The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial

Kyriaki Keramiotou, Christos Anagnostou, Evangelia Kataxaki, Antonios Galanos, Petros P Sfikakis, Maria G Tektonidou, Kyriaki Keramiotou, Christos Anagnostou, Evangelia Kataxaki, Antonios Galanos, Petros P Sfikakis, Maria G Tektonidou

Abstract

Objective: To assess the effect of upper limb exercise on hand function, daily activities performance and quality of life of patients with systemic lupus erythematosus (SLE).

Methods: We performed a pilot randomised, 24-week follow-up, unmasked controlled trial. Inclusion criteria were upper limb arthralgias, a Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score >10 and a stable treatment over the past 3 months. Patients were randomly allocated in the routine care (control) or exercise group that received an individually tailored 30-min daily upper-limb exercise programme by a hand therapist for 12 weeks. We evaluated at 0, 6, 12 and 24 weeks the performance of daily activities for both groups with DASH questionnaire and Health Assessment Questionnaire (HAQ), the grip and pinch strength with Jamar dynamometer and pinch gauge tool, respectively, the dexterity with Purdue pegboard test, the quality of life with Lupus Quality of Life (LupusQoL) Questionnaire and the pain level by Visual Analogue Scale (VAS) score.

Results: From 293 consecutive SLE patients, data from 32 patients allocated to the exercise group and 30 to the control group were analysed. There was a significant difference between the two groups in percentage changes of DASH, HAQ, grip strength, pinch strength, LupusQoL-physical health and fatigue, and VAS scores from baseline to 6, 12 and 24 weeks, and from baseline to 12 weeks for dexterity test (p<0.001). No interaction was observed between exercise and disease activity or medication use at baseline and during the observation period.

Conclusion: Upper-limb exercise significantly improves hand function, pain, daily activity performance and quality of life in SLE.

Trial registration number: NCT03802578.

Keywords: daily performance; exercise; hand function; quality of life; systemic lupus erythematosus; upper limb exercise.

Conflict of interest statement

Competing interests: PPS has received consulting fees and/or grants from AbbVie, Pfizer, MSD, Roche, UCB, GSK and Novartis deposited to the Special Account for Research Funding (ELKE) of the National and Kapodistrian University of Athens Medical School. MGT has received consulting fees and/or grants from AbbVie, GSK, MSD, UCB, Novartis and Pfizer deposited to the ELKE of the National and Kapodistrian University of Athens Medical School.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The exercise programme of participants in exercise group. (A) Strengthening and stretching exercises with a stick. (B) Strengthening and stretching finger exercises. (C) Strengthening and stretching exercises with therapeutic putty.
Figure 2
Figure 2
Trial profile.
Figure 3
Figure 3
Median percentage change from baseline of (A) DASH, (B) HAQ, (C) grip strength DH, (D) pinch strength DH, (E) purdue (Jaws) DH, (F) LupusQoL physical health, (G) LupusQoL fatigue and (H) pain VAS. DASH, Disabilities of Arm, Shoulder and Hand; DH: dominant hand; HAQ, Health Assessment Questionnaire; Jaws: three point pinch; LupusQoL, Lupus quality of life.

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