Rheumatoid arthritis is a common disease that affected 17.6 million people worldwide in 2020 alone.
In order to prevent the emergence of new symptoms, minimize their consequences, improve and maintain patients' functional abilities, and prevent the progression of deformities, occupational therapy should be used alongside pharmacological agents.
The aim of the study is to investigate the effectiveness of combining various methods of occupational therapy in patients with rheumatoid arthritis affecting the joints of the hands.
The study involved 62 patients with rheumatoid arthritis predominantly affecting the hands, divided into two groups. One group received occupational therapy (31 patients), while the other received only pharmacological treatment. To improve joint function, participants performed 12 sessions of the 9-Hole Peg Test (MART) every other day and 12 sessions of the Sollerman Hand Function Test. At the end of the treatment course, follow-up testing using these methods was conducted. The effectiveness of occupational therapy was also assessed using the VAS scale, the morning stiffness index, the Action Research Arm Test (ARAT), the HAQ index, and grip strength measurements.
A comprehensive combination of various occupational therapy methods led to a reduction in the intensity of hand joint pain from 4.9±0.2 to 2.7±0.2 points (P˂0.02), while there were no changes in this indicator in patients who did not receive occupational therapy. The duration of morning stiffness in the small joints of patients in the main group decreased from 154.3±5.0 to 107.3±5.1 minutes (P˂0.05), while in patients who did not undergo hand occupational therapy, the parameters remained unchanged (156.0±6.4 before and 154.6±5.6 minutes after). The score of the 9-hole test after comprehensive occupational therapy sessions was 11.42, 95% CI – 10.00-12.00 (P˂0.05), compared to 44.5, 95% CI – 13.00-16.00 minutes in the control group.
Control testing using the Sollerman test, after completing the course tasks, showed an improvement in this score from 44.5, 95% CI – 28.00-66.00 to 57.9, CI – 38.00-76.00 (P˂0.05), while in patients who did not receive comprehensive occupational therapy, this score remained unchanged (37.09 points, 95% CI – 17.00-60.00 before and 36.1, 95% CI – 19.00-62.00 after).
The set of occupational therapy exercises increased the strength of the right hand from 4.7, 95% CI – 3.3-5.8 kg to 8.3, 95% CI – 4.2-6.0 kg, with no increase in the overall indicator in patients who did not engage in occupational therapy. The HAQ score in the examined patients who underwent occupational therapy decreased from 2.4±0.3 to 1.5±0.2 points, while in patients who did not receive occupational therapy, it remained within the range of moderate impairment of daily functioning.
After completing the course of combined occupational therapy, patients with rheumatoid arthritis affecting the hands experienced a reduction in pain intensity and the duration of morning stiffness. There was a significant decrease in the time required to complete the 9-Hole Peg Test, an improvement in the overall Sollerman Hand Function Test score, an increase in grip strength of the right hand, and a reduction in the quality of hand function score.
Conclusions. The 9-Hole Peg Test and the Sollerman Hand Function Test can be used not only as assessment tools but also as methods of occupational therapy when performed repeatedly. Their prolonged repetition and combination contributed to increased range of motion in the hand joints, enhanced strength, and improved quality of life indicators.
