Introduction: Hand osteoarthritis (OA) is characterized by gradual destruction of cartilage in the joints of the hand. It is commonly characterized by pain, reduced grip strength, stiffness, and reduced pinch strength, resulting in difficulty performing basic daily tasks. Pharmacological and non-pharmacological practices are employed for hand OA treatment. Many research has been conducted on the effectiveness of treating hand OA using pharmacological and non-pharmacological practices. However, not many studies are carried out to review the effectiveness of those treatment processes, especially the non-pharmacological practices. In this thesis, I systematically review the literature to evaluate and analyze the existing non-pharmacological interventions to provide evidence-based knowledge of existing hand OA treatments. Methods:  PRISMA guidelines were used to design the study selection protocol. The identification of non-pharmacological treatments was performed using PubMed, Scopus, PEDro, Cochrane Library, and Web of Science. Initially, 268 articles were selected through a search process. Following the selection procedure, 10 articles were chosen to address the research question. The PEDro scale was used to assess the methodological quality and eligibility of the selected studies.  Result:  In the selected studies, a variety of interventions were examined for managing hand OA, such as exercise therapy, blood flow resistance training (BFRT), high intensity training (HIT)), patient education, conservative therapies (education, splints, and hand exercises), splinting. Other interventions such as paraffin therapy and kinesio taping (KT) and functional consultation were also employed. The selected studies examined pain, grip strength, hand function, pinch strength, and stiffness.  Conclusion: Based on the selected studies, it is found that non-pharmacological rehabilitative intervention has a significant impact on pain, grip strength, hand function, pinch strength, and stiffness.  BFRT and HIT are the two most feasible options for individuals with hand OA that relieve pain, grip strength and hand function and achieve the clinical outcomes that were previously set or examined by the physician.  Additionally, KT combined with paraffin therapy, splinting, and hand exercises can also significantly decrease pain and improve pinch strength, grip strength.

Hand Osteoarthritis (HOA) is the most common joint disease that affects the finger joints of older adults. Individuals with HOA have decreased handgrip strength and hand function. People with this condition have difficulties in grasping, gripping, twisting, and turning objects in daily living. As the disease advances structural changes such as loss of normal joint space, osteophyte formation, and bony nodules in people with HOA are common. Several investigators have examined the relationship between hand or body anthropometrics and handgrip strength and hand function in healthy diverse populations; however, no previous studies have investigated this association in people with HOA. The purpose of this thesis was to investigate the relationship between body and hand anthropometrics with hand strength and function in people with HOA, encompassing 2 papers. The first manuscript in this thesis was to describe the relationship between body and hand anthropometric variables with hand strength in people with HOA. In addition, it sought to establish the relative contribution among those variables for hand grip and pinch strengths in people with HOA. The second manuscript in this thesis was to describe the relationship between body and hand anthropometric variables with hand function in people with HOA. Further, it examines how anthropometric and demographic factors in combination explain hand function and health status in people with HOA. Finally, the thesis addresses the implications for the studies, limitations, and conclusions. / Thesis / Master of Science (MSc)

Background: A computer game based Telerehabilitation platform has been developed to provide a seamless system for hand exercise and assessment in home settings for people with arthritis. The exercise program involves task-oriented training of real life object manipulation tasks performed with computer gaming. The platform will also be integrated with a telemonitoring, computer game based hand function assessment application. Objectives: 1) To determine test-retest reliability and convergent validity of the assessment application protocol in people with rheumatoid arthritis or hand osteoarthritis, 2) To conduct a pilot randomized controlled trial for assessing the feasibility, and therapeutic effects of the task-oriented training compared to conventional hand exercises, and 3) To qualitatively evaluate participants’ experiences on their respective exercise programs. Methods: Performance during three different object manipulation tasks was evaluated by the assessment application protocol on 40 people with arthritis. The performance measures were correlated with other common hand function measures. A six-week pilot randomized trial was conducted on 16 individuals with arthritis. The Arthritis Hand Function Test (AHFT), the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, exercise compliance and task performance during three object manipulation tasks were the clinical outcomes. Focus group interviews were conducted on seven participants who had before received their home exercise programs. Results: The protocol demonstrated moderate to high test-retest reliability (ICCs between 0.5-0.84) of performance measures. Spearman correlation coefficients (rho) between task performance measures and other measures of hand function were low to moderate (0.4 < rho < 0.5 to 0.7). The pilot trial was not successful in terms of participant recruitment but demonstrated feasibility of study procedures, resources, and management. Except for two dexterity sub-scales of the AHFT, there were no significant differences in other clinical measures. Exercise compliance was >85% in both groups. The qualitative study provided initial evidence on the appropriateness, acceptance, perceived benefits, and a few practical difficulties in performing each exercise program. Conclusions: The hand function assessment application warrants validation in a variety of object manipulation tasks and in different patient populations. In order to proceed to a full-fledged trial, additional recruitment strategies, and revisions in the inclusion criteria must be considered. / February 2015

Hand osteoarthritis (OA) is a degenerative joint disease that causes pain, functional limitation and negatively affects the patients' quality of life. The most severe subtype of this disease is erosive OA. Erosive hand OA is characterized by an abrupt onset, inflammation and is linked to worse outcomes than non-erosive hand OA. Current methods do not allow early diagnosis or to distinguish between patients with different forms at disease onset. This could be changed by the utilization of biomarkers in clinical practice. Biomarkers are molecules released into circulation that reflect biological processes. The main goal of this study was to analyze the levels of circulating biomarkers with the aim to differentiate patients from healthy subjects and patients with erosive OA from patients with non-erosive disease. Serum concentrations of seven biomarkers and the expression of plasma microRNAs were determined. Patients with hand OA showed altered cartilage metabolism, increased levels of adiponectin, decreased levels of clusterin and a dysregulated expression of several microRNAs in comparison to the healthy population. Patients with erosive OA had lower levels of clusterin and decreased expression of miR-151-3p than those with the non-erosive form of the disease. These findings suggest the potential...