Carpometacarpal Osteoarthritis, Thumb Basal Joint Osteoarthritis, Thumb Osteoarthritis, Trapeziometacarpal Osteoarthritis
Conditions
Keywords
ICF, Biopsychosocial Assessment, Large Language Model, Artificial Intelligence, Trapeziometacarpal Joint, Prediction Model, Clinical Decision Support, Pain-Activity Patterns
Brief summary
Trapeziometacarpal osteoarthritis (TMC OA) is a common condition affecting the base of the thumb that causes pain, weakness, and difficulty with daily hand use. Current clinical assessment often focuses on physical findings alone, without considering psychological and social factors that also influence patient outcomes. This study has three objectives organized as interrelated work packages: OBJECTIVE 1 (Clinical Assessment): To comprehensively assess individuals with TMC OA using the International Classification of Functioning, Disability and Health (ICF) framework. This includes evaluating pain, joint mobility, grip strength, daily activity limitations, social participation, psychological factors (anxiety, depression, fear of movement, pain beliefs), and environmental factors (family support, ergonomic adaptations). OBJECTIVE 2 (AI Knowledge Evaluation): To compare the performance of four large language models (GPT-5.2, Claude Opus 4.6, Gemini 2.5 Pro, LLaMA 4 Maverick) in answering patient questions about TMC OA, and to test whether adding a clinician-oriented system prompt changes that performance. Each question is submitted under two prompting conditions (zero-shot and clinician-oriented system prompt) and responses are rated by blinded experts for accuracy, comprehensiveness and clinical relevance, with readability assessed by automated indices. OBJECTIVE 3 (AI-Based Prediction): To analyze whether the best-performing large language model can predict multidimensional ICF-based patient profiles using only a limited set of core clinical parameters.
Detailed description
This research consists of three independent but interrelated work packages with different methods and targets. Work Package 1 (Clinical Data Collection and ICF-Based Profile Analysis): Participants with TMC OA will undergo a single face-to-face comprehensive assessment using a cross-sectional design. The assessment battery is structured according to the ICF framework and covers five domains: (a) Body Structure/Function: pain, joint mobility, grip and pinch strength, joint stability, and OA staging; (b) Activity: daily activity limitations and pain-activity patterns (avoidance, overdoing, pacing); (c) Participation: social, domestic, and occupational participation; (d) Personal Factors: pain beliefs, coping strategies, kinesiophobia, anxiety, and depression; (e) Environmental Factors: family support and ergonomic adaptations. Work Package 2 (Comparison of Large Language Models' Clinical Knowledge Performance): Forty patient questions derived from search-engine "People Also Ask" data are submitted programmatically, through provider application programming interfaces, to four large language models (GPT-5.2, Claude Opus 4.6, Gemini 2.5 Pro, LLaMA 4 Maverick) under two prompting conditions: zero-shot, and with a clinician-oriented system prompt. This yields 320 responses. Two experts (a hand therapist and a hand surgeon), blinded to model identity and prompting condition, independently rate each response for accuracy, comprehensiveness and clinical relevance on anchored 5-point scales. Criterion-level disagreements of two points or more are referred to a third blinded hand surgeon, whose rating is substituted for that criterion. Readability is computed automatically as Flesch Reading Ease and Flesch-Kincaid Grade Level. Work Package 3 (LLM-Based Predictive Profile Modeling): The best-performing LLM identified in WP2 will be provided with core clinical predictors from WP1 data. The model's predictions for multidimensional ICF-based patient profiles will be compared against actual assessment results using established agreement and performance metrics. Sample size: Based on a priori power analysis (alpha=0.05, power=0.80, effect size=0.131), a minimum of 93 participants is required.
