BCMC-OA questionnaire: Adult Thumb CMC OA during Tier 2 MSK
Research type
Research Study
Full title
Exploring the Factors Influencing Patients' Decision-Making Process for Surgical Intervention versus Conservative Treatment Options for Thumb Carpometacarpal Osteoarthritis: A Questionnaire-Based Survey Study within a Tier 2 MSK/Orthopaedic Service.
IRAS ID
329398
Contact name
Ritu kharb
Contact email
Sponsor organisation
Bridgewater Community Healthcare NHS Foundation Trust
Clinicaltrials.gov Identifier
BCHC202306, BCHC202306
Duration of Study in the UK
0 years, 6 months, 0 days
Research summary
Summary of the Study:
Thumb Carpometacarpal (CMC) osteoarthritis is a common condition affecting the base of the thumb, causing pain, swelling, and reduced hand function. Treatment options include surgical intervention and conservative approaches like splinting, medication, and hand therapy. Deciding between these options is complex and influenced by various factors. This study aims to explore these factors within a Tier 2 MSK/Orthopaedic Service, using a questionnaire-based survey.
Adult patients diagnosed with CMC osteoarthritis and receiving consultations in the Tier 2 MSK/Orthopaedic Service will participate. The survey will collect data on demographics, disease severity, treatment knowledge, decision-making process, influencing factors, and satisfaction. Closed-ended questions will be analyzed descriptively, while open-ended questions will undergo thematic analysis.
Ethical considerations will be followed, including informed consent, data confidentiality, and approval from the relevant ethics committee. The study's significance lies in enhancing our understanding of patients' decision-making processes, leading to the development of decision-making tools for CMC osteoarthritis management. Healthcare professionals can improve patient-centeredness and satisfaction by utilizing these findings.
The study's outcomes can also form the basis for further research, allowing the development and evaluation of decision-making tools and exploring their implementation in clinical practice. The estimated timeline for this study is 6 months, with required resources including a research team, access to the Tier 2 MSK/Orthopaedic Service, data collection materials, analysis software, and ethical clearance.
Dissemination of results will occur through peer-reviewed publications, conference presentations, and sharing with the participating MSK/Orthopaedic Service for clinical practice improvement. The findings may contribute to the researcher's academic pursuits, including potential publications and public presentations.
In conclusion, this descriptive qualitative study aims to uncover the factors influencing patients' decision-making processes regarding surgical intervention versus conservative treatment options for thumb carpometacarpal osteoarthritis. The insights gained will inform decision-making tools, potentially improving clinical practice and patient outcomes while supporting the researcher's future endeavors.
Summary of results
Study Title: Exploring Factors Affecting Decision-Making between Surgical Intervention and Conservative Treatment for Thumb Carpometacarpal Osteoarthritis in a Tier 2 MSK/Orthopaedic Service
Design: Descriptive qualitative study
Setting: Tier 2 Musculoskeletal/Orthopaedic Service, Bridgewater Community Healthcare NHS Foundation Trust
Sample: 22 adult participants with thumb CMC osteoarthritis or related symptoms
Ethics: Approved by East of England – Cambridge South Research Ethics Committee (REC: 23/EE/0144) Aim and achieving Objectives of the study:
Aim of this qualitative study was to identify the Factors that influence patient Decision Making between surgical and conservative treatments for thumb carpometacarpal arthropathy using a tier 2 musculoskeletal / orthopaedic service. Furthermore, the aim of this qualitative study was to investigate how clinical presentation; patient knowledge of their condition; and the way services deliver care can affect collaborative decisions. The aims of the study were met. The study effectively found and synthesized both clinical and experiential determinants that shape patient choices; recorded patient perceptions of both surgical and nonsurgical paths; and created meaningful insights into what aspects of clinician-patient communication and consultation format can enhance patient Decision-Making and satisfaction in regular musculoskeletal practice.
Key findings:
Patients generally had an important symptom burden, which included pain (mostly > 8/10) for almost all Participants. Many Participants reported many different symptoms for various periods of time ranging from less than 6 months to greater than 5 years. This variation indicated a mix of early and late-stage presentations of OA CMC disease within the service. Every participant received information about conservative management options. Most Participants were offered conservative management options such as physical therapy, splints, activity modifications and corticosteroid injections. Ninety-five percent of Participants received discussion of surgical options and therefore there appears to be a strong implementation of shared-Decision-Making principles in presenting treatment options equally within consultations. Despite having high pain levels, a conservative approach was the preferred option by nearly two thirds (63.6%) of Participants. Approximately one quarter (27.3%) preferred surgery. Only 9.1% Participants could not decide. Therefore, it is evident that when patients are provided adequate information and support, they often choose nonoperative approaches despite having a considerable degree of symptom severity. four major Factors influenced Decision-Making based on qualitative thematic analysis. First factor is the quality and clarity of clinician-communication with patients. Second factor is whether Participants felt that their clinicians completed a comprehensive examination. Thirdly, whether Participants felt their clinicians clearly described the risks/benefits and alternatives associated with each treatment path. Fourthly, the importance of individualized/patient-centred care. Each theme emphasized the role of shared Decision-Making in influencing both patient comprehension of treatment options and preferences for treatment options. Communication quality was found to be significantly associated with participant satisfaction with and confidence in their selected management options.
Plans for disseminating results & publications:
Findings will be disseminated through several planned avenues to achieve both academic and service-based impacts. These plans involve submitting a manuscript to a peer-review journal in musculoskeletal or rehabilitation medicine, presenting findings at relevant clinical governance meetings within the musculoskeletal service, and sharing findings at regional or organizational musculoskeletal/orthopaedic conferences. Additionally, findings will be shared internally within Bridgewater community health care NHS foundation trust to provide evidence to aid in developing tier 2 MSK pathways, specifically focusing on improving shared Decision-Making practices in MSK services and increasing patient educational efforts. Lastly, results will be used to improve current service-improvement efforts that focus on enhancing communication structures and Decision-support tools.
Participant feedback:
Where possible, Participants will receive a plain language summary of the study's findings. The summary will describe study results including patient self-reports of their experience(s) and overall themes that contributed to patient Decision Making, as well as potential contributions to future improvements in msk service delivery. Where contact information exists, this summary will be delivered directly to Participants to provide transparency and closure to the study participation. Participant feedback is designed to demonstrate appreciation for the patient's involvement in study design and ultimately promote continued patient involvement in service development.REC name
East of England - Cambridge South Research Ethics Committee
REC reference
23/EE/0144
Date of REC Opinion
19 Jul 2023
REC opinion
Further Information Favourable Opinion