Knitting as a Promising Pain Self-Management Strategy for Older Women With Osteoarthritis of the Hand
Exercise therapy has shown to be an effective strategy to reduce pain and disability in hand osteoarthritis (HOA), including the involvement of the thumb and affected carpometacarpal joint.1,2 Here, we describe the case of a right-handed, 86-year-old woman who was diagnosed with moderate (fingers R > L: grade 3) to severe (thumb R > L: grade 4) bilateral HOA. The physical examination revealed the presence of several bilateral active joints (i.e. tender joints (n = 7R and n = 4L), join effusion (n = 5R and n = 1L), pain at joint stress (n = 7R and n = 4L), joint deformities (n = 8R and n = 4L) as well as presence of Bouchard (n = 3R and n = 1L) and Heberden’s nodes (n = 4R and n = 4L) (see Fig. 1). A structured low-intensity home knitting program was prescribed to the patient (see Fig. 2), which included daily sessions of knitting activities over 12 weeks. The knitting sessions initially lasted 20 minutes, and were increased by 5 minutes every 4 weeks.
Short-term effects were self-reported each morning following knitting. The mean pain intensity, measured with a 100-mm visual analogue scale (VAS) scale, decreased from 78.8 ± 13.9 mm (mean of all pre-knitting measures) to 29.1 ± 1.6 mm (mean of all post-knitting measures) immediately after the knitting session for the five right fingers, 72.7 ± 10.5 mm to 22.1 ± 1.9 mm for the five left fingers, and 95.6 ± 2.8 mm to 90.1 ± 3.4 mm for her bilateral thumbs, resulting in improvements of 49.7%, 50.6%, and 5.5%, respectively. Based on a 5-point morning stiffness scale, the mean daily morning stiffness score improved from 3. 8 ± 0.2 points (mean of all pre-knitting measures) to 1.9 ± 0.6 points (mean of all post-knitting measures)for the five right fingers, from 3.7 ± 0.3 points to 1.8 ± 0.9 5 for the five left fingers, and from 3.9 ± 0.3 points to 3.8 ± 1.2 points for the bilateral thumbs, corresponding to improvements of 48%, 53%, and 3%, respectively.
Long-term effects were also measured. After 12 weeks, she reported a pain severity score of 10/20 points, a joint stiffness severity with score of 3/5 (R hand) and 2/5 (L hand) and a score of 20/36 for assisted daily living (ADL) based on HOA functional scale, resulting in improvements of 20%, 20%, and 25%, respectively, for the three components. An increase ranging between 6.7% and 53% was observed for bilateral individual finger-thumb pinch grip post-knitting after 12 weeks using a hand dynamometer. According to the patient global assessment at 12 weeks, her daily condition improved by 75%.
According to the patient’s logbooks, her adherence rate to daily knitting was 100%. Her self-reported long-term goal attainment level score was +2 (“much better than expected”). After 12 weeks, her self-efficacy score was 9/10 (i.e. 60% improvement) for each of the three subscales.