Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions

Abstract

Objective To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. Methods Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non‐randomized trials, one‐arm trials, and prospective quasi‐experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. Results A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi‐experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self‐management. Sample sizes varied between 20–267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within‐group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. Conclusion Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.

Can home rehabilitation impact impulse oscillometry and lung ultrasound findings in patients with scleroderma-associated interstitial lung disease? A pilot study

“…Rehabilitation is an important tool to help individuals manage scleroderma and potentially delay its disabling effects, including those involving the respiratory system [ 2 ]. One of the most important issues in the rehabilitation of patients with chronic diseases, including those with scleroderma, is regularity and repeatability, which can be more easily achieved by TOHR, especially during the current COVID-19 pandemic [ 3 ].…”

“…Scleroderma is a chronic, progressive, and autoimmune disease characterized by cutaneous fibrosis, vasculopathy, and visceral damage [ 1 ]. Because it is an incurable condition, people with scleroderma need strategies to help manage the disease, such as rehabilitation, which plays an important role in improving the results reported by patients [ 2 ]. Physical activity has attracted increasing interest in recent years as an adjuvant therapy for people with scleroderma.…”

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

“…Yet, only good or excellent quality studies were reported in its results, and it did not identify all available evidence on this topic. 25 This affected its conclusions, since they were biased by the selection of evidence and only included positive results. All 3 reviews had certain limitations: a small number of participants included in each study, generally high risk of bias across studies, and the use of alternative synthesis methods despite having data susceptible to meta-analysis.…”

“…The latter review synthesized rehabilitation interventions to improve different outcomes in individuals with SSc. Yet, only good or excellent quality studies were reported in its results, and it did not identify all available evidence on this topic 25 . This affected its conclusions, since they were biased by the selection of evidence and only included positive results.…”

“…23 Researchers assessed various oral health interventions, MDT care and diverse therapeutic approaches. In addition to this review, 3 more recent systematic reviews have been published 20,24,25 exploring the effects of nonpharmacological interventions on SSc individuals. One of them evaluated the effectiveness of exercise therapies such as aerobic exercise, muscle strengthening or orofacial exercises in individuals with SSc.…”