A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis

Brorsson, Sofia; Hilliges, Marita; Sollerman, Christer; Nilsdotter, Anna

doi:10.2340/16501977-0334

Cited by 61 publications

(50 citation statements)

References 26 publications

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“…It has been reported that NMES is effective in paralysis [17,32] and rheumatoid arthritis [31]. In rehabilitation of the upper extremities (especially the forearm, hand, and finger), not only the effect of muscle strength but also the effect of hand function is very important [15,16]. Therefore the possible adverse influence on the specific coordination of complex movements needs to be considered in order to use HYB safely.…”

Section: Discussionmentioning

confidence: 99%

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Hybrid-Training Method Increases Muscle Strength and Mass in the Forearm without Adverse Effect of Hand Function in Healthy Male Subjects

et al. 2010

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Summary:Conventional neuromuscular electrical stimulation (NMES) results in surface muscle contraction but high electrical stimulation intensity is required to activate the deep muscles. Therefore, NMES is not useful for training at complicated sites such as the forearm. To make NMES more effective we developed a hybrid training method (HYB), consisting of electrically stimulated antagonists to resist agonist muscle contractions. The purpose of this study was to compare the effects of HYB on the forearm as compared with NMES alone, and to determine whether HYB had any adverse effects on complex hand movements. Thirty subjects were randomly distributed into three groups: a HYB program group, an isometric electrical stimulation group (ES), and a control group (CN). Subjects trained 3 times a week for 6 weeks. Each session consisted of 10 sets of 10 reciprocal 2-sec wrist flexions and extensions separated by 1-min rest intervals. Wrist flexion\extension torques, grip strengths (GS), forearm flexor\extensor cross sectional areas (CSA), and hand dexterity (Purdue Pegboard (PEG) test, finger tapping (Tapping) test were measured. The HYB group demonstrated statistically significant increases in wrist extension torques (22.8%, p<0.01), forearm flexor CSA (9.6%, p<0.01), and in forearm extensor CSA (5.1%, p<0.05) at the end of training. There was no increase in torque or CSA in the ES or CN groups. Hand dexterity showed no significant differences in any of the three groups. HYB had no adverse effect on hand function and was more effective in forearm training than NMES alone.

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Section: Discussionmentioning

confidence: 99%

“…For example, in rheumatoid arthritis or aging, muscle weakness may occur in the upper extremities [15,16]. Especially in the hand and the forearm, not only muscle strength but also hand function decreases, so the effect of these training approaches on hand function must be considered [15].…”

Section: Neuromuscular Electrical Stimulation (Nmes) Ismentioning

confidence: 99%

Hybrid-Training Method Increases Muscle Strength and Mass in the Forearm without Adverse Effect of Hand Function in Healthy Male Subjects

et al. 2010

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“…68 However, few studies have investigated the effect of exercises specifically for the rheumatoid hand. Some improvements in strength, mobility and/or function with no negative effects have been reported, 19,20,22,61,69,70 although the long-term effectiveness has not been established.…”

Section: Evidence Basementioning

confidence: 99%

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

Williams

Williamson

Heine

et al. 2015

Health Technology Assessment

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BackgroundThe effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain.ObjectivesThe study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence.DesignA pragmatic, multicentred, individually randomised controlled trial with an embedded qualitative study. Outcome assessors were blind to group assignment and independent of treatment delivery.SettingSeventeen NHS trusts in England comprising 21 rheumatology and therapy departments.ParticipantsAdults with RA who had pain and dysfunction of the hands and/or wrists and had been on stable medication for at least 3 months. Patients were excluded if they were under 18 years old, had undergone upper limb surgery/fracture in the last 6 months, were on a waiting list for upper limb surgery or were pregnant.InterventionsUsual care or usual care plus an individualised exercise programme. Usual care consisted of joint protection education, general exercise advice and functional splinting if required. The exercise programme consisted of six sessions of strengthening and stretching exercises with a hand therapist, daily home exercises and strategies to maximise adherence.Main outcome measuresThe primary outcome was the Michigan Hand Outcome Questionnaire (MHQ) overall hand function subscale score at 12 months. Secondary outcome measures included the full MHQ, pain, health-related quality of life (Short Form questionnaire-12 items), impairment (grip strength, dexterity and range of motion) and self-efficacy. European Quality of Life-5 Dimensions, medication and health-care use were collected for the health economics evaluation. Follow-up was at 4 and 12 months post randomisation. Analysis was performed on an intention-to-treat basis.ResultsWe randomised 490 patients (244 to usual care, 246 to exercise programme). Compliance with the treatments was very good (93% of usual care participants and 75% of exercise programme participants completed treatment). Outcomes were obtained for 89% of participants at 12 months (222 for usual care, 216 for exercise programme). There was a statistically significant difference in favour of the exercise programme for the primary outcome at 4 and 12 months [mean difference 4.6 points, 95% confidence interval (CI) 2.2 to 7.0 points; and mean difference 4.4 points, 95% CI 1.6 to 7.1 points, respectively]. There were no significant differences in pain scores or adverse events. The estimated difference in mean quality-adjusted life-years (QALYs) accrued over 12 months was 0.01 greater (95% CI –0.03 to 0.05) in the exercise programme group. Imputed analysis produced incremental cost-effectiveness ratio estimates of £17,941 (0.59 probability of cost-effectiveness at willingness-to-pay threshold of £30,000 per QALY). The qualitative study found the exercise programme to be acceptable and highlighted the importance of the therapist in enabling patients to establish a routine and incorporate the exercises into their lives.ConclusionsThe results of the Strengthening And stretching for Rheumatoid Arthritis of the Hand trial suggest that the addition of an exercise programme for RA hands/wrists to usual care is clinically effective and cost-effective when compared with usual care alone. No adverse effects were associated with the exercise programme. The economic analysis suggests that the intervention is likely to be cost-effective.Study registrationCurrent Controlled Trials ISRCTN 89936343.Funding detailsThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 19. See the NIHR Journals Library website for further project information. This report has been developed in association with the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford and the NIHR Biomedical Research Unit Funding Scheme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands.

