The Development of a Symptom-Prevention Hand Therapy Programme for thumb carpometacarpal joint Osteoarthritis

Abstract

Introduction: Thumb carpometacarpal joint osteoarthritis (CMC-1 OA) is a highly prevalent condition globally, leading to disabling pain and loss of function. Individuals suffering from this condition are usually seen after they present with symptoms, but rarely before symptoms start. Although we do not yet know exactly what the risk factors are for developing CMC-1 OA, literature does suggest a few, making it possible to identify individuals more likely to develop this condition. Early conservative hand therapy intervention for CMC-1 OA has been proven to significantly improve symptoms and even avoid surgery altogether. The question we asked ourselves is whether it may be possible to delay or prevent the onset of symptoms if individuals who are at risk of developing the condition, have access to intervention earlier - before symptoms start. To test this, a symptom prevention hand therapy programme (SPHTP) had to be developed first. Our study was aimed at developing the content of such a programme, and we present the results here in the form of a 40 item SPHTP with a high content validity index. Methods: To develop trustworthy content for a SPHTP, a mixed methods QUALquan study was done in two stages. Stage 1 included two phases – firstly asynchronous online focus groups were held with purposely selected global experts (n=19) to establish what to include in a SPHTP. A thematic analysis of the data followed and in the second phase, results were compared with current literature to develop proposed content of a SPHTP. Stage 2 involved sending the developed content to a smaller group of selected experts (n=10) and asking them to rate each proposed item for relevance of preventing or delaying symptoms of CMC-1 OA, using a 4-point Likert Scale. The scores were used to calculate the Content validity index (CVI) of the proposed content. Results: The two themes identified from the online focus groups were education and exercises. These were further corroborated with current literature and 45 items developed as proposed content of a SPHTP. Content included under education was basic information about CMC-1 OA, Risk factors and signs, dynamic stability of the thumb, further resources and hand ergonomics. Exercises included stretching of Adductor Pollicis, strengthening of First Dorsal Interosseus muscle, activation of correct muscles and motor control exercises. The proposed content was scored by international experts. Items scoring below 70% were excluded and based on comments, some items were amalgamated, resulting in a final list of 40 items. The CVI for the final included content was calculated and a score of 93.2% achieved, indicating an excellent content validity index. Discussion: The question about what to include in a SPHTP is far from easy since there are still different opinions of what to include in early intervention programmes. Our study resulted in the development of a helpful tool with excellent content validity, that can be used in further research to assess the impact of hand therapy intervention before symptoms start. Keywords: Osteoarthritis; Symptom prevention; Thumb CMC joint, content validity index, online focus group