The thoughts and feelings held by clinicians about the delivery of a placebo thumb splint in an osteoarthritis rehabilitation trial

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Abstract
Background: The use of a placebo thumb base splint in an osteoarthritis trial is novel and may help identify specific and non-specific effects of hand splinting. This study aimed to explore the thoughts and feelings of trial clinicians who would be delivering a placebo splint to understand their perspective and to identify how these feelings may affect them personally, professionally and practically. Methods: Three senior Occupational Therapists selected from a purposive sample of trial collaborators participated in a focus group interview. Structured questions were used to elicit debate and discussion and three designs of placebo splint developed for this trial were available for consideration. The 60-min audio recorded focus group was transcribed verbatim, validated and underwent thematic analysis. Results: Four main themes were identified; justification of placebo thumb splint use in this research, anxiety about causing of harm, preconceptions about thumb splint activity, and the practicalities of convincing placebo thumb splint delivery. This last theme was broken down into three sub-themes: anxiety about ‘selling’ the splint, the therapeutic relationship in splint delivery, and training requirements for splint delivery. Conclusions: Clinicians have anxieties and practical concerns regarding delivering placebo splints in a clinical effectiveness trial for rehabilitation for thumb base osteoarthritis. Tailored support and training throughout all stages of trial delivery is required to ensure their ability to deliver the intervention in a rigorous, unbiased manner.

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