Interventions
None listed
Sponsors
Hacettepe University
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
25 Years to 74 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of trapeziometacarpal osteoarthritis (TMC OA) confirmed by an orthopedic surgeon and/or hand surgeon * TMC OA-related symptoms persisting for more than 3 months * Aged between 25 and 74 years * Literate in Turkish * Adequate cognitive function (Mini-Mental State Examination score of 25 or above) * No other chronic systemic disease (e.g., rheumatoid arthritis, chronic diabetes, cardiovascular disease, chronic hepatitis) * Voluntary participation with signed informed consent
Exclusion criteria
* Unwillingness to participate * Presence of a different orthopedic condition or prior surgery involving the thumb on the unilateral upper extremity * Uncontrolled systemic diseases (chronic obstructive pulmonary disease, congestive heart failure, endocrine system disease, history of stroke) * Diagnosis of any major psychopathology and currently receiving psychiatric or psychological treatment * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Grip Strength | Baseline (single assessment at enrollment) | Measured using a Jamar dynamometer. The participant performs the test in a seated position with the elbow flexed at 90 degrees. Unit of Measure: Kilograms |
| Pinch Strength | Baseline (single assessment at enrollment) | Measured using a pinchmeter to assess tip-to-tip and key pinch strength. Unit of Measure: Kilograms |
| Thumb Opposition (Kapandji Score) | Baseline (single assessment at enrollment) | Assessment of thumb opposition using the Kapandji score, which ranges from 0 to 10. Higher scores indicate better thumb opposition and mobility. |
| Pain Intensity | Baseline (single assessment at enrollment) | Measured using a Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity. |
| Pain Duration | Baseline (single assessment at enrollment) | Total duration of thumb pain reported by the participant. |
| Radiographic Severity (Eaton-Littler Stage) | Baseline (single assessment at enrollment) | Evaluation of the trapeziometacarpal joint osteoarthritis stage based on the Eaton-Littler classification (Stages I through IV). |
| Radial Subluxation Ratio | Baseline (single assessment at enrollment) | Radiographic measurement of the radial subluxation of the metacarpal base on the trapezium. |
| Upper Extremity Disability (QuickDASH) | Baseline (single assessment at enrollment) | Measured using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. The score ranges from 0 to 100, where higher scores indicate greater disability and symptoms. |
| Hand Disability (Turkish Thumb Disability Index - TDX) | Baseline (single assessment at enrollment) | Assessment of thumb-related disability. Scores range from 0 to 100, with higher scores indicating greater functional impairment. |
| Joint Hypermobility (Beighton Score) | Baseline (single assessment at enrollment) | Assessment of generalized joint laxity using the Beighton score. The total score ranges from 0 to 9, where higher scores indicate greater hypermobility. |
| Thumb Joint Range of Motion | Baseline (single assessment at enrollment) | Active range of motion of the thumb joints measured using a goniometer. Unit of Measure: Degrees |
| Provocative Tests | Baseline (single assessment at enrollment) | Clinical assessment using metacarpal adduction and extension tests to provoke symptoms. Presence or absence of pain (Binary: Yes/No) |
| Environmental Factors: Social Support and Ergonomic Adaptations | Baseline (single assessment at enrollment) | Qualitative assessment of the participant's family support and the presence of ergonomic adaptations in their daily environment. |
| Emotional Status (Hospital Anxiety and Depression Scale) | Baseline (single assessment at enrollment) | Measured using the Hospital Anxiety and Depression Scale (HADS), which consists of two subscales: Anxiety (HADS-A) and Depression (HADS-D). Each subscale ranges from 0 to 21, where higher scores indicate greater levels of anxiety or depression (worse outcome). |
| Kinesiophobia Level (Tampa Scale of Kinesiophobia) | Baseline (single assessment at enrollment) | Measured using the 17-item Tampa Scale of Kinesiophobia (TSK-17) to assess the fear of movement or re-injury. Total scores range from 17 to 68, where higher scores indicate greater kinesiophobia (worse outcome). |
| Pain-Activity Patterns (Patterns of Activity Measure-Pain). | Baseline (single assessment at enrollment). | Measured using the Patterns of Activity Measure-Pain (POAM-P) questionnaire to classify participants into three patterns: avoidance, overdoing, and pacing. Each subscale score indicates the frequency of that specific activity pattern. Higher scores on each subscale indicate a more frequent use of that specific activity pattern. |
| Pain Beliefs Profile (Pain Beliefs Questionnaire) | Baseline (single assessment at enrollment). | Assessed using the Pain Beliefs Questionnaire (PBQ), which evaluates two dimensions: Organic and Psychological pain beliefs. Scores range from 1 to 6 for each subscale, where higher scores indicate a stronger belief in that specific dimension (e.g., higher organic scores mean a stronger belief that pain is due to physical damage). |
