An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial

Abstract

Background Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. Objective This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. Methods A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. Results In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; η2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05). Conclusions Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. Trial Registration ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-04713-4

Experiences of individuals with rheumatoid arthritis interacting with health care and the use of a digital self-care application: a qualitative interview study

“…Virtual care offered additional benefits, including improved treatment adherence, functional status and quality of life 30. However, it is critical that those digital tools are evidence-based and focus on self-management interventions that are developed by healthcare providers and persons with RA to support and empower individuals 31…”

Telerehabilitation in Physiotherapy Science: A Scoping Review

“…The 20 studies that were included were about diseases related to the musculoskeletal system (five) [ 16 , 17 , 18 , 19 , 20 ], the nervous system (six) [ 20 , 21 , 22 , 21 , 24 , 25 , 26 ], the proprioception-balance system (two) [ 27 , 28 ], the respiratory system (one) [ 29 ], the cardiovascular system (one) [ 30 ], the pelvic floor control (two) [ 31 , 32 ], and the autoimmune diseases (three) [ 33 , 34 , 35 ].…”

Fibromyalgia and centralized pain in the rheumatoid arthritis patient

“…Adjunctive treatments such as assessment by hand occupational therapy, structured exercise programs, and utilizing mobile health (mHealth) interventions combining home exercise programs and self-management recommendations have been shown to improve overall joint function, pain levels, and satisfaction compared with usual care [31–33]. Significantly, a recent study evaluating custom-made foot orthoses reported that not only were there expected reductions in foot ( P < 0.001) and leg pain ( P = 0.012), but also pain reduction was noted in the arms and hands ( P = 0.014) [34 ▪ ].…”