Research ArticleOriginal Article
Open Access

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons

Zahir T. Fadel, Zainalabden E. Jefri, Hussain A. Alkhalifah, Hanin M. Y. Ahmad, Raghad A. Alzahrani, Mohammed B. Ashi and Osama A. Samargandi
Saudi Medical Journal September 2024, 45 (9) 919-928; DOI: https://doi.org/10.15537/smj.2024.45.9.20240187

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  • Table 1

    - Sociodemographic and clinical characteristics of participating physicians.

    Variablesn%
    Specialty
    Family medicine4645.0%
    Orthopedic surgeons2827.5%
    Rheumatology2827.5%
    Do you have a subspecialty?
    Yes4342.2%
    No5957.8%
    Years of practice
    Less than 2 years2120.6%
    2–5 years2827.5%
    6–10 years2423.5%
    11–15 years1716.7%
    More than 15 years1211.8%
    Location of practice
    Governmental hospital8179.4%
    Private hospital98.8%
    Polyclinic109.8%
    Primary health care center22.0%

    Values are presented as numbers (n) and percentages (%).

    • Table 2

      - Physicians’ responses regarding the incidence and effects of RHD and thumb CMC arthritis.

      QuestionsScore out of 5 on the Likert scale Median (IQR)P-value
      Family medicine (n=46)Orthopedic surgeons (n=28)Rheumatologists (n=28)
      Q1- Based on your current practice, how frequently are you seeing cases of RHD?2.50 (2.00–3.00)2.00 (2.00–3.00)3.00 (3.00–4.75)<0.001*
      Q2- Based on your current practice, how frequently are you seeing cases of thumb CMC arthritis?2.00 (2.00–2.00)2.00 (2.00–3.00)3.00 (3.00–4.00)<0.001*
      Q3- How much do you think that RHD affects patients’ daily function?4.00 (4.00–5.00)4.00 (3.25–5.00)5.00 (4.00–5.00)0.783
      Q4- How much do you think that thumb CMC arthritis affects patients’ daily function?4.00 (4.00–5.00)4.00 (3.25–5.00)4.00 (3.25–5.00)0.868
      Q5- Do you think that RHD is a cause of psychological distress to your patients?4.00 (3.75–5.00)4.00 (3.00–5.00)4.50 (3.25–5.00)0.493
      Q6- Do you think that thumb CMC arthritis is a cause of psychological distress to your patients?4.00 (3.75–5.00)4.00 (3.00–4.00)4.00 (3.00–5.00)0.153

      Note: Data are expressed as median and IQR. Q 1,2: Always = 5 / Often = 4 / Sometimes = 3 / Rarely = 2 / Never = 1. Q 3–6: Strongly agree = 5 / Agree = 4 / Neither agree nor disagree = 3 / Disagree = 2 / Strongly disagree = 1.

      RHD: rheumatoid hand deformity, CMC: carpometacarpal, IQR: interquartile range

      • ↵* Statistical significance is set at p<0.05.

    • Table 3

      - Physicians’ answers regarding the management options for RHD and thumb CMC arthritis.

