DeQuervains disease: The Impact of a Patient Education Programme on Physical, Functional and Psychol

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DeQuervains disease The Impact of a Patient
Education Programme on Physical, Functional and
Psychological Status. A Pilot Study

• Rachel Batteson PhD, MSc, DipCOT
• University of Derby

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Introduction

• DeQuervains disease is Work Related
  Musculo-skeletal disorder (WRMSD) (Ranney et.al,
  1995 Armstrong et.al. 1987)
• WRMSDs are a major cause of loss of working days
  (Helliwell, 1997 Polanyi et.al., 1997
  Harrington et.al, 1998)
• Prevalence of WRMSDs
• Impact of WRMSDs on the economy

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• Factors involved in onset
• physical
• psychological
• psychosocial
• Structures affected
• tendons
• muscles
• nerves

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DeQuervains disease

• Stenosing tendovaginitis affecting first
  dorsal extensor compartment
• Clinical features (identified in the DeQuervains
  Screening Tool DQST)
• pain over the radial styloid process
• a positive Finkelsteins test
• pain on resisted extension
• swelling
• tenderness
• thickening of the tendon sheath

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• Intervention strategies for WRMSDs
• Medical management
• Physiotherapy
• Occupational therapy
• Ergonomic assessment
• Work conditioning/ work hardening
• Education programmes

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Evidence of the effectiveness of patient
education programmes for WRMSDs

• Dortch Trombly (1990) -- Preventative
  education programmes to change hand use habits
• Parenmark Malmkvist (1992) -- Exercise,
  assessment of functional hand status, work place
  assessment
• Feurestein et al. (1993) -- Multi-disciplinary
  cognitive-behavioural rehabilitation

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• Spence (1989) -- Cognitive-behavioural education
  programme
• Moore Weisner (1996) --Hypnotically induced
  vasodilation
• Karjalainen et.al. (2004) -- Systematic review of
  effectiveness of education programmes

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Karjalainen et.al. (2004) recommended

• Large scale randomised controlled trials
• Specific inclusion/ exclusion criteria
• A definition of WRMSD
• Trials using homogenous groups of patients
• Relevant outcome measures
• Treatment compared with usual care
• Cost effectiveness analysis
• Long term follow up at 6 or 12 months

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AimTo develop and evaluate the impact of a
patient education programme on functional,
physical and psychological status
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Development of the DeQuervains Education
programme (DQEP)

• It is a cognitive-behavioural education programme
  
• Health Belief Model (HBM) (Becker, 1974Janz
  Becker, 1984) Self-Efficacy Theory (Bandura,
  1997) Transtheoretical Model of Behavioural
  Change (Prochaska DiClemente, 1983)
• DQEP is an adaptation of Looking After Your
  Joints (Hammond Freeman, 2001)

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• Six week programme
• Information on deQuervains disease
• Defining changing hand use habits
• Practice changing hand use habits
• Methods to enhance learning
• Hand exercises
• Individual activity analysis
• Problem solving for individual activity

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• Physical/psychological links and stress
• Use a method of relaxation
• Identify the benefits of exercise on
  psychological health
• Use a problem solving process

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Method

• Randomised controlled trial
• Treatment (DQEP) versus standard conservative
  intervention (UC)
• Inclusion criteria
• Exclusion criteria
• Recruitment process
• Sample size analysis identified 26 participants
  were needed

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Outcome measures

• DeQuervains Joint Protection Behaviour
  Assessment (DQJPBA)
• Disabilities of the Arm, Shoulder Hand (DASH)
  (Hudak et.al., 1996)
• Hospital Anxiety Depression Scale (HAD)
  (Zigmond Snaith, 1983)
• Range of motion and grip strength
  (Cambridge-Keeling, 1995 Gilbertson
  Barber-Lomax, 1994)

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• Assessments at 0, 6 and 26 weeks.
• Independent Assessor
• Statistical analysis
• Non- parametric stats
• Chi-square (X2)
• Mann Whitney (U)
• Wilcoxon Signed Rank Test (Z)

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Results

• 21 participants
• 11 DQEP group
• 10 UC group
• Assessment 1 (0 weeks)
• Significant differences on HAD Depression and
  DASH work module

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Assessment 2 3DQJPBA A2. U31.00 p0.09.
A3. U43.00 p0.40
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DASH A2. U33.00 p0.12. A3. U47.00 p0.57
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HADDepression A2. U42.00p0.36. A3. U33.50
p0.13
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Anxiety A2. U46.50 p0.55. A3.U50.00 p0.72

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• Physical status
• Tip pinch A2.U23.00 p0.02. A3.U18.00 p0.01
• Lateral A2.U30.00 p0.08. A3.U51.00 p0.78

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Within Group Analysis -- Assessment 2
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Within Group Analysis -- Assessment 3
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Case History

• Participant A
• 39 year old female
• bilateral deQuervains disease
• previous treatment Physiotherapy
• OT
• NSAIDs
• steroid injections
• surgery x 4
• sick leave for 13 months

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Participant As results. Assessment 1, 2 3
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Discussion

• Changing hand use habits
• Changes in functional status
• Changes in psychological status
• Changes in physical status

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Limitations

• Sample size
• Outcome measures used
• HAD
• Self- efficacy

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Conclusions

• DQEP appears to facilitate a change in hand use
  habits
• There was a trend to improved functional status
  in DQEP group
• A significant difference in tip pinch strength
• No change in psychological function
• Results should be viewed with caution because of
  the small sample size

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Future recommendations

• Further research on a larger sample size

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Acknowledgements

• Grateful thanks to the NHS Executive for funding
  this research
• This research was conducted at the Pulvertaft
  Hand Centre, Derbyshire Royal Infirmary