Effectiveness of an Exercise Program and Education Through a Mobile Application for the Management of Patients With Hand Osteoarthritis and Rheumatoid Arthritis

Study Overview
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Brief Summary
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Strengthening and stretching exercise programs, and recommendations to protect the affected joint have shown to be effective both clinically and economically in conditions such as hand osteoarthritis and hand rheumatoid arthritis. However, their application format is not up to date. In this sense, problems such as the lack of monitoring by the health professional and the lack of patients motivation may cause poor adherence to the treatment protocol, which is one of the main predictors of treatment efficiency. Therefore, an smartphone application has been developed for the rehabilitation of hand osteoarthritis and rheumatoid arthritis to enhance patients adherence and motivation. The smartphone application includes: a) exercise programs and recommendations based on the most up to date scientific evidence adapted to the pathology; and b) enhancers of patient adherence to treatment (patient diaries and behavioral change strategies).The objective is to develop a cost effective digital solution to optimize the health care offered to these pathologies based on up to date scientific evidence in order to improve the functional ability and the quality of life of these patients, and to reduce the number of consultations to primary and specialized care.

Official Title
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Effectiveness of a Mobile Application of Exercise and Education for the Management of Patients With Hand Osteoarthritis and Rheumatoid Arthritis on Self-reported Functional Ability, Dexterity, Pinch and Grip Strength, Pain Intensity and Stiffness

Conditions
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Rheumatoid Arthritis - Hand Joint, Osteoarthritis Hand, Pain, Mobility Limitation, Stiffness of Hand, Not Elsewhere Classified

Intervention / Treatment
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* Other: Smartphone Application
* Other: Conventional treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hand Osteoarthritis (OA) patients: Subjects with hand osteoarthritis according to the American College of Rheumatology (ACR) classification criteria for clinical OA; hand pain, aching or stiffness and 3 of the following points; Hard tissue enlargement of 2 or more of 10 hand joints. Hard tissue enlargement of 2 or more interphalangeal joints. Fewer than 3 swollen Metacarpal joints. Deformity of 1 or more of 10 hand joints. Pain and dysfunction in the joints of the hands and/or wrists Possession of a smartphone with internet. Rheumatoid Arthritis (RA) Hand patients: Subjects with hand arthritis according to the American College of Rheumatology (ACR) clinical and immunological criteria for clinical RA. Patients must meet 4 of the following seven criteria: Morning stiffness in and around joints lasting at least 1 hour. Swelling in three or more joints. Swelling in hand or wrist joints, Symmetrical joint swelling. erosions or decalcification on radiographs of hand and/or wrist. Rheumatoid nodules. Abnormal serum rheumatoid factor. Pain and dysfunction in the joints of the hands and/or wrists. Possession of a smartphone with internet Exclusion Criteria: Hand Osteoarthritis Patients: Age under 18 years People with cognitive impairment Surgery on any upper limb joint or fracture in the upper limb within the previous 6 months People on the waiting list for upper limb surgery. Persons who have received steroid injections into the joints of their hands in the two months prior to recruitment. People with inflammatory rheumatic disease (arthritis, spondylitis or cancer) Rheumatoid Arthritis Hand Patients Age under 18 years People with cognitive impairment Surgery on any upper limb joint or fracture in the upper limb within the previous 6 months People on the waiting list for upper limb surgery. Pregnancy.

Ages Eligible for Study
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Minimum Age: 18 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Smartphone Application<br>A protocol of exercises and general recommendations based on the current scientific evidence will be provided through a smartphone application. A follow-up of the use of the application will be carried out. The treatment protocol will last 6 months, during which a minimum of 4 weekly sessions of exercises will be carried out at home. Each pathology will have an unique program of exercises and recommendations. | Other: Smartphone Application<br>* Exercises and recommendations, based on current scientific evidence, and delivered through the app for Smartphone called CareHand. The intervention protocol is based on strengthening and stretching recommendations for rheumatoid arthritis and osteoarthritis in hands, transferred to an application format through explanatory videos together with tools to improve the autonomy, motivation and adherence of the patient<br>|
| Active Comparator: Conventional Treatment<br>Those in this group will received the conventional treatment protocol provided within the Andalusian Public Health System. This will consist on the delivery of an exercise program and recommendations using a sheet of paper. Participants will be told to perform the exercises during 6 months, with minimum of 4 weekly sessions of exercise that will be carried out at home. | Other: Conventional treatment<br>* Conventional approach provided by the Andalusian Public Health System in Primary Care settings. This approach consists of routine visits to the general practitioner specialist, and the delivery of an exercise sheet and recommendations. This general mobility and stretching worksheet contains detailed images, as well as a description of how to perform the exercises and the dose to be taken. While most exercises are intended for the wrist and hands, this sheet also includes basic exercises for the elbow joint.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self reported functional ability assessed using Michigan Hand Questionnaire (MHQ) in patients with hand Rheumatoid Arthritis | An outcome measurement tool specifically for chronic hand conditions providing information on functionality, satisfaction, appearance and perceived pain, with 37 questions divided into 6 subscales | Change from Baseline Michigan Hand Questionnaire (MHQ) at 3 and 6 months | 
| Self reported functional ability assessed by Australian/Canadian (AUSCAN) Osteoarthritis Hand Index in patients with Hand Osteoarthritis | A self administered measure to assess hand pain, stiffness and functionality in persons with hand osteoarthritis | Change from Baseline Australian/Canadian (AUSCAN) Osteoarthritis Hand Index at 3 and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Grip strength assessed using a hydraulic grip dynamometer | The Maximun power of the hand muscles used to firmly grasp an object by wrapping the fingers around it, pressing it against the palm, and using the thumb to apply counter-pressure, using a Hydraulic grip dynamometer | Change from Baseline Grip Strength at 3 months | 
| Pinch strength assessed using a hydraulic pinch dynamometer | The maximun power of the pinch muscles, pressing the tip thumb against the tip index finger, using an Hydraulic pinch dynamometer | Change from Baseline Pinch strength at 3 months | 
| Self reported pain assessed using a Visual Analog Scale of pain | Amount of perceived pain represented on a scale of 0 (no pain) to 10 (worst pain) | Change from Baseline Visual Analog Scale of Pain at 1, 3 and 6 months | 
| Self reported stiffness assessed using a Visual Analog Scale of Stiffness | Amount of perceived stiffness represented on a scale of 0 (no stiffness) to 10 (worst stiffness) | Change from Baseline Visual Analog Scale of Stiffness at 3 and 6 months | 
| Self-reported functional ability assessed by QuickDASH Questionnaire | Short form of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. A self administered outcome tool designed to measure physical function and symptoms in persons with musculoskeletal disorders of the upper limb | Change from Baseline QuickDASH Questionnaire at 1, 3 and 6 months | 
| Dexterity assessed using the Nine Hole Peg Test | Plastic instrument woth a shallow round dish to contain pegs and nine holes on the opposite side. Consist of measuring the time spent to place and remove all the pegs from the holes. | Change from Baseline Nine Hole Peg Test at 3 months | 
| Quality of life assessed using the EQ-5D-5L questionnaire | A brief multi-attribute health status measure divided in five dimensions questions with Likert response options and a visual analog scale of Health | Change from Baseline EQ-5D-5L Questionnaire at 3 and 6 months | 
| Economic factors relating to cost-utility | Absence due to illness, absence from unpaid work, use of health resources (number of consultations to primary care, specialist doctor, physical therapy, occupational therapy, emergency department), pharmacological use for the pathology, medical or technical equipment purchased for the pathology | Change from Baseline Economic factors relating to cost-utility at 6 months |