The consequences of hand osteoarthritis (OA) are not completely understood. Restriction in self-care and looking after the home are important predictors of increasing disability and are key indicators for home aid services and increased hospital use. The aim of this study was to (i) describe the extent of restriction in self-care/looking after the home in adults aged 50 years and over with hand OA and (ii) explore the relationship with the characteristics of hand OA.
Data were collected in the North Staffordshire Osteoarthritis Project Clinical Assessment study of the hand (CASHA). Restrictions in self-care/looking after the home were measured using three items from the Keele Assessment of Participation (KAP). Analysis was performed on 494 adults aged 50 years and over who (i) reported hand pain/problems in the previous 12 months, (ii) attended a clinical assessment of the hand, (iii) had hand OA, defined clinically (ACR clinical definition) and/or radiographically (Kellgren and Lawrence score >=2 on one or more hand joints) and (iv) completed all 3 KAP items. The prevalence of restriction in self-care/looking after the home was calculated overall and for age and gender. Differences between age groups were tested with a chi-square test. Gender difference was examined by percentage difference with 95% confidence interval. Logistic regression was used to assess the associations between restriction in self-care/looking after the home and characteristics of hand OA; pain severity (AUSCAN), stiffness (AUSCAN), functional limitation (AUSCAN) and duration of pain.
87 (18%) reported restriction in self-care/looking after the home. Restriction was greater in women than men (% difference: 7.0%; 95% confidence interval 0.0%, 13.4%). There was no relationship with age (p<0.05). Restriction in self-care/looking after the home was associated with hand pain, stiffness and functional limitation but not duration of pain. The strongest association was between restricted self-care/looking after the home and those categorised in the highest third for functional limitation (OR: 6.1; 95% CI 3.2, 11.9). The relationship between pain and restricted self-care/looking after the home was explained by functional limitation. However two thirds of people with functional limitation of the hand were not restricted in self-care/looking after the home.

Restriction in self-care/looking after the home affects almost 1 in 5 older adults with hand OA. The characteristics of hand OA contributed to restriction across the genders and age range, indicating the need for a clinical approach to reduce restriction. However adults with high levels of hand pain and functional limitation continued to look after themselves and their home. Further investigation is required to explain this discordance and direct further management.