Joint mobilization and therapeutic exercises in the hands of patients with systemic sclerosis: A preliminary randomized controlled trial

Abstract

Objective: To investigate the effectiveness of Maitland’s joint mobilization and therapeutic exercises on the functionality of the hands in patients with systemic sclerosis. Design: Randomized controlled trial. Setting: Tertiary university hospital. Subjects: Twenty-four patients diagnosed with systemic sclerosis according to ACR/EULAR 2013 criteria; age ⩾18 years and Cochin Hand Functional Scale (COCHIN) score ⩾10. They were randomized to physical therapy group ( n = 12) or control group ( n = 12). Interventions: The physical therapy group received joint mobilization and undertook therapeutic exercises, twice a week, for 12 weeks, and received a booklet with information about the disease. The control group only received the booklet about the disease. Main measures: The primary outcome measure was functionality of the hands (COCHIN). The secondary outcomes measures were disability (SHAQ), pain (visual analogic scale), range of motion (HAMIS and Delta finger-to-palm), grip strength (JAMAR dynamometer), and quality of life (SF12). Results: Twenty-two patients were female, with a mean age of 47.4 ± 11.1 years and 18 had limited cutaneous form. The physical therapy group showed a decrease of 11.33 points in the COCHIN in comparison with the control group ( P = 0.09). There was a significant increase in range of motion by HAMIS (3.00 ± 1.48 vs 5.42 ± 2.64, P = 0.008), reduction in pain VAS (3.42 ± 2.78 vs 7.75 ± 2.53, P < 0.001), and increase in the physical component of SF12 (38.51 ± 9.60 vs 32.65 ± 9.10, P = 0.038). Conclusion: Maitland’s joint mobilization and therapeutic exercises improved the functionality of the hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life in patients with systemic sclerosis.

Systemic sclerosis: one year in review 2022

“…• Supervised rehabilitation therapy is essential for the improvement of hand motility and pain (106,107).…”

“…• Growing interest is raising towards non-pharmacological treatments, such as rehabilitation interventions (106,107).…”

Effects of non‐pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta‐analysis of randomized control trials

“…After thorough reading of the documents, 12 articles were excluded. Finally, a total of 8 RCTs 33–40 involving 487 participants were included – 249 in the experimental group and 238 in the control group (see Table 1). A more detailed description of this process can be found in the PRISMA flow diagram (Figure 1).…”

“…Four studies had been conducted in Italy, 33,35,36,40 1 in France, 38 1 in Brazil, 37 1 in the Netherlands 39 and 1 in Turkey 34 . The included studies evaluated different non‐pharmacological interventions for individuals with a diagnosis of SSc.…”

Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people with systemic sclerosis: the Scleroderma Patient-centered Intervention Network Hand Exercise Program (SPIN-HAND) trial

“…Existing evidence, however, tends to be descriptive or from very small trials with important limitations in design, conduct, and reporting [ 15 ]. As part of an ongoing living systematic review [ 16 ], we identified 11 randomized controlled trials (RCTs) that evaluated physical or occupational therapy interventions designed specifically to improve hand function in SSc, but none analyzed data from ≥ 30 participants per trial arm [ 13 , 14 , 17 – 25 ]. Two other small trials have evaluated a 12-week multidisciplinary day treatment program ( N = 53) [ 26 ] and a minimally supervised general home exercise program ( N = 44) [ 11 ]; both included hand exercises and reported that the interventions improved grip strength.…”