The Efficacy of a Home-Based, Self-Administered Hand Exercise Program for Patients With Systemic Sclerosis

Abstract

Background: For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc.Methods: This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire-Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status.Results: Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m 2 . The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength. Conclusions:The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.

Effects of non‐pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta‐analysis of randomized control trials

“…After thorough reading of the documents, 12 articles were excluded. Finally, a total of 8 RCTs 33–40 involving 487 participants were included – 249 in the experimental group and 238 in the control group (see Table 1). A more detailed description of this process can be found in the PRISMA flow diagram (Figure 1).…”

“…Four studies had been conducted in Italy, 33,35,36,40 1 in France, 38 1 in Brazil, 37 1 in the Netherlands 39 and 1 in Turkey 34 . The included studies evaluated different non‐pharmacological interventions for individuals with a diagnosis of SSc.…”

“…A total of 3 studies explored the effects of exercises, 1 study trained an intervention group with 1 month of physical therapy followed by home sessions, 37 other studies used a home‐based exercise program focus to improve performance of activities of daily living, 33 1 used exercises and mobilization in the intervention, 36 and 1 explored the efficacy of a hand exercise program 34 . Only 1 study used an occupational therapy intervention including a self‐administered stretching program on the hands 40 while another study described a multidisciplinary program including a standard group session and individual sessions 39 .…”

“…All studies evaluated hand function. Four of them used the Hand Mobility in Scleroderma (HAMIS) test, 33,34,36,38 while the remainder used the Cochin Hand Function Scale (CHFS) 37,38,40 …”

Skin involvement in early diffuse cutaneous systemic sclerosis: an unmet clinical need

“…Anecdotally, patients benefit from stretching exercises to maintain range of movement, and many enjoy hydrotherapy (A.H., unpublished observations). In a 2021 study that included 34 patients with dcSSc, but with unspecified disease duration, results suggested a benefit from hand exercises 80 . Ideally, all patients with early dcSSc should be assessed by an occupational therapist, as almost all patients have considerable functional disability, including impairment of hand function 12 .…”