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

Karen Ellegaard, Cecilie von Bülow, Alice Røpke, Cecilie Bartholdy, Inge Skovby Hansen, Signe Rifbjerg-Madsen, Marius Henriksen, Eva Ejlersen Wæhrens, Karen Ellegaard, Cecilie von Bülow, Alice Røpke, Cecilie Bartholdy, Inge Skovby Hansen, Signe Rifbjerg-Madsen, Marius Henriksen, Eva Ejlersen Wæhrens

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 CIPEXERCISE (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 CIPEXERCISE (mean change = 0.24 logits; 95% CI = 0.09 to 0.39) and CIPCONTROL (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 CIPEXERCISE and 12 (44.4%) in the CIPCONTROL 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).

Keywords: ADL performance; Exercise program; Hand function; Observational based assessment; Rheumatoid arthritis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram of the study

References

    1. Terslev L, Torp-Pedersen S, Savnik A, von der Recke P, Qvistgaard E, Danneskiold-Samsøe B, Bliddal H. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum. 2003;48:2434–2441. doi: 10.1002/art.11245.
    1. Flemming A, Benn RT, Corbett M, Wood PH. Early rheumatoid disease. II. Patterns of joint involvement. Ann Rheum Dis. 1976;35:361–364. doi: 10.1136/ard.35.4.361.
    1. Wæhrens EE, Bliddal H, Danneskiold-Samsoe B, Lund H, Fisher AG. Differences between questionnaire- and interview-based measures of ADL ability and the association to observed ADL ability in women with rheumatoid arthritis, knee osteoarthritis and fibromyalgia. Scand J Rheumatol. 2012;41:95–102. doi: 10.3109/03009742.2011.632380.
    1. Thyberg I, Hass UAM, Nordenskiold U, Gerdle B, Skogh T. Activity limitation in rheumatoid arthritis correlates with reduced grip force regardless of sex: the Swedish TIRA project. Arthritis Rheum. 2005;53:886–896. doi: 10.1002/art.21595.
    1. Rønningen A, Kjeken I. Effect of an intensive hand exercise programme in patients with rheumatoid arthritis. Scand J Occup Ther. 2008;15:173–183. doi: 10.1080/11038120802031129.
    1. Brorsson S, Hilliges M, Sollerman C, Nilsdotter A. A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis. J Rehabil Med. 2009;41:338–342. doi: 10.2340/16501977-0334.
    1. Wessel J. The effectiveness of hand exercises for persons with rheumatoid arthritis: a systematic review. J Hand Ther. 2004;17:174–180. doi: 10.1197/j.jht.2004.02.006.
    1. Adams J, Bridle C, Dosanjh S, Heine P, Lamb SE, Lord J, McConkey C, Nichols V, Toye F, Underwood MR, Willams MA, Williamson EM. Strengthening and stretching for rheumatoid arthritis of the hand SARAH : design of a randomised controlled trial of a hand and upper limb exercise intervention. BMC Musculoskelet Disord. 2012;13:230. doi: 10.1186/1471-2474-13-230.
    1. Williams MA, Williamson EM, Heine P, Nichols V, Glover M, Dritsaki M, Dritsaki M, Adams J, Dosanjh S, Underwood M, Rahman MCC, Lord J Lamb SE. Strengthening and stretching for rheumatoid arthritis of the hand SARAH . A randomised controlled trial and economic evaluation. Health Technol Assess. 2015;19:1–222.
    1. Lamb SE, Williamson EM, Heine PJ, Adams J, Dosanjh S, Dritsaki M, Glover MJ, Lord J, McConkey C, Nichols V, Rahman A, Underwood M, Williams MA. Exercises to improve function of the rheumatoid hand SARAH: a randomised controlled trial. Lancet. 2015;385(9966):421–429. doi: 10.1016/S0140-6736(14)60998-3.
    1. Hammond A, Freeman K. The long term outcomes of a randomised controlled trail of an educational-behavioural joint protection programme for people with rheumatoid arthiritis. Clin Rehabil. 2004;18:520–528. doi: 10.1191/0269215504cr766oa.
    1. Hammond A, Bryan J, Hardy A. Effects of a modular behavioural arthritis education programme: a pragmatic parallel group randomized controlled trail. Rheumatology (Oxford) 2008;47:1712–1718. doi: 10.1093/rheumatology/ken380.
    1. Masiero S, Boniolo A, Wassermann L, Machiedo H, Volante D, Punzi L. Effects of an educational-behavioural joint proctection program on people with moderate to severe rheumatoid arthritis: a randomized controlled trail. Clin Rheumatol. 2007;26:2043–2050. doi: 10.1007/s10067-007-0615-0.
    1. Danish Society of Rheumatologists. Reumatoid artrit - klinisk retningslinje (Rheumatoid Arthritis-Clinical Guideline). .
    1. Amris K, Wæhrens EE, Jespersen A, Bliddal H, Danneskiold-Samsøe B. Observation-based assessment of functional ability in patients with chronic widespread pain: a cross-sectional study. Pain. 2011;152:2470–2476. doi: 10.1016/j.pain.2011.05.027.
    1. Amris K, Waehrens EE, Stockmarr A, Bliddal H, Danneskiold-Samsoe B. Factors influencing observed and self-reported functional ability in women with chronic widespread pain: a cross-sectional study. J Rehabil Med. 2014;46:1014–1021. doi: 10.2340/16501977-1878.
