Research Article|Articles in Press

Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management

Published:March 12, 2023DOI:


      • Patients with TMO can experience moderate to severe pain, disability, disturbed emotional well-being, limited quality of life, and reduced work productivity.
      • Pain frequency and magnitude of disability accounted for 59.0% of the variance in TMO pain intensity while sex, pain intensity, depression, and education explained 60.1% of the variance in magnitude of disability.
      • The greater the intensity of the pain and the magnitude of the disability, the more the hand therapist should be attentive to depressive symptoms (eg, feelings of worry or despair).
      • Education in ergonomic principles and assistive devices are provided to only a small proportion of the participants (20%); since the efficacy of these interventions has been soundly demonstrated, they should be more broadly offered.
      • Since pain experience is unique to each individual, patients with TMO should benefit from interventions most suited to their specific needs from a biopsychosocial perspective.



      Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis.


      This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities.

      Study Design



      Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability.


      Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants’ norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services.


      Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians’ priorities.


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