Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review

Abstract

Objective. To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc). Methods. Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ‡10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist. Results. Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life. Conclusion. The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures.

Personalized Physical Therapy Versus Usual Care for Patients With Systemic Sclerosis: A Randomized Controlled Trial

“…A recent systematic review of trials of nonpharmacologic treatments for SSc identified 9 RCTs. Only 3 of these were rated as high quality, and the largest one included 53 patients .…”

“It's Not Me, It's Not Really Me.” Insights From Patients on Living With Systemic Sclerosis: An Interview Study

“…Similarly, while the most recent core outcome set for SSc outlines a domain of health‐related quality of life, there is no instrument or specific tool to measure fatigue or body image dissatisfaction . A recent systematic review of nonpharmacologic intervention in SSc outlined the limited evidence base available to inform guidelines or outcomes measures . Recent work from the University of California, Los Angeles Scleroderma Quality of Life study has validated a measure of body image dissatisfaction .…”

Aerobic and resistance exercise in systemic sclerosis: State of the art

“…Rehabilitation with a multidisciplinary team is recommended for patients with SSc (Poole, 2010), and may improve handgrip strength and hand function (Willems et al, 2015). Mouth exercises have been shown to improve eating, speaking, oral hygiene and dental treatments (Cazal et al, 2008;Maddali-Bongi et al, 2011;Naylor, Douglass, & Mix, 1984;Pizzo, Scardina, & Messina, 2003;Willems et al, 2015). In addition to this, there is an increasing body of evidence supporting the inclusion of various types of physical exercise as important therapeutic tools in the treatment of SSc.…”