Case Report| Volume 31, ISSUE 2, P265-270, April 2018

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A client-centered approach for thumb carpometacarpal joint osteoarthritis pain: Two case studies


      • Two case studies have been presented in which the participants received an orthosis and joint protection education using a client-centered approach that was facilitated by the utilization of the Canadian Occupational Performance Measure.
      • Both participants showed improvement in pain, activity, and participation.
      • Focusing our rehabilitation strategies on that which is most important to the client should be considered to optimize their occupational performance by tailoring treatment interventions to their identified occupational performance issues.



      Case study.


      Hand therapists are often called upon to provide treatment for thumb carpometacarpal joint osteoarthritis.


      These 2 case studies present a client-centered approach in the selection of orthoses and joint protection strategies for patients with thumb carpometacarpal joint osteoarthritis. At baseline, the participants presented with pain, decreased active range of motion, decreased pinch strength, and limitations in activity and participation.


      The outcome measures utilized at study entry and 6 weeks included the pain Visual Analog Scale, the Australian Canadian Osteoarthritis Hand Index, the Disabilities of the Arm, Shoulder and Hand questionnaire, the Canadian Occupational Performance Measure, active range of motion measured with goniometry, and pinch strength measured with a pinch gauge. The Canadian Occupational Performance Measure facilitated the client-centered approach by identifying occupational performance issues and rating the participant's performance and satisfaction for each. Each participant was prescribed a different orthotic design, received client-centered joint protection instruction, and evidence-based exercises.


      After 6 weeks, both clients had decreased pain and improvement in their activities, participation, and satisfaction.


      Using a client-centered approach can help therapists to carefully consider a patient's occupational needs when designing and fabricating orthoses and customizing their joint protection education for carpometacarpal joint osteoarthritis.


      Focusing rehabilitation strategies on that which is most important to the client should be considered to optimize their occupational performance.


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      JHT Read for Credit

      Quiz: #540

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The study design is
        • a.
        • b.
          an RCT
        • c.
          case report
        • d.
          prospective cohort
      • #2.
        Results were assessed at
        • a.
          6 weeks after treatment was started
        • b.
          6 months after treatment was started
        • c.
          2 months after treatment was started
        • d.
          1 year after treatment was started
      • #3.
        Evaluation measures included
        • a.
          ROM & pinch strength
        • b.
          the DASH
        • c.
          the Canadian Occupational Performance Measure
        • d.
          all of the above
      • #4.
        A key feature of patient management was
        • a.
          ultrasound and massage
        • b.
          manual joint mobilization
        • c.
          a static orthosis
        • d.
          a dynamic orthosis
      • #5.
        The authors refer to their intervention strategy as a “Client-centered approach”
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.