WEST PALM BEACH, Fla. — People with hand osteoarthritis experienced greater improvements in pain and hand function and reduced disease activity if they used a smartphone app for patient education and guided exercises compared to those who received only usual care, according to research presented at the World Congress on Osteoarthritis (OARSI) 2026 Annual Meeting.

“Despite a higher than expected dropout rate, it seems that the Happy Hands app is an effective and safe mode of delivery for recommended first-line treatment in people with hand osteoarthritis, and it may be a way to reach more people with hand osteoarthritis,” Anne Therese Tveter, MSc, PhD, physiotherapist and professor at Diakonhjemmet Hospital, Oslo, Norway, told attendees.

The first-line treatment for people with hand osteoarthritis is patient education, hand exercises, and advice about assistive devices, yet quality of care remains suboptimal, Tveter said. Researchers therefore developed the Happy Hands app to provide evidence-based information about hand osteoarthritis and guided hand exercises over a 3-month period. Since the app does not require any interaction with a healthcare system, it can be used regardless of a person’s location, although it is currently offered only in Norwegian. 

After first conducting a feasibility study and incorporating several patients’ feedback into updates to the app, Tveter and colleagues assessed the app’s effectiveness in a randomized controlled trial as a self-management intervention for reducing pain and disease activity and improving hand function.

The trial enrolled 375 participants from 20 different primary and specialist healthcare sites across four health regions in Norway. All participants were at least 40 years old and had symptomatic hand osteoarthritis. They were randomly assigned to either usual care (n = 185) or usual care along with the Happy Hands app (n = 190). Participants completed a digital questionnaire at the start of the study and at 3 and 6 months later.

The researchers defined their primary endpoint as the probability of being an OMERACT-OARSI responder at 3 months. This measure is a composite that incorporates changes in self-reported pain (0-10 on a numeric rating scale with zero being no pain), hand function (1-4 on the Measure of Activity Performance of the Hand), and disease activity (0-10 on a numeric rating scale with zero indicating no activity). They defined adherence to using the app as watching 22 of the 29 information videos and performing hand exercises at least twice a week for at least 8 weeks.

The participants were mostly women (86%) and had an average age of 63 years. More than half had at least a college-level education (64%), and just over a third were working full-time or part-time (36%). A third used analgesics (33%), and more participants in the intervention group (71%) had additional comorbidities compared to the control group (59%).

Most participants (59%) reported symptoms in both their hands, while 24% had symptoms only in their right hand and 17% only in their left hand. Only 27% of participants had received previous treatment for their hand osteoarthritis, though this proportion was slightly higher in the intervention group than in the usual care group.

After 3 months, about 70% of participants in each group completed the digital follow-up questionnaire. Nearly half the participants (47%) using the Happy Hands app experienced an improvement in pain, disease activity, and hand function compared to just 20% of those in the usual care group.

In an intention-to-treat analysis, those using the Happy Hands app had 4.6 times higher odds of being an OMERACT-OARSI responder than those in the control group, with a risk difference of 26% if imputing participants who dropped out or 25% without imputation (both P < .001).

In terms of adherence, the majority of participants (69%) in the Happy Hands group exercised at least twice a week for at least 8 weeks, and about half (51%) watched at least 22 of the 29 videos. Twenty participants reported adverse events, including 12 who reported persistent pain and eight who reported transient pain, an expected outcome given the increased exercise, Tveter said.

Translations in Progress

To reach a wider pool of patients, the app is currently being translated for use in several additional languages — English, Dutch, and Swedish — with plans for a Danish and German version as well, Tveter said.

Maxime Auroux, MD, rheumatologist at Hospices Civils de Lyon in Lyon, France, who was not involved in the research, seemed impressed with this method of delivery for patient education and exercise recommendations.

“I found it very interesting that they developed an app for patients to engage and to empower patients in disease management,” Auroux told Medscape Medical News. “I think we should probably do more of that.”

He did note that using a mobile app may be more difficult for those who explicitly have hand osteoarthritis, and that may also have been the reason for the higher dropout rate, with fewer people filling out the questionnaires. “I would be great if the app were available in more places and in more languages,” Auroux added.

No external funding was noted for the study. Auroux and Tveter reported having no disclosures.

Tara Haelle is a science/health journalist based in Dallas.