1. The effects of a hand
exercise regimen for
women with
osteoarthritis: A
quantitative approach
Julia Poynter
November 14, 2015
Research Methods
Florida Gulf Coast University

2. Introduction: Literature Review
The most common form of arthritis in the United States is osteoarthritis
(OA) with symptoms progressing over time (Lawrence et al., 2008). A patient with
OA may have persistent joint pain, difficulty with gripping, crepitus, or a mild form
of synovitis with symptoms typically peaking after periods of inactivity (Walker,
2011). As these symptoms may be present in any synovial joint of the human
body, it often affects the patient’s quality of life as they would find difficulty with
completing daily living tasks, driving, and leisure activities. No cure for OA has
been found; however, with early detection, supportive treatment and symptom
management therapies with an exercise element has been proven to benefit
patients (Hennig et all., 2014). Current treatment options are often
pharmaceutical or may include thermal treatments which provide a temporary
relief to the pain caused by OA. In severe cases, surgical intervention may be
necessary as the bone forms osteophytes which cause painful bone crystal
formations in the degrading cartilage of the affected joint (Walker, 2011). With
these being a temporary relief of pain, a long-term treatment plan is necessary for
managing this disease.

3. Topic, Problem, and Purpose
 Topic
 How hand exercise influences cartilage repair,
range of motion, and grip strength
 Problem
 Insufficient evidence that exercise of the hand
promotes long-term repair of cartilage
 Purpose
 Find a correlation between regular, long-term
hand exercising and cartilage repair

4. Research Questions
1. Does exercising for 15- 30 minutes each day
for 5 years increase cartilage thickness?
2. Does exercise improve range of motion of
fingers and overall grip strength?
3. How does this affect the participants quality
of life?

5. Methods

6. Research Design
 Longitudinal Time series research design
 Randomization- will examine any cartilage
every 6 month with an MRI
 In control group and research group

7. Population
 Women
 Age: 50-75 years old
 From health clinics or orthopedic clinics in the
United States

8. Inclusion Criteria
 Diagnosed with osteoarthritis
 Must take pre-test’s and post-tests
 Be willing to participate in long term

9. Exclusion Criteria
 Persons without a diagnosis of osteoarthritis
 Missing 3 or more clinical appointments in a
row without prior notice
 Males

10. Sampling Method
 From health clinics*
 From Orthopedic clinics*
*Physicians and nurse practitioners would ask
their patient that meets the inclusion criteria if
they would be interested in partaking in the
study

11. Randomization Technique
 Randomization should represent the overall
population of females with hand osteoarthritis
 250 participants will be placed in the control
group
 250 participants will be placed in the research
group

12. Human Rights Issue
 Will get IRB approval
 Consent form will include:
 Privacy/ HIPAA disclaimer
 All information pertaining to the study
 Approximate time commitment necessary
 Compensation
 Women pregnant/ intending on becoming
pregnant will get IRB approval:
 Should pregnancy occur during the study, will sign
additional forms

13. Sampling
 500 women
 250 in control
 250 in research group
 United States
 Orthopedic clinics
 Health clinics

14. Analysis of Sampling
 Sample should represent the general
population of females with a diagnosis of
hand osteoarthritis
 Demographics
 All races
 Ages 50-75 years old
 Female

15. Treatment: Exercise Program
 Hand exercises at research facility for 15
minutes
 Appointment duration may be extended for the
first 6 months as participants learn new
exercise routine and habits
 Time in clinic will not extend beyond 1 hour in
length
 Perform home exercises on non-clinic days
for 15-30 minutes

16. Time in study 0 mo. – 6 mo. 6 mo.-1 year 1 year+
1. Exercise at clinic
2. Progress survey
2 days a week 1 day biweekly 1 day monthly
Home exercise *3 days a week *4-5 days a week *5 days a week
*On non-clinic days

17. Treatment: Exercise Program
(Continued)
 Warm-up:
 Ballistic stretch (30 seconds)
 Hand extender (Hold 10 seconds)
 Exercises:
 Flexion and extension of the hand (20 intervals)
 Make a fist (Hold 15 seconds)
 Thumb flex (10 intervals)
 Thumb touches
 Touch thumb to each finger (5 intervals alternating)
 Squeeze thumb and finger like pinching a paper from
blowing away in the wind

