Wrist osteoarthritis - Impact on daily life, self-management and outcome

Sammanfattning: For individuals with symptomatic wrist osteoarthritis (OA), pain is the central problem negatively affecting all aspects of life. Despite the recommendations that all OA patients should be offered self-management treatment options, this approach is often lacking for patients with wrist OA. In addition, there has been surprisingly little interest shown in investigating wrist OA patients' wishes and thoughts regarding their care.This thesis comprises four studies with the overall aim of investigating and increasing knowledge of wrist OA from various perspectives, with patients' functionality in focus. In Paper I, 13 individuals with advanced wrist OA, surgically treated with either total wrist fusion (TWF) or total wrist arthroplasty (TWA), were interviewed about their experiences of living with advanced wrist OA before and after surgery. Data were analyzed by qualitative content analysis. In Paper II, the Numerical Pain Rating Scale (NPRS/NRS), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) questionnaires were evaluated in 50 participants with wrist OA regarding test-retest reliability and construct validity. In Papers III and IV, 48 patients with wrist OA were randomized to a 12-week self-management program with either a neuromuscular joint-protective exercise therapy program (intervention group) or a placebo training program with range of motion (ROM) exercises only (control group). Primary outcome was pain and function assessed at 12 weeks with PRWE. The results showed that the painful osteoarthritic wrist had a negative impact on the participants whole lives. Pain relief was the main expectation and successful coping strategies were developed enabling the participants to adapt to challenges in daily life (Paper I). The NRS, DASH and PRWE demonstrated excellent test–retest reliability and moderate to high construct validity in patients with wrist OA (Paper II). After a 12-week self-management program including education and exercises, there was no significant between-group difference for the primary outcome PRWE. Overall, at 12 weeks, the neuromuscular joint-protective exercise therapy program was no better at reducing pain and improving function than the placebo ROM training program (Papers III and IV).In conclusion, this thesis provides an enhanced understanding of how patients' reason regarding their surgical choices between a motion-preserving (TWA) as opposed to a motion-sacrificing procedure (TWF) and how they cope with life after TWF or TWA. In addition, this thesis shows that pain and function in wrist OA can be measured reliably using NRS, DASH and PRWE. The thesis also acknowledges the lack of research within the area of exercise therapy in wrist OA and makes, to my knowledge, a first attempt to incorporate wrist OA in a first-line exercise therapy treatment approach.