Revision of an Occupational Therapy (OT) and Physiotherapy (PT) combined care pathway for the conservative management of OA of the first CMC joint; A quality improvement project


Paula Minchin, Senior Occupational Therapist; Carol Rafferty, Senior Occupational Therapist; Sarah O’Driscoll, Senior Physiotherapist; Maria Mc Grath, Senior Physiotherapist


Occupational Therapy & Physiotherapy Department, Tallaght Hospital


A combined OT/PT evidence-based OA CMCj pathway, established in 2013, ceased functioning due to OT staff shortages in 2016. This created a 12 month wait for OT input, which increased the chronicity of the caseload, and failed to maximise outcomes post-injection. Where OT was not involved, patients missed the vital components of joint protection group education, functional adaptation and pain management through splinting (1-3). When OT input was delayed, increased numbers of patients were referred back to the medical team for injection/surgical review. Also, Physiotherapy input for stability and strengthening was delayed as a result.


To update the original pathway, ensuring it is in line with current evidence based practice (EBP) (4) and providing maximum efficiency and minimal waiting times for OA CMCj patients.

To set up a database of outcome measures to facilitate a study of pathway outcomes in 2018.


When staff allocation was restored, the pathway was revised as follows, to include Joint OT/PT assessment, joint documentation, inclusion of the Arthritis Self-Efficacy Scale (A)SES as an outcome measure to reflect the importance of self-management (2), and earlier inclusion of stabilisation exercise for suitable patients. We set an aim to see ‘post-injection’ patients within 1 month, and conservatively managed patients within 3 months.

Figure 1 to be included here


20 patients have commenced the new pathway via 10 joint OT/PT appointments. 50% (n=10) have been seen within the target timeframe of 3 months (a reduction of 9 months). All post-injection patients (n=5) have been seen within the target of 1 month (a reduction of 11 months). Pre-treatment outcome measures have been recorded for these patients, in preparation for an upcoming review of the service in 2018.


In response to increased waiting lists, and following a review of current evidence-based practice, a revised OT/PT combined care pathway for patients with OA CMCj has been established. Waiting times have reduced and the (A)SES has been included as an outcome measure to reflect the importance of self-management in this condition. A study design has been established and a full pathway review will be completed in 2018, to also include a post-treatment patient satisfaction measure. It is hoped that the new combined assessment approach will safeguard against any future growth in waiting lists, due to staff shortages in either Allied Health department.