Hand osteoarthritis is one of the most common joint diseases on the planet, affecting roughly half of all women and a quarter of all men as populations age. It causes pain, stiffness, weakened grip and lost mobility, eroding quality of life and pushing people out of the workforce. Yet paradoxically, the specialists best placed to treat inflammatory joint disease often have almost nothing to offer these patients, because no curative drug exists and pharmacological options are limited. A new qualitative study from Norway, published in the Scandinavian Journal of Occupational Therapy, has now mapped out exactly what makes it possible, and what gets in the way, when the first consultation for hand osteoarthritis is moved from rheumatologists to occupational therapists.
The research, led by Silje Zink, Marte Feiring and Ingvild Kjeken, comes at a moment when health systems worldwide are struggling with ageing populations and rising chronic disease. One widely discussed remedy is task-shifting, defined by the World Health Organization as the rational redistribution of tasks among health workforce teams. In rheumatology, previous trials have shown that nurse-led care for rheumatoid arthritis can be more cost-effective than physician-led care, with better disease control and higher patient satisfaction, while physiotherapists have proven equally capable as primary assessors for suspected knee osteoarthritis. What remained unclear was how such redistribution actually works in practice for hand osteoarthritis, and which factors decide whether it succeeds or stalls.
To find out, the researchers interviewed ten rheumatologists and five occupational therapists across two Norwegian hospitals with very different setups. At one hospital, an occupational-therapist-led pathway had been running since 2013, with all referrals suggesting hand osteoarthritis routed directly to therapists. At the other, an ongoing trial randomised patients to an initial consultation with either a rheumatologist or an occupational therapist. The team conducted seventeen semi-structured interviews, some lasting up to two hours, and analysed them using template analysis guided retrospectively by the Capability, Opportunity and Motivation model of behaviour, known as COM-B, together with the Theoretical Domains Framework, a validated tool for understanding what drives health professional behaviour.
The analysis produced four overarching themes. The first concerns how clinical understandings of hand osteoarthritis shape task redistribution. Both professional groups agreed that diagnosing the condition is usually straightforward, which lowered the perceived risk of handing over first consultations. One rheumatologist put it bluntly: diagnosing hand osteoarthritis is not difficult at all. But the picture was complicated by ambiguous referrals from general practitioners, and occupational therapists described cases where they suspected something other than osteoarthritis, such as psoriatic arthritis, underscoring that strong differential diagnosis skills remain essential when therapists become the first point of contact in specialist care.
Strikingly, the very absence of effective drug treatment turned out to be a facilitator. Rheumatologists described hand osteoarthritis as a low-status disease and not a particularly attractive diagnosis, precisely because they could offer little beyond referring patients for exercises and assistive devices. One reflected that conditions they cannot treat or improve leave them with dissatisfied patients. This lack of professional ownership opened space for therapists to take over, especially since international guidelines recommend exactly the non-pharmacological interventions, ergonomic counselling, patient education, hand exercises and orthoses, that sit at the heart of occupational therapy. Therapists, for their part, emphasised the enormous everyday impact of the disease and the simple, cheap measures that can restore function and reduce pain.
The second theme revealed that context and infrastructure can make or break the shift. A major barrier was unequal access to technology: occupational therapists lacked ultrasound machines, which rheumatologists use to look inside joints and quickly rule out inflammatory conditions. Therapists argued that access to ultrasound would let them clarify diagnoses independently, cut unnecessary referrals and save everyone time. Physical proximity mattered just as much. Where therapists and doctors sat next door to each other, quick consultations created a safety net for uncertain cases; where departments were relocated apart, informal contact withered, and rheumatologists stopped calling colleagues they no longer knew personally. The study highlights how seemingly trivial details of hospital geography ripple through collaboration and even patient safety.
Legal and regulatory constraints created further friction, which teams solved through pragmatic workarounds. At one hospital, rheumatologists allowed occupational therapists to file x-ray referrals and applications for orthoses using the doctors’ credentials, trusting their judgements and eliminating delays. Therapists at the other hospital, lacking such flexibility, had to hunt down a physician for a signature after completing all the paperwork themselves, a practice they described as simply unnecessary. These informal flexibilities, documented in earlier research on professional boundaries, proved pivotal in streamlining clinics, though they also raise questions about how formal systems should adapt to expanded allied health roles.