    1. Amris K, Waehrens EE, Christensen R, Bliddal H, Danneskiold-Samsoe B. Interdisciplinary rehabilitation of patients with chronic widespread pain: primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial. Pain. 2014;155:1356–1364. doi: 10.1016/j.pain.2014.04.012.
    1. Sreerangaiah D, Grayer M, Fisher BA, Ho M, Abraham S, Taylor PC. Quantitative power Doppler ultrasound measures of peripheral joint synovitis in poor prognosis early rheumatoid arthritis predict radiographic progression. Rheumatology (Oxford) 2016;55:89–93. doi: 10.1093/rheumatology/kev305.
    1. Taylor PC, Steuer A, Gruber J, Cosgrove DO, Blomley MJK, Marsters PA, Wagner CL, Maini RN. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum. 2004;50:1107–1116. doi: 10.1002/art.20123.
    1. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3 rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Khanna D, Kvien TK, Laing T, Liao K, Mease P, Ménard HA, Moreland LW, Nair R, Pincus T, Ringold S, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G;. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580–1588.
    1. Ramey Dena R., Raynauld Jean-Pierre, Fries James F. The health assessment questionnaire 1992. Status and review. Arthritis Care & Research. 1992;5(3):119–129. doi: 10.1002/art.1790050303.
    1. Rheumatoid arthritis in adults: management. Clinical guideline. . National Institute for Health and Care Excellence NICE . 15-5-2017.
    1. Heine PJ, Williams MA, Williamson E, Bridle C, Adams J, O'Brien A, Evans D, Lamb SE. Development and delivery of an exercise intervention for rheumatoid arthritis: strengthening and stretching for rheumatoid arthritis of the hand SARAH trial. Physiotherapy. 2012;98:121–130. doi: 10.1016/j.physio.2011.03.001.
    1. Moritani T, deVries HA. Neural factors versus hypertrophy in the time course of muscle strength gain. Am J Phys Med. 1979;58:115–130.
    1. Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports Med. 2006;36:133–149. doi: 10.2165/00007256-200636020-00004.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–381.
    1. Fisher AG. Assessment of motor and process skills: user manual. 7. Fort Collins: Three Star Press; 2010.
    1. Fisher AG. Assessment of motor and process skills: development, standardization, and administration manual. 7. Fort Collins: Three Star Press; 2010.
    1. AMPS computer scoring software version 9.0 (computer program). Fort Collins: Three Star Press; 2010.
    1. Wæhrens EE. Measuring quality of occupational performance based on self-report and observation: development and validation of instruments to evaluate ADL task performance (dissertation) Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Sweden 2010.
    1. Thorsen H, Hansen TM, McKenna SP, Sorensen SF, Whalley D. Adaptation into Danish of the Stanford health assessment questionnaire HAQ and the rheumatoid arthritis quality of life scale RAQoL. Scand J Rheumatol. 2001;30:103–109. doi: 10.1080/03009740151095402.
    1. Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–48. doi: 10.1002/art.1780380107.
    1. Terslev L, Qvistgaard E, Kristoffersen H, Topr-Pedersen, Bliddal H. Doppler ultrasonography in rheumatic diseases. Ugeskr Laeger. 2004;166:371–374.
    1. Ellegaard K, Torp-Pedersen S, Terslev L, Danneskiold-Samsøe B, Henriksen M, Bliddal H. Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis - assessment of concurrent validity. Rheumatology (Oxford) 2009;48:254–257. doi: 10.1093/rheumatology/ken459.
    1. Naredo E. Ultrasonographic assessment of inflammatory activity in rheumatoid arthritis: comparison of extended versus reduced joint evaluation. Clin Exp Rheumatol. 2005;23:881–884.
    1. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, Wakefield RJ, P J O’C, Emery P. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum. 2006;54:3761–3773. doi: 10.1002/art.22190.
    1. Hammer HB, Bolton-King P, Bakkeheim V, Berg TH, Sundt E, Kongtorp AK, Haavardsholm Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70:1995. doi: 10.1136/ard.2011.152926.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. doi: 10.1136/bmj.c869.
    1. Schulz KF, Altman DG, Moher D, CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. doi: 10.1136/bmj.c332.
    1. Fransen J, van Riel PL. The disease activity score and the EULAR response criteria. Rheum Dis Clin N Am. 2009;35:745–757. doi: 10.1016/j.rdc.2009.10.001.
    1. Ellegaard K, Torp-Pedersen S, Lund H, Pedersen K, Henriksen M, Danneskiold-Samsoe B, Bliddal H. The effect of isometric exercise of the hand on the synovial blood flow in patients with rheumatoid arthritis measured by color Doppler ultrasound. Rheumatol Int. 2013;33:65–70. doi: 10.1007/s00296-011-2314-z.
    1. Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. Br J Sports Med. 2014;48:1456–1457. doi: 10.1136/bjsports-2014-e787rep.

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