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“…As antigas estratégias terapêuticas utilizadas para o tratamento das articulações inflamadas favoreciam o repouso e uso somente de medicações. Os estudos, recentemente, demonstram que pacientes incluídos nos programas de exercícios regulares, melhoram a força máxima, o equilíbrio, a flexibilidade, o condicionamento físico e cardiovascular, diminuem a dor e o edema, sem aumentar os sintomas articulares provenientes da artrite (11)(12)(13) . Nas abordagens fisioterapêuticas dos pacientes com AR é de extrema importância a execução da uma boa avaliação, o que permitirá estabelecer melhores objetivos e condutas condizentes com cada caso.…”

Section: Resultsunclassified

“…É importante ressaltar que as medidas de fisioterapia manual estejam adequadas ao quadro inflamatório do paciente (28,30) . Simples exercícios fisioterapêuticos para as mãos de pacientes com AR proporcionam melhora significativa da força manual dos flexores e de extensores e da função da mão, mesmo com apenas 6 semanas de tratamento (11) . Outra modalidade terapêutica muito utilizada em pacientes com AR é a hidroterapia.…”

Section: Estudo Qualitativounclassified

Abordagem Fisioterapêutica De Pacientes Com Artrite Reumatoide: Revisão De Literatura

Conceição¹,

Sinhorim²,

Martins³

et al. 2015

ACS

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IntroduçãoA artrite reumatoide (AR) é uma das doenças inflamatórias sistêmica, crônica e progressiva mais comumente relatadas (1) . Apresenta etiologia desconhecida, sendo sugerida uma conotação multifatorial. Acomete aproximadamente 1% da população mundial, sendo que as mulheres são afetadas três vezes mais do que os homens, na proporção 1:3-4 (2) . O diagnóstico da AR é estabelecido considerando-se achados clínicos e exames complementares, ou seja, nenhum teste isolado, seja laboratorial, de imagem ou histopatológico, confirma o diagnóstico (3) . As manifestações clínicas da AR podem ter início em qualquer idade, embora sejam observadas com mais frequência na quarta e quinta décadas de vida. A AR pode se manifestar de forma bastante variável, desde manifestações mais brandas, de menor duração, até uma poliartrite progressiva e destrutiva, associada a vasculite e outras manifestações extra-articulares, como febre, astenia, fadiga, mialgia e perda ponderal que podem preceder ou acompanhar o inicio das manifestações articulares (4)(5) . Diante das inúmeras manifestações da AR, existem relatos de que essa doença está relacionada muito frequentemente às dificuldades na execução das atividades de vida diária, trabalho e lazer (6) , com graus variados quanto à dependência decorrente das limitações nas atividades sociais e profissionais (7) . Um dos Resumo Introdução: Artrite reumatoide é uma doença autoimune que resulta em uma desordem inflamatória, sistêmica e crônica que pode levar à incapacidade funcional. Objetivo: Realizar uma revisão de literatura, abordando as principais condutas fisioterapêuticas utilizadas em pacientes com artrite reumatoide e os resultados observados nesses estudos. Material e Métodos: A pesquisa eletrô-nica foi realizada por meio dos bancos de dados PubMed, Medline, LILACS, Google Acadêmico e biblioteca eletrônica SciELO. Resultados: Não há um tratamento único totalmente eficaz. Intervenções de fisioterapia para pessoas com artrite reumatoide são predominantemente orientadas para amenizar as deficiências resultante de manifestações das doenças articular e periarticular, e fornecer orientações e educação para melhorar a capacidade funcional e qualidade de vida. Conclusão: Eletrotermofototerapia e cinesioterapia estão entre algumas das condutas fisioterapêuticas muito utilizadas no tratamento de pacientes com artrite reumatoide, apresentando resultados satisfatórios quanto à redução do quadro álgico e ganho de amplitude de movimento.Descritores: Artrite reumatoide; Fisioterapia; Modalidades de fisioterapia. AbstractIntroduction: Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic and systemic inflammatory disorder, leading to deformities and disabilities. Objective: The purposes of this review are to evaluate the literature related to the main physiotherapeutic conducts used in patients with rheumatoid arthritis, and the results observed in those studies. Materials and Methods: We searched the published studies using an initial survey of the PubMed and Medline databa...

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A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis

Cited by 61 publications

References 26 publications

Hybrid-Training Method Increases Muscle Strength and Mass in the Forearm without Adverse Effect of Hand Function in Healthy Male Subjects

Hybrid-Training Method Increases Muscle Strength and Mass in the Forearm without Adverse Effect of Hand Function in Healthy Male Subjects

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

Abordagem Fisioterapêutica De Pacientes Com Artrite Reumatoide: Revisão De Literatura

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