The third theme centred on communication and trust as the foundation of collaboration. Successful sites were marked by open, low-threshold interaction, with therapists simply knocking on a doctor’s door when unsure. Complementary expertise, therapists in function and ergonomics, physicians in diagnostics and medication, replaced competition. Joint teaching sessions, shared morning meetings and therapists sending consultation summaries to general practitioners all built mutual understanding. Notably, trust was not automatic: newer doctors unfamiliar with occupational therapy showed lower trust, prompting therapists to continually advertise their competencies. The researchers suggest this is a solvable problem, and that professional identity itself was not the obstacle many might expect.
The fourth theme exposed the patient side of the equation. At the hospital with the long-established therapist-led pathway, patients often did not understand what occupational therapy was, sometimes googled it, formed misconceptions, and occasionally failed to show up or insisted on seeing a doctor. Rheumatologists themselves acknowledged that therapists are the true experts for this condition, and urged better patient and GP education so that referrals are not wasted on physicians who have little to offer. According to the COM-B model, improving patients’ understanding and reshaping their beliefs about the benefits of therapist-led care are key levers for smoother implementation.
The broader message is that sustainable task-shifting in specialist care depends less on resolving professional turf wars and more on system-level design: ensuring access to technology, co-locating collaborating professions, providing training in diagnostic reasoning, and clearly communicating provider roles to patients. With osteoarthritis projected to become one of the largest contributors to years lived with disability worldwide, the Norwegian experience offers a template for health systems everywhere: put the right professional, not necessarily the most expensive one, in front of the right patient, and build the organisational scaffolding to make that handover stick.
Subject of Research: Task-shifting of hand osteoarthritis first consultations from rheumatologists to occupational therapists in Norwegian specialist healthcare
Article Title: Factors influencing task-shifting between rheumatologists and occupational therapists in hand osteoarthritis care: A qualitative study
Article References: Zink, S., Feiring, M., & Kjeken, I. (2025). Factors influencing task-shifting between rheumatologists and occupational therapists in hand osteoarthritis care: A qualitative study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2572343. https://doi.org/10.1080/11038128.2025.2572343
Image Credits: AI Generated
DOI: 10.1080/11038128.2025.2572343
Keywords: hand osteoarthritis, task-shifting, occupational therapy, rheumatology, COM-B model, Theoretical Domains Framework, interprofessional collaboration, qualitative research, Norway, healthcare workforce, non-pharmacological treatment, patient preferences
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Ophelia Keating. (October 1, 2026). Why Hand Arthritis Care Is Shifting From Doctors to Therapists. Scienmag. https://scienmag.com/why-hand-arthritis-care-is-shifting-from-doctors-to-therapists/
Ophelia Keating. “Why Hand Arthritis Care Is Shifting From Doctors to Therapists.” Scienmag, 1 October 2026, https://scienmag.com/why-hand-arthritis-care-is-shifting-from-doctors-to-therapists/. Accessed 1 October 2026.
Ophelia Keating. “Why Hand Arthritis Care Is Shifting From Doctors to Therapists.” Scienmag. October 1, 2026. https://scienmag.com/why-hand-arthritis-care-is-shifting-from-doctors-to-therapists/
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Tags: aging population impact on arthritis carechallenges in rheumatology treatment optionsCOM-B modelcost-effectiveness of nurse-led arthritis carehand osteoarthritishand osteoarthritis managementhealthcare workforceinterprofessional collaborationmultidisciplinary approach to osteoarthritisnon-pharmacological treatmentnon-pharmacological treatment for hand arthritisNorwayoccupational therapyoccupational therapy interventions for joint stiffnesspatient preferencespatient satisfaction in hand arthritis treatmentqualitative researchquality of life improvements through therapyrheumatologyrole of occupational therapists in joint diseaseshifting responsibilities in chronic disease managementtask-shiftingtask-shifting in healthcaretheoretical domains framework
