strength between groups from baseline to 6 or 12 months.
• At lower willingness-to-pay thresholds up to £20,000 per quality-adjusted life-year, occupational therapy would be more cost-effective; rheumatologist-led care would be optimal at higher thresholds.

IN PRACTICE:

“This study advocates for the strategic use of occupational therapists in hand osteoarthritis management, aligning with global healthcare recommendations for task shifting, potentially leading to more efficient use of healthcare resources without compromising patient care quality,” the study authors wrote.

SOURCE:

The study was led by Annikka Polster, PhD, and Unni Olsen, PhD, Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway. It was published online on June 10, 2025, in The Lancet Rheumatology.

LIMITATIONS:

Because ethnicity is not commonly recorded in Norwegian studies, generalizability is limited by the lack of ethnic diversity data. The experience level of participating occupational therapists may not have reflected the broader population, potentially affecting the applicability of the findings. The study was conducted in a secondary care setting, whereas OA management is typically recommended in primary care.

DISCLOSURES:

The study was funded by the Norwegian Research Council, the Norwegian Rheumatism Association, the Norwegian Association of Occupational Therapists, and the Research Fund at Diakonhjemmet Hospital. One author disclosed receiving consulting fees from Novartis, GSK, and Grünenthal and being a member of the OARSI executive committee.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.