The effectiveness of galvanic electrotherapy and a conservative hand exercise program in a rheumatoid hand: a randomized controlled trial

Abstract

Objectives: This study aims to evaluate whether the galvanic electrotherapy can relieve rheumatic hand pain and whether conservative hand exercises increase the hand strength.Patients and methods: Between March 2012 and November 2012, 30 female patients with rheumatoid arthritis (mean age 54.0±11.2 years; range 50 to 75 years) who were followed in our outpatient clinic were randomized into two groups. The study group (n=16) was administered the galvanic electrotherapy combined with a conservative exercise program. The patients in the control group (n=14) were administered the conservative exercise program alone. The pain level of the hand was evaluated using the Visual Analog Scale (VAS). Hand grip and pinch strength were measured by dynamometry. The level of disability was examined using the Health Assessment Questionnaire (HAQ). The functional disability of the hand was assessed using the Duruöz Hand Index (DHI). All measurements were performed on both hands before and immediately and at five weeks after therapy. Results:The VAS scores did not significantly differ between the groups. In the study group, a significant increase was noted in the grip strength of the right and left hand between the first and second measurement (p=0.011 and p=0.025). In the control group, there was no significant difference between the measurements in terms of the grip strength of the right hand. In the study group, significant differences in the HAQ scores were recorded between first and subsequent measurements (p=0.001 and p=0.007). Conclusion:Our study results show that the galvanic electrotherapy and conservative hand exercises are effective in the treatment of rheumatic hands.

A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis

“…We assessed eight RCTs (25%) to be at overall low RoB [ 39 , 46 , 49 , 53 , 54 , 58 , 61 , 68 ], eleven RCTs (34%) to be at unclear RoB [ 40 , 42 , 48 , 50–52 , 56 , 57 , 59 , 64 , 70 ] and thirteen (41%) RCTs to be at high RoB [ 41 , 43–45 , 47 , 55 , 60 , 62 , 63 , 65–67 , 69 ] ( Supplementary Table S2 , availale at Rheumatology online).…”

“…We found twenty-two examples across nine RCTs [ 48 , 50 , 52 , 54–56 , 59 , 61 , 68 ] where the dose used was the same as the dose used/recommended by the underpinning evidence source. There were forty-nine examples across eight RCTs where the dose used was different [ 48 , 53 , 54 , 56 , 59 , 61 , 65 , 68 ]. We found forty-six examples across nine RCTs [ 48 , 52–54 , 59–61 , 65 , 68 ] where we were unable to compare dose used due to insufficient detail and across six RCTs [ 48 , 50 , 55 , 56 , 60 , 65 ], we found thirty-seven examples where individual dose parameters were unsupported with evidence.…”

“…We explored whether we could identify if a relationship existed between the RoB for the twelve RCTs and the judged quality (OCEBM level of evidence) of the underpinning evidence ( Supplementary Table S6 ). Relating to RoB, four (33.3%) were assessed to be at low RoB [ 53 , 54 , 61 , 68 ], five (41.6%) were assessed to be at unclear RoB [ 48 , 50 , 52 , 56 , 59 ] and three (25%) were assessed to be at high RoB [ 55 , 60 , 65 ]. While there were too few studies for reliable statistical evaluation, of the eight RCTs assessed as unclear, or at high risk of bias, seven (87.5%) had evidence rated as incorrect or unclear [ 50 , 52 , 55 , 56 , 59 , 60 , 65 ].…”