Severity and progression of hand pain and functional difficulty: a prospective cohort study in community-dwelling older adults with hand pain

Abstract

Background
Hand problems are common in older adults causing pain and disruption to daily living. Understanding prognosis of such problems is therefore important to provide information on likely symptom course and to target treatment to those in most need. The aim of this thesis was to investigate prognosis of hand pain and functional difficulty in communitydwelling older adults with hand pain.

Methods
The majority of data analysis was based on a cohort of adults aged 50 years and over reporting hand pain in the last 12-months at baseline (N=623). The Australian/Canadian Hand Osteoarthritis Index (AUSCAN) was the primary measure of hand pain (0-10) and function (0-10), measured at baseline and four follow-up time-points (1.5, 3, 5, and 7.5-years). Random effect models, latent class growth models, parallel process growth
models and parallel process growth mixture models were used to model longitudinal trajectories of AUSCAN pain and functional difficulty over time.

Results
Trajectories of hand pain and functional difficulty were shown to be relatively stable for the majority of participants over the 7.5-year follow-up period with an overall mean change per year of 0.05 (95% confidence interval: 0.02, 0.07) and 0.07 (95% confidence interval 0.05, 0.09) points for AUSCAN pain and function respectively. Although combinations of predictors were identified that predicted symptom course, the strongest predictor was the baseline measure for the outcome of interest, with model fit not greatly improved by adding three further predictors to the model e.g. Nagelkerke’s pseudo R-square: Hand pain, baseline only 0.64; with additional predictors 0.70; Hand function, 0.80 and 0.83
respectively. A group of participants with hand pain trajectories that differed greatly from their hand function trajectories was not identified suggesting that changes in hand pain are linked to changes in hand function over time.

Conclusions
Progression of hand symptoms was not inevitable for all participants when assessed over a 7.5 year time-period. Baseline symptom severity may be the single most important predictor to identify those with an unfavourable symptom course and where early onward
referral/treatment may be useful. This work remains exploratory however until findings are replicated in an external dataset.