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There Is Inadequate Evidence to Determine the Effectiveness of Nonpharmacological and Nonsurgical Interventions for Hand Osteoarthritis: An Overview of High-Quality Systematic Reviews

R.H. Moe, PT, MSc, is Research Fellow, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, 0319 Oslo, Norway.
I. Kjeken, OT, PhD, is Researcher, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital.
T. Uhlig, MD, PhD, is Leading Consultant, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital.
K.B. Hagen, PT, PhD, is Professor, Institute of Nursing and Health Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.

Rikke.Moe{at}nrrk.no

Background: Patients with hand osteoarthritis are commonly treated by health care professionals (allied to medicine). Practice should be informed by updated evidence from systematic reviews of randomized controlled trials.

Purpose: The purpose of this overview is to summarize the evidence from systematic reviews of the effectiveness of nonpharmacological and nonsurgical interventions for patients with hand osteoarthritis.

Data Sources and Study Selection: Systematic reviews published between January 2000 and October 2008 were identified by a comprehensive literature search.

Data Extraction and Synthesis: Two reviewers independently selected reviews for inclusion, assessed their methodological quality, and extracted and synthesized data according to predefined criteria. Four systematic reviews finally were included. Based on single randomized controlled trials, there is some evidence of the effect of pain relief from topical capsaicin compared with placebo and for favorable functional outcomes for exercise and education compared with osteoarthritis information alone.

Limitations: In overviews, results are dependent on available systematic reviews. They are important tools to guide directions in choice of interventions and locate areas where more research is needed, but they might not be useful for deciding specifically how interventions should be carried out.

Conclusions: There currently is insufficient high-quality evidence regarding nonpharmacological and nonsurgical interventions for hand osteoarthritis. Considering the limited research evidence and the prevalence and impact of the disease, there is an urgent need for more trials of nonpharmacological and nonsurgical interventions for hand osteoarthritis.

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