None listed
Conditions
Brief summary
Background: The prevalence of hand osteoarthritis (HOA) has been reported to be higher amongst women over 50 years old (66%) compared to men of the same age (34%). Although exercise therapy has been shown effective in reducing symptoms and disability associated with HOA, adherence to treatment programs remains low. The primary objective of this RCT is to examine the effectiveness of a 12-week knitting program for morning stiffness (primary outcome) and pain relief (secondary outcome) 2 h post-wakening in females (aged 50 to 85 years old) with mild to moderate hand osteoarthritis (HOA). Methods/design: A single-blind, two-arm randomized controlled trial (RCT) with a parallel group design will be used to reach this objective and compare results to a control group receiving an educational pamphlet on osteoarththritis (OA) designed by the Arthritis Society. The premise behind the knitting program is to use a meaningful occupation as the main component of an exercise program. The knitting program will include two components: 1) bi-weekly 20-min knitting sessions at a senior’s club and 2) 20-min home daily knitting sessions for the five remaining weekdays. Participants assigned to the control group will be encouraged to read the educational pamphlet and continue with usual routine. Pain, morning stiffness, hand function, self-efficacy and quality of life will be measured at baseline, six weeks, 12 weeks (end of program) with standardized tools. We hypothesize that participants in the knitting program will have significant improvements in all clinical outcomes compared to the control group. A published case study as well as the preliminary results of a feasibility study as examined through a 6-week pre-post study (n = 5 women with HOA) involving 20-min daily knitting morning sessions led to this proposed randomized controlled trial research protocol. This article describes the intervention, the empirical evidence to support it. Discussion: This knitting RCT has the potential to enhance our understanding of the daily HOA symptoms control and exercise adherence, refine functional exercise recommendations in this prevalent disease, and reduce the burden of disability in older women.
Interventions
Participants in both groups will continue with their ongoing medical care to measure the true effect of the knitting intervention, active hand exercises need to be avoided
since they are proven effective for hand osteoarthritis. This may not be possible thus all participants will complete a daily activity log. Participants in Group 1 will take part in a low-intensity knitting program, performed as a morning functional activity, which will comprise two components: 1) bi-weekly 20-min knitting ses
Participants in both groups will continue with their ongoing medical care to measure the true effect of the knitting intervention, active hand exercises need to be avoided since they are proven effective for hand osteoarthritis. This may not be possible thus all participants will complete a daily activity log. Participants in Group 1 will take part in a low-intensity knitting program, performed as a morning functional activity, which will comprise two components: 1) bi-weekly 20-min knitting sessions at a senior’s club and 2) 20-min home daily knitting sessions for the five remaining weekdays over 12 consecutive weeks (total of 90 sessions). The bi-weekly 20-min knitting session will take place, at a Senior’s Club in metropolitan Ottawa, on Tuesday and Thursday mornings with a group of regular members who knit wool blankets for sick children admitted CHEO, a regional Children’s Hospital. The blankets are composed of individual squares that are assembled together. Each wool square takes approximately 20 min for a beginner knitter. Each knitter will be encouraged to knit one wool square per day for a total of seven squares per week. To avoid excessive isometric strength and potential muscle fatigue with the use of small needles that require precise pinching, participants will use specific knitting needle and wool sizes (sizes #6 and #5 respectively according to the Standard Yarn Weight System (http://www.craftyarncouncil.com/weight.html). Study participants will learn how to knit with a qualified instructor from Senior’s Club during the knitting sessions which will also be supervised by a trained occupational therapist to ensure that the physiological and clinical characteristics of therapeutic exercise are being met. A knitting instructor will ensure that participants follow the prescribed program and if their individual logbooks, where they recorded their daily hand activities and morning stiffness and pain levels, are filled properly. In the event that a session is missed, participants in Group 1 will receive a telephone reminder from the research assistant to encourage them to attend the next session. At the end of 12 weeks, participants will be encouraged to continue on with the program if they gained an improvement of their condition.
Sponsors
University of Ottawa Research Chair
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
50 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
To be eligible for this randomized controlled trial, participants will be required to: 1) meet the American College of Rheumatology clinical and radiographic criteria of definite hand osteoarthritis and of mild to moderate severity status and have experienced pain symptoms for at least three months, 2) be between 50 and 85 years of age, 3) have a level of morning stiffness of at least 4/10 on a visual analogue scale for most days of the prior month at the time of study entry, 4) display X-ray evidence of joint space narrowing of the hands, 5) have no knowledge of knitting (do not know how to knit) or have not knitted in the last 2 months; 6) be available for sessions at the senior’s club twice a week, 7) be able to understand written and verbal English instructions.
Exclusion criteria
Participants will be excluded if they: 1) are current active knitters; 2) are unwilling or unable to adhere to the knitting program for 12 consecutive weeks, 3) have other orthopedic, rheumatologic diseases (i.e. inflammatory arthritis, psoriasis arthritis, gout…), or evidence of chondrocalcinosis, 4) had any prior surgery for the finger joints, 5) have any acute disease, such as uncontrolled diabetes mellitus, untreated hypertension, neurological deficits (motor or sensory) or cognitive deficit and mental health conditions, 6) are taking osteoarthritis medication that is expected to change during the study period, 7) receiving current rehabilitation treatment or any other pain-related treatment besides medication for osteoarthritis, 8) have received corticosteroid injection of finger joints within the last 6 months, 9) plan to move or relocate within six months.
Outcome results
None listed