The effects of a hand exercise regimen for women with osteoarthritis: A quantitative approach

Julia PoynterNovember 14, 2015Research MethodsFlorida Gulf Coast University

Introduction: Literature ReviewThe most common form of arthritis in the United States is osteoarthritis (OA) with symptoms progressing over time (Lawrence et al., 2008). A patient with OA may have persistent joint pain, difficulty with gripping, crepitus, or a mild form of synovitis with symptoms typically peaking after periods of inactivity (Walker, 2011). As these symptoms may be present in any synovial joint of the human body, it often affects the patient’s quality of life as they would find difficulty with completing daily living tasks, driving, and leisure activities. No cure for OA has been found; however, with early detection, supportive treatment and symptom management therapies with an exercise element has been proven to benefit patients (Hennig et all., 2014). Current treatment options are often pharmaceutical or may include thermal treatments which provide a temporary relief to the pain caused by OA. In severe cases, surgical intervention may be necessary as the bone forms osteophytes which cause painful bone crystal formations in the degrading cartilage of the affected joint (Walker, 2011). With these being a temporary relief of pain, a long-term treatment plan is necessary for managing this disease.

Topic, Problem, and Purpose Topic

How hand exercise influences cartilage repair, range of motion, and grip strength

Problem Insufficient evidence that exercise of the

hand promotes long-term repair of cartilage

Purpose Find a correlation between regular, long-

term hand exercising and cartilage repair

Research Questions1. Does exercising for 15- 30 minutes each day for 5 years increase cartilage thickness?

2. Does exercise improve range of motion of fingers and overall grip strength?

3. How does this affect the participants quality of life?

Methods

Research Design Longitudinal Time series research

design Randomization- will examine any

cartilage every 6 month with an MRI In control group and research group

Population Women Age: 50-75 years old From health clinics or orthopedic clinics

in the United States

Inclusion Criteria Diagnosed with osteoarthritis Must take pre-test’s and post-tests Be willing to participate in long term

Exclusion Criteria Persons without a diagnosis of

osteoarthritis Missing 3 or more clinical appointments

in a row without prior notice Males

Sampling Method From health clinics* From Orthopedic clinics*

*Physicians and nurse practitioners would ask their patient that meets the inclusion criteria if they would be interested in partaking in the study

Randomization Technique Randomization should represent the

overall population of females with hand osteoarthritis 250 participants will be placed in the

control group 250 participants will be placed in the

research group

Human Rights Issue Will get IRB approval Consent form will include:

Privacy/ HIPAA disclaimer All information pertaining to the study Approximate time commitment necessary Compensation

Women pregnant/ intending on becoming pregnant will get IRB approval: Should pregnancy occur during the study, will

sign additional forms

Sampling 500 women

250 in control 250 in research group

United States Orthopedic clinics Health clinics

Analysis of Sampling Sample should represent the general

population of females with a diagnosis of hand osteoarthritis

Demographics All races Ages 50-75 years old Female

Treatment: Exercise Program Hand exercises at research facility for

15 minutes Appointment duration may be extended

for the first 6 months as participants learn new exercise routine and habits

Time in clinic will not extend beyond 1 hour in length

Perform home exercises on non-clinic days for 15-30 minutes

Time in study 0 mo. – 6 mo.

6 mo.-1 year 1 year+

1. Exercise at clinic2. Progress survey

2 days a week 1 day biweekly 1 day monthly

Home exercise *3 days a week

*4-5 days a week

*5 days a week

*On non-clinic days

Treatment: Exercise Program (Continued) Warm-up:

Ballistic stretch (30 seconds) Hand extender (Hold 10 seconds)

Exercises: Flexion and extension of the hand (20 intervals) Make a fist (Hold 15 seconds) Thumb flex (10 intervals) Thumb touches

Touch thumb to each finger (5 intervals alternating) Squeeze thumb and finger like pinching a paper from

blowing away in the wind

Treatment: Exercise Program (Continued)

