Occupational Therapy Treatment to Improve Upper Extremity Function in Individuals with Early Systemic Sclerosis: A Pilot Study

Murphy, Susan L.; Barber, Mary; Homer, Kate; Dodge, Carole; Cutter, Gary; Khanna, Dinesh

doi:10.1002/acr.23522

Cited by 19 publications

(19 citation statements)

References 26 publications

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“…keeping warm and protecting the fingers to avoid traumatic ulcers). 97,98 Furthermore, meticulous wound care is mandatory for all ulcers to prevent infection and to minimise further tissue damage/loss. 99 The ulcer wound bed should be closely examined for signs of inflammation/infection, hyperproliferation around the wound edges, evidence of exposure of the deeper structures (e.g.…”

Section: Non-pharmacological Interventionsmentioning

confidence: 99%

Raynaud phenomenon and digital ulcers in systemic sclerosis

et al. 2020

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Raynaud's phenomenon (RP) is a symptom complex related to impaired digital perfusion and can occur as a primary phenomenon or secondary to a wide range of underlying causes. RP occurs in virtually all patients with systemic sclerosis (SSc) and is often the earliest clinical manifestation in the natural history of the disease. Careful assessment is required in RP patients to avoid missing secondary causes of RP, including SSc. Digital ulcers (DUs) are a painful and disabling visible manifestation of the digital vascular injury. Significant progress has been made in the definition and assessment of DUs and understanding ulcer pathogenesis. There are a wide range of available treatments to both prevent and heal DUs; some of which are also used in RP management. The present review shall consider the assessment of patients with RP, including 'red flags' suggestive of SSc. We shall review the pathogenesis, definition and classification across the spectrum of SSc-DU disease, alongside a review on management approaches including drug therapies and surgery for SSc-RP and ulcers. We also highlight unmet needs and research priorities in SSc-RP and SSc-DUs and introduce the concept of a unified vascular phenotype in which vascular therapies may support disease modification strategies.

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Section: Non-pharmacological Interventionsmentioning

confidence: 99%

Raynaud phenomenon and digital ulcers in systemic sclerosis

et al. 2020

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“…For SSc, only a number of small studies have assessed the efficacy of particular methods of PT, e.g., paraffin bath and occupational therapy (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). The lack of efficacy data on a larger scale may explain why treatment recommendations, such as the recently published update to the European Scleroderma Trials and Research (EUSTAR) group guidelines, do not explicitly recommend PT (20).…”

Section: Introductionmentioning

confidence: 99%

Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis

Belz

Moinzadeh

Riemekasten³

et al. 2020

Arthritis Care & Research

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Objective. To determine the type and frequency of physical therapy (PT) prescribed by physicians for patients in the registry of the German Network for Systemic Sclerosis.Methods. The data for 4,252 patients were analyzed using descriptive statistics, chi-square tests, and odds ratios (ORs).Results. Overall, 37.4% of patients (1,590 of 4,252) received PT at the end of a yearly follow-up. The most frequently used type of PT was lymphatic drainage (n = 1,061, 36.8%), followed by exercise therapy (n = 1,047, 36.3%) and heat therapy (n = 689, 23.9%). More than three-fourths of treated patients (82%) received 1 or 2 different forms of PT simultaneously. The prescription of PT was associated with the extent of skin fibrosis as measured by the modified Rodnan skin thickness score (<10 [41.8% of patients], 11-20 [55.8% of patients], and >21 [63.9% of patients]; P < 0.001). Patients with musculoskeletal involvement (e.g., arthritis, muscle weakness, joint contractures, tendon friction rubs) had a higher chance of receiving PT than patients without these symptoms, with corresponding ORs ranging from 1.96 (95% confidence interval [95% CI] 1.69-2.28) for joint contractures to 3.83 (95% CI 2.89-5.08) for arthritis. When comparing the type of PT prescription across the initial and all follow-up visits from 2003 to 2017, significant alterations with a decreasing frequency of patients receiving PT could be observed (P = 0.001).Conclusion. To our knowledge, this is the first study reporting the use of PT in patients with systemic sclerosis (SSc) in a large cohort. Although SSc is characterized by considerable disability and restriction of motion, <40% of patients received PT.

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“…20 The device has been previously tested as part of a broader occupational therapy intervention for SSc. 21 Although the mechanism of action for SSc rehabilitation is not known, this treatment is hypothesized to break up skin adhesions, allowing freer movement and improving hand and arm function.…”

Section: Methodsmentioning

confidence: 99%

Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis

Murphy

Krause

Roll

et al. 2020

Journal of Diagnostic Medical Sonography

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Objectives: This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. Materials and Methods: Three MSUS methods (gray-scale, Doppler, strain elastography) and two acquisition techniques (long- vs short-axis; transducer on skin vs floating on gel) were examined in the forearm before and after rehabilitation treatment. For gray-scale, tissue thickness measures and intrarater and interrater reliability were calculated (intraclass correlation coefficients [ICCs]), and paired t tests examined differences among techniques. Results: Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable gray-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intrarater and interrater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. Conclusion: A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.

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Occupational Therapy Treatment to Improve Upper Extremity Function in Individuals with Early Systemic Sclerosis: A Pilot Study

Cited by 19 publications

References 26 publications

Raynaud phenomenon and digital ulcers in systemic sclerosis

Raynaud phenomenon and digital ulcers in systemic sclerosis

Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis

Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis

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