POS0314 PROSPECTIVE EVALUATION OF A DEDICATED, SERIAL OCCUPATIONAL THERAPY EXERCISE PROGRAM ON HAND FUNCTION IN RHEUMATOID ARTHRITIS (RA)
Authors: Pietrowski W. , Richter-Bastian K. , Storck-Müller K. , Müller-Ladner U. , Lange U. , Tarner I. 
Published: May 2021

Background:

Rheumatoid arthritis (RA) frequently affects the joints of the hands causing severe pain and significant functional impairment affecting all activities of daily living. At early stages, functional impairment is primarily caused by reversible joint and tendon sheath effusions while at later stages synovial thickening, muscular atrophy and irreversible damage to cartilge, bone, tendons and ligaments cause a reduced range of motion and deformities. Occupational therapy aims to maintain and improve joint mobility and function. However, there is limited data on the effectiveness of serial exercise programs specifically aiming at maintaining and improving hand function in RA.

Objectives:

To prospectively evaluate the effects of a dedicated exercise program on hand function, grip strength, joint mobility and pain compared with conventional outpatient physiotherapy not specifically targeting hand function.

Methods:

A total of 51 RA patients receiving outpatient physiotherapy once a week were enrolled and randomized to either continue their usual therapy (control group) or to participate in a dedicated hand function training (HFT) twice a week in addition to their usual therapy (HFT group). The HFT program was supervised by an occupational therapist who conducted once weekly HFT sessions and instructed the participants to perform an additional self-administered HFT session at home once a week. Study duration was six months with an option to continue HFT for additional 6 months. Study participants were evaluated at baseline and every 3 months.

The primary outcomes hand function and grip strength were assessed using standardized questionnaires (Cochin hand function scale (CHFS), Australian/Canadian Osteoarthritis Hand Index (AUSCAN), Michigan Hand Outcomes Questionnaire (MHOQ)) and dynamometer/pinch gauge readings for different types of grip (cylindrical grasp, spherical grasp, hook grasp, tip to tip pinch and key pinch), respectively. The secondary outcomes joint mobility and pain were assessed using a digital goniometer and visual analogue scales (VAS), respectively. Statistical analysis used the Wilcoxon test for evaluating changes of parameters over time within the groups and the Kruskal Wallis test for group comparisons and Bonferroni-Holm correction.

Results:

41 of the 51 patients (HFT group: n = 20, mean age 60.3 ± 8.4 years; control group: n = 21, mean age 60.5 ± 11.5 years) completed the 6-month study period, 14 patients extended their HFT to 12 months. Within the 6-month study period there were no significant improvements of the primary outcome parameters and of pain within the groups vs. baseline and no significant differences between the groups. Only the CHFS improved significantly in the HFT group as of month 9. A significant improvement of the range of motion vs. baseline was achieved by HFT as early as 3 months after baseline which persisted up to month 12. As some improvement was also seen in the control group, there was no significant difference between the groups. Hand mobility improved particularly in the subgroup of patients >60 years of age. There was no influence by pain intensity at baseline (VAS ≤50 mm vs. VAS >50 mm).

Conclusion:

Serial dedicated HFT for 6 months resulted in improved joint mobility but did not improve global hand function, grip strength and pain in RA patients. A longer treatment duration (≥12 months), a higher treatment frequency (>2 times/week) and a larger cohort of patients may be required.

Disclosure of Interests:

None declared