      QuestionsScore out of 5 on the Likert scale Median (IQR)P-value
      Family medicine (n = 46)Orthopedic surgeons (n = 28)Rheumatologists (n = 28)
      Q7- Based on your current practice, are you managing RHD patients with systemic medications only?3.00 (2.00–4.00)3.00 (3.00–4.00)4.00 (3.25–5.00)0.010*
      Q8- Based on your current practice, are you managing thumb CMC arthritis patients with systemic medications only?3.00 (2.00–4.00)3.00 (3.00–4.00)4.00 (3.00–4.00)0.483
      Q9- Based on your current practice, are you offering RHD patients local steroid injections to the hand or wrist?3.00 (2.00 –4.00)3.00 (2.00–4.00)3.00 (2.00–4.00)0.773
      Q10- Based on your current practice, are you offering thumb CMC arthritis patients local steroid injections to the hand or wrist?3.00 (2.00–4.00)4.00 (3.00–4.00)4.00 (2.25–4.00)0.136
      Q11- Based on your current practice, are you recommending the use of a hand brace or splint for RHD patients?3.00 (2.75–4.00)4.00 (3.00–5.00)3.00 (2.25–4.00)0.208
      Q12- Based on your current practice, are you recommending the use of a hand brace or splint for thumb CMC arthritis patients?3.00 (3.00–4.00)4.00 (3.00–5.00)3.00 (3.00–4.00)0.098
      Q13- Do you think that hand surgery can help with pain relief for some RHD patients?3.00 (3.00–4.00)4.00 (3.00–5.00)3.00 (2.00–4.00)0.007*
      Q14- Do you think that hand surgery can help with pain relief for some thumb CMC arthritis patients?4.00 (3.00–4.00)4.50 (4.00–5.00)3.00 (3.00–4.00)<0.001*
      Q15- Do you think that surgery can help some RHD patients improve their hand function?4.00 (3.00–4.00)4.00 (3.00–5.00)3.50 (2.00–4.00)0.086
      Q16- Do you think that surgery can help some thumb CMC arthritis patients improve their hand function?4.00 (3.00–4.00)4.00 (3.25–5.00)4.00 (3.00–4.00)0.014*
      Q17- Do you think that surgery can help some RHD patients improve the cosmetic appearance of their hands?4.00 (3.00–4.00)4.00 (3.25–5.00)4.00 (3.00–4.00)0.442
      Q18- Do you think that surgery can help some thumb CMC arthritis patients improve the cosmetic appearance of their hands?4.00 (3.00–4.00)4.00 (3.00–4.00)3.50 (3.00–4.00)0.729

      Data are expressed as median and IQR. Q7 -12: Very likely = 5 / Likely = 4 / Neutral = 3 / Unlikely = 2 / Very unlikely = 1. Q13-18: Strongly agree = 5 / Agree = 4 / Neither agree nor disagree = 3 / Disagree = 2 / Strongly disagree = 1.

      RHD: rheumatoid hand deformity, CMC: carpometacarpal, IQR: interquartile range

      • ↵* Statistical significance is set at p<0.05.

    • Table 4

      - Physician response regarding the referral for RHD and thumb CMC arthritis patients.

      QuestionsScore out of 5 on the Likert scale Median (IQR)P-value
      Family medicine (n=46)Orthopedic surgeons (n=28)Rheumatologists (n=28)
      Q-19 Based on your current practice, are you referring RHD patients to physiotherapy?4.00 (3.00–5.00)4.00 (3.00–4.00)4.00 (4.00–5.00)0.186
      Q-20 Based on your current practice, are you referring thumb CMC arthritis patients to physiotherapy?4.00 (3.00–5.00)4.00 (3.00–4.00)4.00 (3.00–4.75)0.482
      Q-21 Based on your current practice, are you referring RHD patients to an occupational therapist?4.00 (2.75–5.00)4.00 (3.00–4.75)4.00 (3.00–4.00)0.950
      Q-22 Based on your current practice, are you referring thumb CMC arthritis patients to an occupational therapist?4.00 (2.00–5.00)4.00 (3.00–4.75)4.00 (3.00–4.00)0.625
      Q-23 Based on your current practice, are you referring RHD patients to a hand surgeon?3.00 (2.00–4.00)4.50 (3.25–5.00)3.00 (2.00–4.00)<0.001*
      Q24- Based on your current practice, are you referring thumb CMC arthritis patients to a hand surgeon?3.00 (2.00–4.00)4.50 (3.25–5.00)3.00 (2.00–3.75)<0.001*

      Data are expressed as median and IQR. Q19-24: Very likely = 5 / Likely = 4 / Neutral = 3 / Unlikely = 2 / Very unlikely = 1, RHD: rheumatoid hand deformity, CMC: carpometacarpal, IQR: interquartile range,

      • ↵* Statistical significance is set at p<0.05.

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