Hand exercise for women with rheumatoid arthritis and decreased hand function: an exploratory randomized controlled trial

Abstract

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.

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

“…In addition, participants must have a smartphone or tablet with internet access. Exclusion criteria are as follows: (a) previous history of hand surgery or fracture in the 6 months before data collection [ 28 ], (b) waiting list for upper limb surgery [ 20 ], (c) having received intramuscular or intraarticular steroid injections within 4 weeks [ 23 ], (d) pregnancy [ 2 ], and (e) a moderate or severe cognitive impairment [ 9 ]. Participants will be told not to be involved in other manual therapy interventions during the study period.…”

“…Participants will have to show at least 4 out of 7 of the following signs or symptoms: (a) morning stiffness at or around hand joints and/or wrist for more than 1 h during 6 weeks or more; (b) three or more actively swollen joints during 6 weeks or more; (c) swollen wrist, MCP, or PIP joints; (d) asymmetrical joint swelling; (e) radiographic evidence of erosion or decalcification at hand or wrist; (f) presence of rheumatoid nodules; and (g) positive rheumatoid factor. Participants will have to self-report pain in their hands and/or wrists, and decrease ability to carry out daily life activities involving the hands [28]. In addition, participants must have a smartphone or tablet with internet access.…”

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis. A randomized controlled trial protocol.

“…Participants will have to self-report pain in their hands and/or wrists, and decrease ability to carry out daily life activities involving the hands (28). In addition, participants must have a smartphone or tablet with internet access.…”

“…In addition, participants must have a smartphone or tablet with internet access. Exclusion criteria are as follows: a) previous history of hand surgery or fracture in the 6 months before data collection (28); b) waiting list for upper limb surgery (20); c) having received intramuscular or intraarticular steroid injections within 4 weeks (23); d) pregnancy (2); and e) a moderate or severe cognitive impairment (9). Participants will be told not to be involved in other manual therapy interventions during the study period.…”

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis. A randomized controlled trial protocol.

“…Participants will have to show at least 4 out of 7 of the following signs or symptoms: a) morning stiffness at or around hand joints and/or wrist for more than one hour during 6 weeks or more; b) three or more actively swollen joints during 6 weeks or more; c) swollen wrist, MCP or PIP joints; d) asymmetrical joint swelling; e) radiographic evidence of erosion or decalci cation at hand or wrist; f) presence of rheumatoid nodules; and g) positive rheumatoid factor. Participants will have to self-report pain in their hands and/or wrists, and decrease ability to carry out daily life activities involving the hands (28). In addition, participants must have a smartphone or tablet with internet access.…”