Incorporation of occupational based intervention into joint protection education for individuals with thumb carpometacarpal osteoarthritis: A case series

Published:August 28, 2022DOI:



      To our knowledge, the use of occupational performance in education on joint protection techniques has not been studied for individuals with thumb carpometacarpal (CMC) osteoarthritis.


      This case series was designed to investigate if occupation-based instruction inside the clinic was useful and found satisfactory as an educational tool for individuals with thumb CMC joint arthritis.


      Three participants with thumb CMC joint osteoarthritis performed washing, rinsing, and drying a dish, moving a pot and pan, maneuvering a laundry basket, and pouring from a pitcher during joint protection education in the therapy clinic with a skilled hand therapist in addition to routine treatment. Satisfaction with this intervention was assessed via a 3-question satisfaction survey. Pain with activity and function via the Thumb Disability Examination were assessed at baseline and a 4week follow up.


      Patients in this study expressed satisfaction with the inclusion of the performance of occupations in their joint protection education in the clinic. Pain with activity improved by an average of 1.7/10 on a 10-point Numeric Pain Rating Scale and function improved by an average of 10.04 on the Thumb Disability Examination.


      Although no causal relationships can be assumed in this study, hand therapists should consider adding occupation-based intervention as a component of patient education on joint protection for individuals with thumb CMC joint osteoarthritis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Therapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Weinstock-Zlotnick G
        • Mehta SP.
        A systematic review of the benefits of occupation-based intervention for patients with upper extremity musculoskeletal disorders.
        J Hand Ther. 2019; 32: 141-152
        • Skubik-Peplaski C
        • Howell D
        • Harrison A.
        Becoming occupation-based: a case study.
        Occup Ther Health Care. 2014; 28: 431-443
        • Guzelkucuk U
        • Duman I
        • Taskaynatan MA
        • Dincer K
        Comparison of therapeutic activities with therapeutic exercises in the rehabilitation of young adult patients with hand injuries.
        J Hand Surg. 2007; 32A: 1429-1435
        • Keller JL
        • Henderson JP
        • Landrieu DImick MP
        • Walsh JM
        The 2019 practice analysis of hand therapy and the use of orthoses by certified hand therapists [e-pub ahead of print April 14, 2021].
        J Hand Ther. 2021;
        • World Health Organization
        International Classification of Functioning, Disability and Health: ICF.
        WHO, Geneva2001
        • Valdes K
        • Naughton N
        • Burke CJ
        Therapist-supervised hand therapy versus home therapy with therapist instruction following distal radius fracture.
        J Hand Surg Am. 2015; 40: 1110-1116
        • Hammond A
        • Prior Y
        The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review.
        Br Med Bull. 2016; 119: 49-62
        • Lyngcoln A
        • Taylor N
        • Pizzari T
        • Baskus K
        The relationship between adherence to hand therapy and short-term outcome after distal radius fracture.
        J Hand Ther. 2005; 18: 2-8
        • Ouegnin A
        • Valdes K
        Client preferences and perceptions regarding a written home exercise program or video self-modeling: a cross-sectional study.
        J Hand Ther. 2020; 33: 67-72
        • Choi Y
        • Nam J
        • Yang D
        • Jung W
        • Lee HR
        • Kim SH
        Effect of smartphone application-supported self-rehabilitation for frozen shoulder: a prospective randomized control study.
        Clin Rehabil. 2019; 33: 653-660
        • Valdes K
        • Gendernalik E
        • Hauser J
        • Tipton M
        Use of mobile applications in hand therapy.
        J Hand Ther. 2020; 33: 229-234
        • O'Brien V
        • Giveans MR
        Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: a retrospective study.
        J Hand Ther. 2013; 26: 44-51
        • Wouters RM
        The effect of an exercise program in patients with thumb base osteoarthritis: a prospective cohort study with propensity score matching [Unpublished Master's Thesis].
        Utrecht University, Utrecht, The Netherlands2016
        • Standring S. Gray's Anatomy
        The Anatomical Basis of Clinical Practice.
        39th ed. Elsevier, St Louis2005
        • Flatt AE
        The Care of the Rheumatoid Hand.
        4th ed. CV Mosby, St. Louis:1983
        • Mathes T
        • Pieper D
        Clarifying the distinction between case series and cohort studies in systematic reviews of comparative studies: potential impact on body of evidence and workload.
        BMC Med Res Methodol. 2017; 17: 107
        • Nissen T
        • Wynn R
        The clinical case report: a review of its merits and limitations.
        BMC Res Notes. 2014; 7
        • Bertozzi L
        • Valdes K
        • Vanti C
        • Negrini S
        • Pillastrini P
        • Villafañe JH
        Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.
        Disabil Rehabil. 2015; 37: 2025-2043
        • Öncel A
        • Küçükşen S
