In-person treatment sessions were feasible in the patients with SSc and resulted in statistically significant and clinically meaningful improvements in upper extremity and physical function. In future studies, the effects of SSc should be compared with those in a control condition, and the durability of treatment effects should be examined.
Objective
Systemic sclerosis (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 8-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 to 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.
Objectives: This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. Materials and Methods: Three MSUS methods (gray-scale, Doppler, strain elastography) and two acquisition techniques (long- vs short-axis; transducer on skin vs floating on gel) were examined in the forearm before and after rehabilitation treatment. For gray-scale, tissue thickness measures and intrarater and interrater reliability were calculated (intraclass correlation coefficients [ICCs]), and paired t tests examined differences among techniques. Results: Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable gray-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intrarater and interrater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. Conclusion: A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.
Date Presented 03/27/20
In the emerging field of telerehab, OTs can provide rehabilitation in novel ways, such as by using apps or other technologies. Adherence to home exercise is a critical part of sustaining therapeutic gains, but often home exercise is not completed and function may decline after discharge. We show how an app was used to track home exercises, as well as facilitators of and barriers to use. Such information will be important for practitioners when considering using apps and other technologies.
Primary Author and Speaker: Susan Murphy
Additional Authors and Speakers: Donnamarie Krause
Contributing Authors: Erin Welsh, Angela Lyden, Mary Barber, Maya Sabbagh, Vivek Nagaraja, Erica Bush, Janet Poole, Dinesh Khanna
Date Presented 4/9/2016
Occupational therapy sleep tool intervention demonstrates a positive effect on pain reduction associated with sleep deprivation. To improve patient outcomes, hospital-based occupational therapist roles should routinely include sleep education as part of their domain.
Primary Author and Speaker: Kristen Clore
Additional Authors and Speakers: Mary Whitehouse Barber, Melissa Johnson, Christelle David
Contributing Authors: Steven Heidt, Julia Meireles, Brittany Gappy, Bridget Higgy, Zainab Rasheed, Ryan Scott, Giancarlo Vanini, Peter Farrehi
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