JHT READ FOR CREDIT ARTICLE # 065 A Multidisciplinary Hand Clinic for Patients with Rheumatic Diseases: a Pilot Study F.J. van der Giesen, PT Department of Rheumatology, Leiden University Medical Center, The Netherlands R.G.H.H. Nelissen, MD, PhD P.M. Rozing, MD, PhD Department of Orthopaedics, Leiden University Medical Center, The Netherlands J.H. Arendzen, MD, PhD Department of Rehabilitation, Leiden University Medical Center, The Netherlands Z. de Jong, MD, PhD Department of Rheumatology, Leiden University Medical Center, The Netherlands R. Wolterbeek, MSc Department of Medical Statistics, Leiden University Medical Center, The Netherlands T.P.M. Vliet Vlieland, MD, PhD Department of Rheumatology, Leiden University Medical Center, The Netherlands ABSTRACT: To describe the characteristics, management strate- gies and outcomes of patients with rheumatic diseases and com- plex hand function problems referred to a multidisciplinary hand clinic. Assessments (baseline and after three months of follow-up) included sociodemographic and disease characteristics and various hand function measures. The most frequently men- tioned impairments and limitations of the 69 patients enrolled in the study pertained to grip, pain, grip strength, and shaking hands. Fifty-six patients received treatment advice, conservative therapy (n ¼ 39), surgery (n ¼ 12), or a combination of both (n ¼ 5). In 38 of 56 patients (68%) the recommended treatment was performed, and 33 completed the follow-up assessment. On average, patients improved, with an increase in grip strength and the Michigan Hand Outcomes Questionnaire scores reached statistical signifi- cance. Two-thirds of patients with rheumatic conditions visiting a multidisciplinary hand clinic reportedly followed the treatment advice (recommendations), with an overall trend toward a benefi- cial effect on hand function. To further determine the added value of a structured, multidisciplinary approach a controlled compari- son with other treatment strategies is needed. J HAND THER. 2007;20:251–61. Hand function problems are common in patients with rheumatic diseases. It is estimated that the hands and wrists are affected in 80e90% of the patients with rheumatoid arthritis (RA), 1 whereas the hand is the most frequent site of involvement in osteoarthritis (OA). 2 Involvement of the hand is also common in patients with psoriatic arthritis, 3 scleroderma, 4 and systemic lupus erythematosus (SLE). 5 The importance of hand function in rheumatic conditions is underlined by the fact that the ‘‘fine hand use’’ domain is included in the recently devel- oped preliminary International Classification of Functioning, Disability, and Health (ICF) 6 Core Sets for both RA and OA. 7,8 The ICF is aimed at providing a unified and standard language and framework for the description of health and health-related states (Figure 1). Although the importance of hand function problems in rheumatic diseases is generally acknowl- edged, there is little evidence on how and when to use conservative or surgical interventions to optimize hand function. 9 This lack of knowledge can be partly explained by the complexity of hand function prob- lems in many patients. Limitations in hand function during activities of daily living (ADL) are often ac- companied by a combination of multiple impair- ments on the ICF level of body functions or body structures, such as pain, stiffness, joint swelling, limited range of motion (ROM), joint destruction, or deformities. Moreover, personal and environmental factors may play an important role in the occurrence and impact of hand function problems. SCIENTIFIC/CLINICAL ARTICLES Correspondence and reprint requests to F.J. van der Giesen, PT, Leiden University Medical Center, Department of Physical Therapy, H0-Q, PO Box 9600, 2300 RC Leiden, The Netherlands; e-mail: <f.j.van_der_giesen@lumc.nl>. 0894-1130/$ e see front matter Ó 2007 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. doi:10.1197/j.jht.2007.04.004 JulyeSeptember 2007 251