Effectiveness of Technology-Supported Hand Strengthening and Stretching Exercises in Patients With Rheumatoid Arthritis

Study Overview
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Brief Summary
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Growing research evidence supports the effectiveness of mHealth interventions for improving exercise adherence and motivation. The aims of our study are; 1) to develop and design a smartphone application for a structured hand exercise program for patients with RA and to test its usability. 2) Evaluate the feasibility and effectiveness of hand exercise app. This study is a mixed-methods study that aims to investigate the effectiveness of the Mar-HandTherapy app: a qualitative and quantitative study with the iterative design approach.

Detailed Description
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The long-term beneficial effects of strengthening and stretching for rheumatoid arthritis (RA) for hand programs (SARAH) on functions have been shown in recent studies. Also, recently a usable web-based hand exercise program developed for patients with RA in UK. 1- The aim of our study is to develop and design a smartphone application for structured hand exercise program for patients with RA and to test its usability. 2- Evaluate the feasibility and effectiveness of smartphone app hand exercise app. In our study, a qualitative iterative design approach that includes focus groups of experts/patients was used. The mobile application was designed in 3 phases: PHASE 1: we conducted focus group meetings to compromise the content, feature and design of app in the first phase (Prototype version of smartphone software for RA hand training program/Mar-Hand-Therapy app). Focus Group were consisted two physiotherapist (PT), three hand therapists (HT) working in the field in different rheumatology or hand rehabilitation clinics, two software-computer engineers, 3 patients with RA who had previously participated hand therapy. All focus group members (n=10) and 6 patients used the app for one week. All users filled the usability questionnaire, made the comments and advises. The revised version was tested again for one week. The last revised version completed after two weeks tested. 40 patients diagnosed with rheumatoid arthritis will be included to the study. Participants randomized to digital intervention and waiting list control. After the 6-week digital intervention qualitative interviews have done with 6-15 patients from intervention group to assess the feasibility of digital intervention. The primary outcomes are hand pain and function and exercise adherence.

Official Title
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Development, Feasibility, and Effectiveness of Smartphone Application for Hand Therapy for Patients With Rheumatoid Arthritis: Mix Method Study

Conditions
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Rheumatoid Arthritis

Intervention / Treatment
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* Behavioral: Digital exercise group
* Other: General Home Hand Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Those diagnosed with rheumatoid arthritis according to ARA criteria RA patients with stage 2 or 3 according to ACR criteria The first symptoms started at least a year ago and those who are undergoing medical treatment Those between the ages of 18-65 Exclusion Criteria: Those who are in the inflammatory period Those who have had surgery for neurological, orthopedic or other reasons recently Those with specified depression or other psychological diagnosis Those who have received physiotherapy and ergotherapy in the past year

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Digital exercise group<br>After the 6-week digital intervention, 1) qualitative interviews have done with 6-15 patients from intervention group to assess the feasibility of digital intervention. 2) The primary outcomes are hand pain and function and exercise adherence will be evaluated for all participants | Behavioral: Digital exercise group<br>* Hand Rehabilitation Program: Developed hand exercise smartphone app which include: Self-assessment, (b) self-monitoring (c) exercises types/frequency/ diary, (d) patient education, (e) behavioral change and encouragement (f) exercise adherence Sample exercises Hand and finger movements: 6-8 repetitions, according to the diagnosis of the patient Strengthening exercises of hand and finger muscles Exercises to increase grip and pinch strength Exercises to increase tendon swing and pull angle<br>|
| Active Comparator: Waiting list conrol<br>A hand rehabilitation home program will be given to the patients in the group through the telephone messages with brochures. | Other: General Home Hand Therapy<br>* Hand rehabilitation home program will be given to the through the telephone messages with brochures. Hand and finger movements: 6-8 repetitions, according to the diagnosis of the patient Strengthening exercises of hand and finger muscles Exercises to increase grip and pinch strength Exercises to increase tendon swing and pull angle<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline of Hand pain at 7 week | Measurement of health perspective with 100 mm visual analogue scale (VAS). We assess the hand pain score change from baseline scores at 7th week. The leftmost value in the 100mm horizontal line used for VAS is scored between 0 mm (no pain) and the rightmost value is rated between 100mm (unbearable pain). | Baseline and week 7 | 
| exercise adherance | Qualitative data from smartphone (Time using the app, times of using videos etc) | week 7 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline of Hand Function | Measure of Activity Performance in the Hand (MAP-HAND). It consists of 18 questions. Each question scores between 0 and 3 points. It worsens as the total score increases.We assess the hand function score change from baseline. scores at 7th week. | Baseline and week 7 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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mhealth, hand exercise, rheumatoid arthritis