Clinical significance and usefulness of rehabilitation for systemic sclerosis

Abstract

Systemic sclerosis is a multisystem connective tissue disorder characterized by excessive fibrosis of the skin and internal organs. Impairments in skin, the musculoskeletal system, and respiratory system require rehabilitation therapy because they may lead to disabilities and reduce the quality of life in daily activities. Rehabilitation for systemic sclerosis mainly comprises two distinct approaches that include local and global rehabilitation. Local rehabilitation is applied to maintain and/or improve hand and face functions, while global rehabilitation includes aerobic and resistance exercises. Although few high-quality randomized clinical trials have been conducted to date, previous studies indicated the effectiveness of rehabilitation therapy for decreasing local and systemic disabilities, resulting in improved quality of life. Rehabilitation for systemic sclerosis needs to be regularly and constantly performed at home as well as in hospitals. Physicians involved in the treatment of systemic sclerosis need to consider rehabilitation, and skilled physiotherapists and occupational therapists also play a crucial role in evaluating and treating systemic sclerosis patients.

The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review

“…This systematic review on the effect of exercise therapy in patients with SSc overall points in the direction of beneficial effects and no adverse outcomes, but the evidence is weak. The conclusion of this review is in line with three reviews conducted in the past 4 years [10, 22, 29], one being a systematic literature review [10]. Previous literature reviews concluded that SSc patients without or with mild pulmonary involvement can be as physically active as the general population, whereas the present review provides more insights into the effect of exercise therapy on top of other non-pharmacological interventions, into different types of exercise programmes and into the methodological quality of the studies.…”

“…Nine articles met the inclusion criteria. No additional titles were obtained by checking the references of included papers and the available literature reviews [10, 22, 29].…”

“…The authors concluded that SSc patients who participate in exercise programmes involving aerobic exercise and aerobic exercise combined with resistance training improve in exercise tolerance, cardiorespiratory fitness, walking distance, muscle strength and function, in addition to health-related quality of life [22]. The most recent review, published in 2019 by Mugii et al [29], was not performed systematically and included 11 studies concerning rehabilitation therapy applied for SSc categorized into four domains: hand, face, global and pulmonary rehabilitation. Three studies [11, 13, 27] concerned exercise therapy specifically, and eight studies concerned comprehensive care [14, 15, 17, 18, 28, 30–32].…”

Effect of a tailored home‐based exercise program in patients with systemic sclerosis: A randomized controlled trial

“…Although extensive efforts have been made to develop therapeutic agents for SSc, satisfactory results have yet to be achieved. Rehabilitation for SSc needs to be regularly and constantly performed at home, as well as in hospitals, 8 but to date, rehabilitation therapy for SSc patients is not widespread 9 . Previous studies have suggested that aerobic exercise or aerobic exercise combined with resistance exercise may improve exercise tolerance, aerobic capacity, walking distance, muscle strength and function, and HRQoL 10 .…”

Self‐management interventions in systemic sclerosis: A systematic review

“…In a systematic review by Willems et al (2015), variability in the content, intervention components, and outcomes of nonpharmacologic interventions for patients with systemic sclerosis was found. Research on nonpharmacologic, rehabilitative, and exercise interventions in systemic sclerosis has also addressed the poor methodological quality of studies, limiting the authors' ability to synthesize the data and make recommendations for the use of these interventions in patients with systemic sclerosis (Liem et al, 2019; Mugii et al, 2018; Willems et al, 2015).…”