        • Ecesoy H
        • Sodali E
        • Yalçin Ş
        Comparison of efficacy of fluidotherapy and paraffin bath in hand osteoarthritis: a randomized controlled trial.
        Arch Rheumatol. 2020; 36: 201-209
        • Cantero-Téllez R
        • Valdes K
        • Schwartz DA
        • Medina-Porqueres I
        • Arias JC
        • Villafañe JH
        Necessity of Immobilizing the Metacarpophalangeal Joint in Carpometacarpal Osteoarthritis: Short-term Effect.
        Hand (N Y). 2018; 13: 412-417
        • Cantero-Téllez R
        • Pérez-Cruzado D
        • Villafañe JH
        • García-Orza S
        • Naughton N
        • Valdes K
        The effect of proprioception training on pain intensity in thumb basal joint osteoarthritis: a randomized controlled trial.
        Int J Environ Res Public Health. 2022; 19: 3592
        • McQuillan TJ
        • Kenney D
        • Crisco JJ
        • Weiss AP
        • Ladd AL
        Weaker functional pinch strength is associated with early thumb carpometacarpal osteoarthritis.
        Clin Orthop Relat Res. 2016; 474: 557-561
        • Villafañe JH
        • Valdes K
        • Pedersini P
        • Berjano P
        Thumb carpometacarpal osteoarthritis: a musculoskeletal physiotherapy perspective.
        J Bodyw Mov Ther. 2019; 23: 908-912
        • Kjeken I
        • Dagfinrud H
        • Slatkowsky-Christensen B
        • Mowinckel P
        • Uhlig T
        • Kvien TK
        • et al.
        Activity limitations and participation restrictions in women with hand osteoarthritis: patients’ descriptions and associations between dimensions of functioning.
        Ann Rheum Dis. 2005; 64: 1633-1638
        • Østerås N
        • Gulbrandsen P
        • Garratt A
        • et al.
        A randomised comparison of a four- and a five-point scale version of the Norwegian Function Assessment Scale.
        Health Qual Life Outcomes. 2008; 6: 14
        • Noback PC
        • Lombardi JM
        • Seetharaman M
        • Lee DH
        • Strauch RJ
        • Rosenwasser MP
        Development and validation of a disease-specific questionnaire for basal joint arthritis.
        J Wrist Surg. 2017; 6: 126-133
        • Beaton DE
        • Katz JN
        • Fossel AH
        • Wright JG
        • Tarasuk V
        • Bombardier C
        Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity.
        J Hand Ther. 2001; 14: 128-146
        • Bäcker HC
        • Freibott CE
        • Rizzo M
        • et al.
        Thumb disability examination (tdx) as a new reliable tool for basal joint arthritis.
        J Wrist Surg. 2020; 9: 209-213
        • Bobos P
        • MacDermid JC
        • Boutsikari EC
        • et al.
        Evaluation of the content validity index of the Australian/Canadian osteoarthritis hand index, the patient-rated wrist/hand evaluation and the thumb disability exam in people with hand arthritis.
        Health Qual Life Outcomes. 2020; 18: 302
        • Johnson L
        • Karau R
        • McGee C
        Concurrent validity and precision of the thumb disability examination (TDX) in first carpometacarpal osteoarthritis [e-pub ahead of print, 2021 Sep 22].
        J Hand Ther. 2021;
        • Hjermstad MJ
        • Fayers PM
        • Haugen DF
        • et al.
        Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review.
        J Pain Symptom Manage. 2011; 41: 1073-1093
        • Michener L
        • Snyder A
        • Leggin B
        Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status.
        J Sport Rehabil. 2011; 20: 115-128
        • Salaffi F
        • Stancati A
        • Silestri CA
        • Ciapetti A
        • Grassi W
        Minimally clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
        • Egan MY
        • Brousseau L
        Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence.
        Am J of Occup Ther. 2007; 61: 70-78
        • Valdes K
        • Marik T
        A systematic review of conservative interventions for osteoarthritis of the hand.
        J Hand Ther. 2010; 23: 334-351
        • Kjeken I
        • Smedslund G
        • Moe RH
        • Slatkowsky-Christensen B
        • Unlig T
        • Hagen KB
        Systematic review of design and effects of splints and exercise programs in hand osteoarthritis.
        Arthritis Care Res. 2011; 63: 834-848
        • Bertozzi L
        • Valdes K
        • Vanti C
        • Negrini S
        • Pillastrini P
        • Villafane JH
        Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.
        Disabil Rehabil. 2015; 37: 2025-2043
        • Spaans AJ
        • van Minnen P
        • Kon M
        • Schuurman AH
        • Schreuders AR
        • Vermeulen GM
        Conservative treatment of thumb base osteoarthritis: a systematic review.
        J Hand Surg. 2015; 40: 16-21
        • Hansen AO
        • Kristensen HK
        • Cederlund R
        • Moller S
        • Tromborg H
        An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale- a randomized controlled trial.
        J Hand Ther. 2020; 33: 455-469
        • Berlet L
        • Kaskutas V
        Developing occupation kits in a hand therapy student experiential learning clinic.
        Hand Therapy. 2020; 25: 73-82
        • Grice KO
        The use of occupation-based assessments and intervention in the hand therapy setting- a survey.
        J Hand Ther. 2015; 28: 300-306