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Clinical Assessment Study of the HAnd (CASHA) - 6-year follow-up Background and study aims The Clinical Assessment Study of the Hand (CAS-HA) started in 2004 and participants have been followed-up every 18 months over 6 years. The study aims to describe the long-term course of hand pain, hand problems and hand osteoarthritis (pain/stiffness of the joints of the hand) in community-dwelling adults aged 50 years and over. Together with a linked study, this study also aims to look at associations between hand and knee osteoarthritis. Who can participate? Participants were originally recruited in 2004 and 2005 via questionnaire from the practice lists of two participating local General Practices. All those who indicated on the questionnaire that they experienced hand pain or hand problems in the previous 12 months and who provided consent to further contact were invited to attend for a clinical assessment. Participation at follow-up points has been restricted to those in the original cohort who consent to further contact. What does the study involve? The study involves completion of a questionnaire and attendance at a research clinic based within the local hospital for a clinical assessment and x-rays. The questionnaire consists of a Health Questionnaire, which asks about general health and hand problems, and a Regional Pains Survey, which asks about hip, knee and foot pain. The clinical assessment involves an interview, hand examination and assessment, digital imaging of the backs and fronts of both hands, and anthropometric measurement (height and weight). Participants are also assessed using a test of lower limb function. The clinical assessments will be carried out by a team of trained research therapists (occupational therapists and physiotherapists). Plain x-rays are taken of both hands and knees. Participants who do not wish to attend the research assessment clinics will be offered the opportunity to complete postal questionnaires only. Medical records will be reviewed in consenting participants. This is linked to a specific study objective to link osteoarthritis sub-types to GP consultation data in order to explore which hand pain and problems are presented to primary care over the follow-up period of 6 years. What are the possible benefits and risks of participating? As this is an observational study, there are no direct benefits for participants in relation to providing treatment or advice. The x-rays can be reported on by a consultant radiologist should the participant wish this, and the report sent to the GP. The risks from clinical assessment are negligible. Joint pain may be increased during examination, but the participant is fully informed of their rights to request that examinations are not done, and their right to withdraw from the study at any point. The main risk to the participant in this study is from exposure to radiation from the x-rays. The dose has been set by a radiation protection advisor and is relatively low (the equivalent to a few days natural background radiation). The risk from exposure to radiation from x-rays is covered in the Participant Information Sheet, which is sent to the participant prior to attending the research clinic, and is discussed fully during the consent process in the research clinic. Participants are informed that they can still participate in the study without having the x-rays taken. Where is the study run from? The Arthritis Research UK Primary Care Centre at Keele University, Staffordshire, England, UK When is study starting and how long is it expected to run for? October 2011 to August/September 2012 Who is funding the study? The current stage of the study (6-year follow-up) is funded by Arthritis Research UK. Earlier stages of the study were funded by the Medical Research Council (MRC). Who is the main contact? Dr Helen Myers [email protected]

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