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The effects of a hand exercise regimen for women with osteoarthritis: A quantitative approach
Julia PoynterNovember 14, 2015Research MethodsFlorida Gulf Coast University
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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.
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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
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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?
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Methods
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Research Design Longitudinal Time series research
design Randomization- will examine any
cartilage every 6 month with an MRI In control group and research group
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Population Women Age: 50-75 years old From health clinics or orthopedic clinics
in the United States
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Inclusion Criteria Diagnosed with osteoarthritis Must take pre-test’s and post-tests Be willing to participate in long term
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Exclusion Criteria Persons without a diagnosis of
osteoarthritis Missing 3 or more clinical appointments
in a row without prior notice Males
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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
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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
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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
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Sampling 500 women
250 in control 250 in research group
United States Orthopedic clinics Health clinics
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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Data Collection: Finger Strength
Pinch Gauges Measures key, tip, and, palmar grasp Different ranged of scales (0-10,30,60
kgs)
(Beneficial Designs, 2015)
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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
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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
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Discussion
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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
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Feasibility Moderate, would require a long time
commitment Skype/ video calls may be implemented
to reduce travel time at convenience of the participant
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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
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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.
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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