Intensive and app-delivered occupational therapy to improve upper extremity function in early diffuse cutaneous systemic sclerosis: a pilot two-arm trial

Abstract

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.

Telehealth Delivery of Evidence-Based Intervention Within Older Adult Populations: A Scoping Review

“…The study types were as follows: case study ( n = 2), experimental ( n = 2), formative evaluation ( n = 1), narrative ( n = 1), randomized controlled trial (RCT: n = 4). The review team (SW, EE, LM, SS) organized and identified the themes of the 10 articles: Cognition (Perkins et al, 2022); Environment/Home Modifications (Breeden, 2016); Health Management (Scriven et al, 2019); Occupational Engagement (Laver et al, 2020); and Performance-Based intervention (Boehm et al, 2015; Lafaro et al, 2020; Murphy et al, 2021; Perkins et al, 2022; Plow et al, 2019; Sclarsky & Kumar, 2021). Two of the studies were published in the American Journal of Occupational Therapy (Boehm et al, 2015; Sclarsky & Kumar, 2021), and one in a rehabilitative journal (Plow et al, 2019); two within aging-specific journals (Laver et al, 2020; Perkins et al, 2022); four within health-specific journals (Beit Yosef et al, 2022; Lafaro et al, 2020; Murphy et al, 2021; Scriven et al, 2019), and one in a technology-specific journal (Breeden, 2016).…”

“…The tele-CO–OP group showed greater improvement in their Canadian Occupational Performance Measure (COPM; Law et al, 1990) performance and satisfaction scores than the waitlist control group participants (Beit Yosef et al, 2022). Second, the Murphy et al (2021) study investigated the Rehabilitation for Arm Coordination and Hand (REACH; Murphy et al, 2018) EB upper extremity intervention with App-delivered home exercises (intensive group) and occupational therapy sessions, compared to App-delivered home exercise only (telehealth group) for individuals with scleroderma ( N = 32). Participants completed weekly 45- to 60-minute sessions over 7 weeks.…”

EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis

“…Non-pharmacological management of connective tissue diseases (CTDs) may be invasive and non-invasive, and includes, but is not limited to patient education,9 self-management,10 physical exercise,11 lifestyle or behaviour interventions (eg, photoprotection or smoking cessation),12 13 psychological counselling,14 cognitive behavioural therapy,15 relaxation or yoga,16 17 dietary, nutritional or microbiome interventions,18 19 stretching,20 massage,21 hand and foot interventions, assistive technology and devices,22 mouth exercise therapy,23 dental health and hygiene,24 modalities such as paraffin baths,25 shockwave therapy,26 acupuncture27 and transcutaneous electrical nerve stimulation,28 hydrotherapy and manual lymph drainage (MLD) 29. Furthermore, it may include skin and wound care, ulcer management (eg, debridement),30 minor surgical procedures such as calcinosis removal and detection and management of malnutrition 31…”

Skin involvement in early diffuse cutaneous systemic sclerosis: an unmet clinical need

“…Ideally, all patients with early dcSSc should be assessed by an occupational therapist, as almost all patients have considerable functional disability, including impairment of hand function 12 . ‘Remote’ occupational therapy via a mobile app 81 could be a way forward, at least in some patients.…”