18. Treatment: Exercise Program
(Continued)
Phase
Warm- up Ballistic
30 seconds
Hand extender
10 seconds
Ballistic
15 seconds
Routine 1* Flex./Ext.
20 times
Make fist
Hold 15 seconds
Thumb Flex.
10 times
Thumb
touch (each
finger 5
times)
Cool- down Ballistic
30 seconds
Hand extender
10 seconds
Ballistic
15 seconds
*Repeat routine 3 times
http://www.webmd.com/osteoart
hritis/oa-treatment-options-
12/slideshow-hand-finger-
exercises

19. Treatment: Exercise Program
(Continued)
 Measure cartilage growth, grip strength, and
finger strength every 6 months
 Monthly survey’s including:
 Quality of life
 Pain level of hands and affected joints
 Additional comments by participant

20. Non-treatment: Control
 Continue with prescribed osteoarthritic
therapy
 Measure cartilage, grip strength, and finger
strength every 6 months
 Monthly survey’s including:
 Quality of life
 Pain level
 Additional comments

21. Data Collection: Grip Strength
 Multi-finger assessment device (MFAD):
 flexion and extension of all fingers
 MCP or PIP joints
 Smedley Spring Dynamometer
(Beneficial Designs, 2015)

22. Data Collection: MRI
 MRI of cartilage
 Measure an increase in density, growth, or
repair of the cartilage in hand osteoarthritis
 Degree of joint malalignment
 Ligament laxity

23. Data Collection: Finger Strength
 Pinch Gauges
 Measures key, tip, and, palmar grasp
 Different ranged of scales (0-10,30,60 kgs)
(Beneficial Designs, 2015)

24. Data collection: Finger range of
motion
 Finger range of motion will be measured
using a goniometer
 Data will be displayed in a chart similar to this
design

25. Data Analysis
 ANOVA will be utilized to analyze the means
of the data
 Values will be reported as a mean for each
measurement taken.
 Each measurement will be reported in a
scatter plot graph for individual variations to
display trends over periods of time

26. Discussion

27. Limitations
 Cartilage repair takes a long time to do
 Time required for this study may be too much
for participants
 Pain management
 Pain and inflammation management should
improve as study progresses

28. Feasibility
 Moderate, would require a long time
commitment
 Skype/ video calls may be implemented to
reduce travel time at convenience of the
participant

29. Study Implications
 Determine the approximate time frame of
cartilage growth/ repair and effectiveness in
treating osteoarthritis
 The outcome of this study would provide more
insight into the replication of the cartilage
matrix

30. Recommendations for Future
Research
 Determine what metabolic factors might
influence the increased prevalence in females
compared to males.
 If cartilage growth is mild over the course of
the 5 year study, a longer study may be
necessary.

31. Resources
Beneficial Designs. (2015). Objective Measures of Hand and Finger Strength. Finger Strength measurement devices Retrieved
from http://www. beneficialdesigns.com/products/wheelchair-seating -mobility /objective-measures-of-hand-and-
finger-strength
Google. (2015). Measuring grip and pinch strength: norms, variances and precautions. What instruments are used for measuring
grip and pinch strength. Retrieved from https://sites.google.com/site/ 12movementincontext/what-instruments-are-
used-for-measuring-grip-and-pinch-strength
Hennig, T., Hæhre1, L., Hornburg, V. T., Mowinckel, P., Norli, E. S., & Kjeken, I. (2014). Effect of home-based hand exercises in
women with hand osteoarthritis: a randomised controlled trial. The Eular Journal. doi: 10.1136/annrheumdis-2013-
204808
Lawrence R. C., Felson D. T., Helmick C. G., Arnold L. M., Choi H., Deyo R. A., Gabriel S., Hirsch R., Hochberg M. C., Hunder
G. G., Jordan J. M., Katz J. N., Kremers H. M., Wolfe F. (2008). Estimates of the prevalence of arthritis and other
rheumatic conditions in the United States part II. PubMed, 58(1), 26-35. doi: 10.1002/art.23176
Walker, J. (2011). Management of osteoarthritis. Nursing Older People, 23(9), 14-19. Retrieved from
http://search.proquest.com.ezproxy.fgcu.edu/healthcomplete/docview/904405490/
34F4C00E0FC44FABPQ/7?accountid=10919