| Pain Coping Strategies (Pain Coping Questionnaire). | Baseline (single assessment at enrollment). | Measured using the Pain Coping Questionnaire (PCQ) to assess the frequency of different coping strategies (e.g., information seeking, problem solving, distraction). Higher scores indicate a more frequent use of the respective coping strategy. |
| Large Language Model Clinical Knowledge Accuracy | Baseline (single assessment during the data collection period) | Accuracy of responses from four large language models to 40 patient-derived questions, each submitted under two prompting conditions (320 responses). Two blinded experts rate each response on an anchored 5-point scale (1 = mostly incorrect or potentially harmful, 5 = no factual error); criterion-level disagreements of two points or more are resolved by a third blinded expert. Higher scores indicate greater accuracy. |
| Large Language Model Content Comprehensiveness | Baseline (single assessment at enrollment) | Coverage of the elements a specialist would expect in an answer, rated by two blinded experts on an anchored 5-point scale (1 = question not genuinely answered, 5 = all essential elements covered), with third-expert arbitration of disagreements of two points or more. |
| Large Language Model Clinical Relevance | Baseline (single assessment) | Alignment of the response with the question asked, rated on an anchored 5-point scale (1 = unrelated, 5 = precisely and fully answers the question), with third-expert arbitration. |
| Large Language Model Readability Score | Baseline (calculated immediately after response generation) | Readability of generated responses, computed automatically as the Flesch Reading Ease score and the Flesch-Kincaid Grade Level. Higher Flesch Reading Ease scores indicate easier text; higher Flesch-Kincaid values indicate a higher required reading grade. |
| LLM Prediction Accuracy for Continuous ICF Profiles | Within 3 months after the completion of clinical data collection. | Prediction accuracy of the best-performing LLM (identified in WP2) in estimating continuous clinical scores (e.g., Grip Strength, QuickDASH scores) from core clinical predictors. Accuracy will be measured using the Intraclass Correlation Coefficient (ICC) to evaluate the agreement between LLM-predicted values and actual clinical assessment results. |
| LLM Prediction Accuracy for Categorical ICF Profiles | Within 3 months after the completion of clinical data collection. | Prediction accuracy of the best-performing LLM in estimating categorical patient profiles (e.g., Eaton-Littler Stage, POAM-P activity patterns). Accuracy will be measured using Cohen's Kappa coefficient to evaluate the agreement between LLM-predicted categories and actual expert-diagnosed categories. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlations Between Pain-Activity Patterns and Clinical Variables | Baseline (single assessment at enrollment) | This measure evaluates the correlation between the subscale scores of the Patterns of Activity Measure-Pain (POAM-P) questionnaire (Avoidance, Overdoing, and Pacing) and clinical parameters, including pain intensity (VAS), grip strength (kg), upper extremity disability (QuickDASH), and emotional status (HADS). Correlation will be analyzed using Spearman's or Pearson's correlation coefficients depending on the data distribution. Unit of Measure: Correlation Coefficient |
| Kinesiophobia Level (Tampa Kinesiophobia Scale) | Baseline (single assessment at enrollment). | Level of fear of movement or re-injury will be assessed using the unabbreviated 17-item Tampa Scale of Kinesiophobia (TSK-17). Total scores range from a minimum of 17 to a maximum of 68. Higher scores indicate a greater level of kinesiophobia (worse outcome). |
| Pain Beliefs Profile (Pain Beliefs Questionnaire) | Baseline (single assessment at enrollment) | This measure assesses the patients' beliefs about the cause of their pain using the unabbreviated Pain Beliefs Questionnaire (PBQ). The PBQ consists of two subscales: Organic Beliefs and Psychological Beliefs. Each subscale score is evaluated, and their correlation with coping strategies and emotional status is analyzed. For each subscale, scores range from 1 to 6 (calculated as an average of items), where higher scores indicate a stronger belief in that specific dimension (e.g., higher organic scores mean a stronger belief that pain has a physical cause). |
| Anxiety and Depression (Hospital Anxiety and Depression Scale) | Baseline (single assessment at enrollment). | Emotional status will be assessed using the Hospital Anxiety and Depression Scale (HADS). The scale consists of two subscales: HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D). Each subscale ranges from 0 to 21, where higher scores indicate greater levels of anxiety or depression (worse outcome). |
| Pain Coping Strategies (Pain Coping Questionnaire) | Baseline (single assessment at enrollment) | Evaluation of the various methods used by participants to manage their pain using the unabbreviated Pain Coping Questionnaire (PCQ). The questionnaire assesses different subscales such as Information Seeking, Problem Solving, and Distraction. Each subscale is scored, and higher scores indicate a more frequent use of that specific coping strategy (higher scores generally represent better or more active coping, depending on the specific subscale). |
Countries
Turkey (Türkiye)
Contacts
CONTACTTugba Ulusoy, MSc
STUDY_DIRECTORCigdem Ayhan Kuru, Professor
Hacettepe University, Faculty of Physical Therapy and Rehabilitation
Outcome results
None listed