THE SUBGROUP EFFECTS OF SURGICAL TREATMENT OF PATIENT WITH HAND OSTEOARTHRITIS - A PROTOCOL FOR AN INDIVIDUAL PATIENT DATA META-ANALYSIS IN THE OA TRIAL BANK

Thissen, G.; Middelkoop van, M.; Colaris, J.; Selles, R.; Dziedzic, K.; Nicholls, E.; Bierma-Zeinstra, S.

Abstract

Purpose: The hand joints are frequently affected by osteoarthritis (OA) in the adult population. Patients whose pain and disability are persistent may benefit from surgical treatment. However, based on current evidence, small and moderate effect sizes are found for surgical treatment of hand OA. The OA Trial Bank Steering Committee recommends analyzing subgroups based on both demographic and clinical characteristics in order to identify predictors of response. Since Individual Patient Data (IPD) meta-analyses are considered the gold standard for subgroup analyses, we will conduct an IPD meta-analysis that aims to identify subgroup effects for different types of surgical treatment in patients with hand OA.

Methods: We will conduct a meta-analysis using IPD. For this meta-analysis we are interested in patients aged over 18 years, and diagnosed with hand OA according to the American College of Rheumatology classification criteria, based on other relevant clinical and/or radiographic information, or by a health professional. All surgical interventions on the affected hand joint(s) to treat hand OA will be included. The main outcome measure will be pain. The corresponding authors of the eligible trials will be contacted to collaborate. The revised Cochrane Risk of Bias tool (RoB 2.0) will be used to evaluate the quality of all included studies. After signing the data delivery agreement and the data transfer, the anonymized IPD will be transferred to the OA Trial Bank. A two-stage approach will be performed to investigate subgroup effects of the surgical interventions. During the first stage, from each trial the IPD will be analyzed separately to obtain aggregate data of effect estimates of interest and its confidence intervals. Then, all aggregate data of included RCTs will be synthesized in the second stage to produce summary meta-analysis results. Treatment effects will be analyzed using a random effects model to account for between-study heterogeneity. Interaction terms will be used in the model to identify the predictors of response. A one stage approach will be applied when only little data will be available, or when included studies have small sample sizes. The primary outcome will be pain. We will investigate change in pain at time points up to 12 weeks (short term), up to 6 months (mid-term) and up to one year (long-term). Secondary outcomes will be related to physical function and other patient reported outcome measures. Possible predictors of response will be discussed by professionals in the field, but depending on availability of the data, will potentially include age, sex, body mass index, hypermobility and other comorbidities, pain medication, occupation, baseline pain, type and number of hand joints involved, radiological severity of OA, and duration of symptoms.

Results: The systematic literature search identified 1452 potentially eligible studies. After screening abstracts and full-text articles by two independent reviewers, 31 full-text articles were found to be eligible. All corresponding authors of these RCTs are requested to collaborate on this IPD meta-analysis. One data delivery agreement is signed yet.

Conclusions: This IPD meta-analysis will be the first study that gives insight in subgroup effects of surgical treatment in patients with hand OA. Our goal is to improve clinical decision-making on individual patient level.

Citation

Thissen, G., Middelkoop van, M., Colaris, J., Selles, R., Dziedzic, K., Nicholls, E., & Bierma-Zeinstra, S. (2022). THE SUBGROUP EFFECTS OF SURGICAL TREATMENT OF PATIENT WITH HAND OSTEOARTHRITIS - A PROTOCOL FOR AN INDIVIDUAL PATIENT DATA META-ANALYSIS IN THE OA TRIAL BANK. Osteoarthritis and Cartilage, 30, S423. https://doi.org/10.1016/j.joca.2022.02.577

• Journal Article Type: Conference Paper
• Conference Name: 2022 OARSI World Congress on Osteoarthritis; 7-10 April 2022
• Acceptance Date: Mar 28, 2022
• Online Publication Date: Mar 28, 2022
• Publication Date: 2022-04
• Deposit Date: Jun 28, 2023
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Pages: S423
• DOI: https://doi.org/10.1016/j.joca.2022.02.577
• Keywords: Orthopedics and Sports Medicine; Biomedical Engineering; Rheumatology
• Additional Information: This article is maintained by: Elsevier; Article Title: THE SUBGROUP EFFECTS OF SURGICAL TREATMENT OF PATIENT WITH HAND OSTEOARTHRITIS - A PROTOCOL FOR AN INDIVIDUAL PATIENT DATA META-ANALYSIS IN THE OA TRIAL BANK; Journal Title: Osteoarthritis and Cartilage; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.joca.2022.02.577; Content Type: simple-article; Copyright: Copyright © 2022 Published by Elsevier Ltd.