title: Limited effects of exercises in people with hand osteoarthritis: results from a randomized controlled trial.
abstract: OBJECTIVE
  To determine the clinical effectiveness of an exercise programme on self-reported hand activity performance in people with hand osteoarthritis (OA).
  
  
  METHODS
  In this randomized, controlled trial, participants with physician-confirmed hand OA were randomly allocated to a 12-week exercise intervention (group- and home-based) or usual care. The primary outcome was self-reported hand activity performance at 3 months measured by the Functional Index for Hand Osteoarthritis (FIHOA) and a patient-generated measure of disability, the Patient-Specific Functional Scale (PSFS).
  
  
  RESULTS
  Of 130 randomized participants (mean age 66 (standard deviation (SD) 9); female 90%), 120 (92%) and 119 (92%) completed the 3- and 6-month follow-ups. The adjusted mean difference for the exercise vs control group was -0.5 points (95% confidence interval (CI) -1.6, 0.6) for the FIHOA score (0-30 scale, 0 = best) and 0.9 points (95% CI 0.1, 1.7) for the PSFS score (0-10 scale, 10 = best). Small significant mean differences in favour of the intervention group were found for hand pain, hand stiffness and disease activity, whereas no mean differences were observed in hand dexterity or maximal grip strength. A significantly larger proportion in the intervention (46%) vs control group (16%) fulfilled the Outcome Measures in Rheumatological Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria at 3 months (OR = 4.4, 95% CI 1.9, 10.2). At the 6-month follow-up, there were no significant group differences in any outcome.
  
  
  CONCLUSIONS
  The exercise programme was well tolerated among people with hand OA, but resulted only in small, beneficial short-term improvements on self-reported measures and not on most performance-based tests. Future studies should address optimal grip strength exercises and dosage.
  
  
  BACKGROUND
  ClinicalTrials.gov registration number: NCT01245842.
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway. Electronic address: nina.osteras@medisin.uio.no.
authors.forename: N
authors.initials: N
authors.lastname: Østerås
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; Department of Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway. Electronic address: k.b.hagen@medisin.uio.no.
authors.forename: K B
authors.initials: KB
authors.lastname: Hagen
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; FORMI (Communication Unit for Musculoskeletal Disorders), Division for Surgery and Neurology, Oslo University Hospital, Ullevål, Oslo, Norway. Electronic address: margreth.grotle@medisin.uio.no.
authors.forename: M
authors.initials: M
authors.lastname: Grotle
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway. Electronic address: anne-lene.svartrud@diakonsyk.no.
authors.forename: A-L
authors.initials: AL
authors.lastname: Sand-Svartrud
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway. Electronic address: petter.mowinckel@diakonsyk.no.
authors.forename: P
authors.initials: P
authors.lastname: Mowinckel
authors.affiliation: National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; Department of Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway. Electronic address: ingvild.kjeken@diakonsyk.no.
authors.forename: I
authors.initials: I
authors.lastname: Kjeken
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D050823:Hand Joints / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000534:rehabilitation*; D010349:Patient Compliance; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Exercises; Hand; Osteoarthritis; Randomized controlled trial