Intensive and app-delivered occupational therapy to improve upper extremity function in early diffuse cutaneous systemic sclerosis: a pilot two-arm trial

Abstract

Objective: SSc reduces upper extremity function and performance of everyday activities; however, there are few evidence-based rehabilitation interventions. This study examined short and longer-term effects of two occupational therapy interventions on hand disability.

Methods: Participants with diffuse cutaneous SSc were randomized to one of two 18-week interventions: Intensive group, receiving eight weekly in-person occupational therapy sessions with App-delivered home exercises, or App Alone group. The primary outcome was QuickDASH hand disability; secondary outcomes were physical function (PROMIS scale), and total active hand motion. Linear mixed models were used to examine treatment effects.

Results: Most participants were female (72%); the mean age was 52 years (13.4) (n = 32). There were no significant between-group effects on QuickDASH (P = 1.0; mean change -6.4 on 0-100 scale in both groups at 18 weeks). Left lateral pinch, an exploratory outcome, improved in App Alone compared with Intensive from baseline to 18 weeks. Within groups, the Intensive group had the largest improvements after 8 weeks (-8.5 on QuickDASH; P = 0.03), but then lost gains from 8 to 18 weeks while the App Alone group had modest improvements from baseline to 8 weeks, but then continued to improve. Of completers, 50% had clinically meaningful improvement on QuickDASH in the Intensive group and 64% had improvement in App Alone.

Conclusion: Both interventions showed beneficial effects on hand disability. Participants in the App Alone group improved equally to the Intensive group at 18 weeks. Our findings provide support for further study into telehealth rehabilitation approaches.

Trial registration: NCT03482219.

Keywords: hand; occupational therapy; quality of life; rehabilitation; scleroderma and related disorders.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Figures

Fig. 1

App screenshots for home exercise

Fig. 2

REACH trial study flow diagram

Fig. 3

Treatment group least square mean changes over the study period for primary and secondary outcomes (a) QuickDASH, (b) PROMIS physical function, (c) Left total active range of motion, (d) Right total active range of motion. For QuickDASH (a), negative change denotes improvement. For all others, positive change denotes improvement.

Fig. 4

Adherence to app by participants assigned to App Alone or Intensive group

Fig. 5

Adherence quality measured by time spent viewing guiding videos by group