An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility

Abstract

Few data are available to assess the efficacy of rehabilitative interventions in systemic sclerosis (SSc). We refer here the results of an individualized rehabilitation program in 16 patients with SSc. In particular, when possible, the number of patients who achieved a minimal clinically important difference (MCID) was determined. Results were evaluated taking advantage of the development of validated questionnaires and tests to assess quality of life (QOL) and disability in SSc. At the end of a period of 4 months of observation, 69% and 62% of patients reported an improvement of the physical and mental components of the SF-36 higher than the MCID (as established in other rheumatic conditions). Analogously, an improvement of the impact of respiratory disease on patients' QOL, as assessed by the Saint George's Respiratory Questionnaire, was perceived by 67% of them. These results might be explained by better exercise tolerance, which was suggested by the significant reduction of the heart rate and of a visual analogue scale for dyspnoea at the end of the 6-min walking test. Finally, a statistically significant improvement of hand mobility, as assessed by the hand mobility in scleroderma test was obtained. This study suggests that a significant proportion of patients with SSc experience an improvement in their perception of QOL, a better exercise tolerance, and a better hand mobility after a rehabilitation program consisting by a 2-week period of daily individual 30-min sessions as outpatient, followed by at-home exercise program.

Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review

“…The effectiveness of the following interventions was assessed: education (26), oral therapy (24,25,27,28), comprehensive rehabilitation program for physical and/or psychological functioning (29,30), self-management (31,32), comprehensive rehabilitation for the hands and/or face (33)(34)(35)(36), aerobic training (37), stretching (38), paraffin treatment (39,40), carbon dioxide baths (41), manual lymph drainage (42), ultrasound (43), extracorporeal shock wave therapy (44), biofeedback (45), deep oscillation (45), transcutaneous electrical nerve stimulation (46), and home total parenteral nutrition (47). The most frequently examined interventions were aimed (among other treatment targets) to improve hand function (33)(34)(35)(38)(39)(40)(42)(43)(44)(45) and the function of the mouth and face (24,25,27,28,34,36).…”

“…The most frequently examined interventions were aimed (among other treatment targets) to improve hand function (33)(34)(35)(38)(39)(40)(42)(43)(44)(45) and the function of the mouth and face (24,25,27,28,34,36). The intervention duration ranged from 2 days (26) to 1 year (38).…”

“…The intervention duration ranged from 2 days (26) to 1 year (38). Of the included studies, 9 were home-based interventions (24,25,28,31,32,(38)(39)(40)46,47), 5 were clinic/hospitalbased interventions (26,30,34,37,42), 5 were combined home/hospital-based interventions (27,29,33,35,36), and 4 studies did not report the setting of the intervention (41,(43)(44)(45).…”

Nonpharmacological Treatment in Systemic Sclerosis

“…The authors evaluated aerobic capacity, hand function, limitations in activities of daily living, quality of life, and skinrelated problems. At the end of the 4-month period, the examiners observed an improvement in the perception of quality of life, better exercise tolerance, and better mobility of hand in a significant number of patients with SSc [16].…”

Selected methods of rehabilitation in systemic sclerosis

“…At later stages, marked by thickening and tightening of the skin, the purpose of treatment is to prevent joint contractures and improve hand function. Therefore, the recommended strategy in more advanced disease stages is the combination of various methods of physiotherapy complemented by exercise programmes that can be completed by patients at home [14,15].…”