Patients With Rheumatoid Arthritis Find no Additional Benefit to Hand Exercise With ADL Education

In women with rheumatoid arthritis (RA) that affects their hands, a hand exercise program in addition to education in performing activities of daily life (ADL) did not improve ADL ability more than ADL education alone. These findings were presented at the 2017 Annual European Congress of Rheumatology Meeting (EULAR) held June 14-17 in Madrid, Spain.

Eva Ejlersen Waehrens, PhD, from The Parker Institute in Frederiksberg, Denmark and colleagues randomly assigned 55 patients to either the intervention group (n=28) (ADL education plus hand exercises) or the control group (n=27) (only ADL education). Of the randomly assigned patients, 22 in the intervention group and 25 in the control group completed the study. The average age of the intention-to-treat population was 63.8 (12.8), and the average disease duration was 12.4 (11.0) years. (Clinicaltrials.gov Identifier: NCT02140866.)

The baseline measurements were as follows:

• Tender joint count: 5.07(4.85)
• Swollen joint count: 1.37(1.72)
• Hand pain: 41.95 mm (right); 35.78 mm (left)
• Hand grip strength: 18.25 kg (right); 17.46 kg (left)
• ADL motor measure: 1.36 (0.46), as assessed by the observation-based Assessment of Motor and Process Skills (AMPS)

All participants received training with an occupational therapist 3 to 4 times per week to learn how to overcome their specific hand problems. The intervention group also participated in a hand exercise program 4 times a week for 8 weeks to improve range of motion and strength. Once a week, exercises were supervised by a physiotherapist to correct and prevent overload, and to increase load if possible.

The primary outcome was observed change in ability to perform ADL tasks at 8 weeks. Secondary outcomes included grip strength, pain, joint count, inflammatory markers, and self-reported function.

At 8 weeks, no difference in change from baseline was seen in either the group (CI: 95%).

Change from baseline at 8 weeks:

• Tender joint count: intervention group: −0.57 (−1.86-0.73); control group: 0.20 (0.05-0.35); difference between groups: 0.04 (−0.17-0.25)
• Swollen joint count: intervention group: 0.25 (−0.23-0.73); control group: 0.16 (−0.32-0.64); difference between groups: 0.10 (−0.59-0.77)
• Hand pain: intervention group: −1.17 (−7.82-5.48) (right hand); −3.43 (−11.07-4.20) (left hand); control group: 0.55 (−6.23-7.31) (right hand); −0.81 (−8.59-6.97) (left hand); difference between groups: −1.71 (−11.20-7.79) (right hand); −2.62 (−13.62-8.38) (left hand)
• Hand grip strength: intervention group: 1.43(0.40-2.45) (right hand); 1.00 (−0.47-2.47) (left hand); control group: 0.18 (−0.86-1.23) (right hand); −0.36 (−1.83-1.11) (left hand); difference between groups: 1.24 (−0.23-2.71) (right hand); 1.36 (−0.71-3.44) (left hand)
• AMPS ADL motor measure: intervention group: 0.24(0.09-0.39); control group: 0.20 (0.05-0.35); difference between groups: 0.04 (−0.17-0.25)

“A hand exercise program as add-on to an ADL education did not improve ADL ability more than ADL education alone in women with RA experiencing decreased ADL ability involving the hands,” the researchers concluded.

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Reference

Ellegaard K, von Bülow C, Røpke A, et al. Hand exercise for women with rheumatoid arthritis and decreased ADL ability: an exploratory randomized controlled trial. Presented at: The Annual European Congress of Rheumatology Meeting (EULAR). June 14-17, 2017. Madrid, Spain. Abstract OP0254-HPR. doi:10.1136/annrheumdis-2017-eular.2911