Background People with hand-related rheumatoid arthritis (RA) experience problems performing activities of daily living (ADL). Compensatory strategies to improve ADL ability have shown effective. Similarly, hand exercise has shown effect on pain, grip strength, and self-reported ability. A combination has shown positive effects based on self-report, but self-report and observation provide distinct information about ADL. The purpose of this study was to examine whether hand exercise as add on to compensatory intervention (CIP) will improve observed ADL ability in RA. Methods Women ( n = 55) with hand-related RA were randomized to CIP EXERCISE (intervention) or CIP only (control). CIP is focused on joint protection, assistive devices, and alternative ways of performing AD. The hand-exercise program addressed range of motion and muscle strength. Primary outcome was change in observed ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Baseline measures were repeated after 8 weeks. Results Improvements in ADL motor ability in CIP EXERCISE (mean change = 0.24 logits; 95% CI = 0.09 to 0.39) and CIP CONTROL (mean change =0.20 logits; 95% CI = 0.05 to 0.35) were statistically significant, with no differences between groups (mean difference = 0.04 logits; 95% CI = − 0.16 to 0.25). Thirteen (46.4%) participants in the CIP EXERCISE and 12 (44.4%) in the CIP CONTROL obtained clinically relevant improvements (≥ 0.30 logits) in ADL motor ability; this group difference was not significant ( z = 0.15; p = 0.88). Conclusion Adding hand exercise to a compensatory intervention did not yield additional benefits in women with hand-related RA. The study was approved by the ethics committee 14th of April 2014 (H-3-2014-025) and registered at ClinicalTrials.gov 16th of May 2014 (NCT02140866). Electronic supplementary material The online version of this article (10.1186/s13075-019-1924-9) contains supplementary material, which is available to authorized users.

ObjectivesTo develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently.DesignQualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles.SettingsUniversity Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities.ParticipantsOne research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists).ResultsThree generic categories were identified: (1) ‘Challenge older adults with goal-oriented ADL tasks’, (2) ‘Implement strategies to enhance independent and safe performance of ADL tasks’, and (3) ‘Communicate the important information to the target group and across sectors’. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call.ConclusionsEngaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme.Trial registration numberThis article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.

Background A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. Methods Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. Results Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. Conclusion We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.

BackgroundDecreased strength and range of motion in the hand are often seen in rheumatoid arthritis (RA). Positive effects on hand function in RA patients after hand exercise and individual education in joint projection including coping strategies (ADL education) is shown (1;2). However, it is unknown if a combination of both will further improve hand performance.ObjectivesTo investigate the effect on ADL ability of a hand exercise program as add on to an ADL education program in women with RA.MethodsWomen with RA involving the hand on stable medication for at least three months were recruited.At baseline participants were examined by a rheumatologist who assessed joints of the hand and ruled out contraindications for participation e.g. massive malalignment of the joints. Inflammatory markers of the blood, hand pain and grip strength were also measured. The ADL motor ability was assessed using the observation-based Assessment of Motor and Process Skills (AMPS). After baseline examination randomized to ADL education + hand exercises (intervention; IG) or only ADL education (control; CG) was made.All participants received three to four sessions with an occupational therapist learning how to perform ADL tasks overcome their specific hand problems. The intervention group also received a hand exercise program, to be conducted four times a week, for eight weeks, containing exercises for improving range of motion and strength; once a week the exercise program was supervised by a physiotherapist, to correct and prevent overload and to increase load if possible.Primary outcome measure was change in observed ability to perform ADL tasks (AMPS) at week 8. Secondary outcomes include grip strength, pain, joint count, inflammatory markers and self-reported function.After eight weeks, all baseline measures were repeated and changes from baseline were calculated based on the Intention To Treat (ITT) population.Clinicaltrials.gov Identifier: (NCT02140866)ResultsFifty five patients were randomised to IG (n=28) or CG (n=27); 22 and 25 patients, respectively, completed the trial. The ITT-populations mean age was 63.8 (12.8) years, mean disease duration was 12.4 (11.0) years. Baseline tender and swollen joint count was 5.07 (4.85) and 1.37 (1.72) respectively, the hand pain was 41.95mm (right) and 35.78mm (left) (VAS) and hand grip strength was 18.25 kg (right) and 17.46 kg (left). Baseline AMPS ADL motor measure was 1.36 (0.46).As judged by the 95% confidence intervals, no difference in change from baseline was seen between the groups (see table).ConclusionsA hand exercise program as add on to an ADL education did not improve ADL ability more than ADL education alone in women with RA experiencing decreased ADL ability involving the hands.References Masiero S et al. Effects of an educational-behavioral joint protection program on people with moderate to severe rheumatoid arthritis: a randomized controlled trial. Clin Rheumatol 2007 Dec;26:2043–50.Lamb SE et al. Exercises to improve function of the rheumatoid hand (SARAH): a randomised...