PhaseWarm- up Ballistic

30 seconds

Hand extender10 seconds

Ballistic15 seconds

Routine 1* Flex./Ext.20 times

Make fistHold 15 seconds

Thumb Flex.10 times

Thumb touch (each finger 5 times)

Cool- down Ballistic30 seconds

Hand extender10 seconds

Ballistic 15 seconds

*Repeat routine 3 times

http://www.webmd.com/osteoarthritis/oa-treatment-options-12/slideshow-hand-finger-exercises

Treatment: Exercise Program (Continued) Measure cartilage growth, grip strength,

and finger strength every 6 months Monthly survey’s including:

Quality of life Pain level of hands and affected joints Additional comments by participant

Non-treatment: Control Continue with prescribed osteoarthritic

therapy Measure cartilage, grip strength, and

finger strength every 6 months Monthly survey’s including:

Quality of life Pain level Additional comments

Data Collection: Grip Strength Multi-finger assessment device (MFAD):

flexion and extension of all fingers MCP or PIP joints

Smedley Spring Dynamometer

(Beneficial Designs, 2015)

Data Collection: MRI MRI of cartilage

Measure an increase in density, growth, or repair of the cartilage in hand osteoarthritis

Degree of joint malalignment Ligament laxity

Data Collection: Finger Strength

Pinch Gauges Measures key, tip, and, palmar grasp Different ranged of scales (0-10,30,60

kgs)

(Beneficial Designs, 2015)

Data collection: Finger range of motion Finger range of motion will be measured

using a goniometer

Data will be displayed in a chart similar to this design

Data Analysis ANOVA will be utilized to analyze the

means of the data Values will be reported as a mean for

each measurement taken. Each measurement will be reported in a

scatter plot graph for individual variations to display trends over periods of time

Discussion

Limitations Cartilage repair takes a long time to do Time required for this study may be too

much for participants Pain management

Pain and inflammation management should improve as study progresses

Feasibility Moderate, would require a long time

commitment Skype/ video calls may be implemented

to reduce travel time at convenience of the participant

Study Implications Determine the approximate time frame

of cartilage growth/ repair and effectiveness in treating osteoarthritis

The outcome of this study would provide more insight into the replication of the cartilage matrix

Recommendations for Future Research Determine what metabolic factors might

influence the increased prevalence in females compared to males.

If cartilage growth is mild over the course of the 5 year study, a longer study may be necessary.

ResourcesBeneficial Designs. (2015). Objective Measures of Hand and Finger Strength. Finger Strength measurement devices Retrieved from

http://www. beneficialdesigns.com/products/wheelchair-seating -mobility /objective-measures-of-hand-and- finger-strength

Google. (2015). Measuring grip and pinch strength: norms, variances and precautions. What instruments are used for measuring grip

and pinch strength. Retrieved from https://sites.google.com/site/ 12movementincontext/what-instruments-are- used-for-

measuring-grip-and-pinch-strength

Hennig, T., Hæhre1, L., Hornburg, V. T., Mowinckel, P., Norli, E. S., & Kjeken, I. (2014). Effect of home-based hand exercises in

women with hand osteoarthritis: a randomised controlled trial. The Eular Journal. doi: 10.1136/annrheumdis-2013-204808

Lawrence R. C., Felson D. T., Helmick C. G., Arnold L. M., Choi H., Deyo R. A., Gabriel S., Hirsch R., Hochberg M. C.,

Hunder G. G., Jordan J. M., Katz J. N., Kremers H. M., Wolfe F. (2008). Estimates of the prevalence of arthritis and other

rheumatic conditions in the United States part II. PubMed, 58(1), 26-35. doi: 10.1002/art.23176

Walker, J. (2011). Management of osteoarthritis. Nursing Older People, 23(9), 14-19. Retrieved from

http://search.proquest.com.ezproxy.fgcu.edu/healthcomplete/docview/904405490/ 34F4C00E0FC44FABPQ/7?

accountid=10919