Conservative hand therapy treatments in rheumatoid arthritis--a randomized controlled trial.
OBJECTIVE
To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the rheumatoid hand.


METHODS
In a randomized controlled trial, participants with rheumatoid arthritis (RA) recruited from a rheumatology department in Mid-Staffordshire, UK (February 1999 to January 2001) were randomized to three groups. All received joint protection (JP) information delivered by a therapist at baseline. Group 1 participants received a set of additional hand-strengthening and mobilizing home exercises, group 2 a different set of additional hand-stretching exercises and group 3 the JP information alone. The primary outcome was the Arthritis Impact Measurement Scales II (AIMS II) (upper limb; hand and finger function subscales). Outcomes were assessed at baseline and 1, 3 and 6 months. Analysis was by intention to treat.


RESULTS
Sixty-seven participants (mean age 59.6 yr) were recruited: group 1 n = 21, group 2 n = 24 and group 3 n = 22. A 78% follow-up was achieved at 6 months. There was a mean fall (SD) in AIMS II upper limb function 0-6 month change scores in group 1 of 1.00 (1.07). In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 (1.54) and 0.30 (1.22), respectively. The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant (P = 0.007) and remained so after adjustment for multiple testing (P = 0.012).


CONCLUSIONS
Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening hand exercises in RA patients compared with simple stretches or advice alone.
O'Brien
A V
AV
School of Health and Rehabilitation, Keele University, Keele, Staffordshire ST5 5BG, UK. a.v.o'brien@shar.keele.ac.uk
Jones
P
P
Mullis
R
R
Mulherin
D
D
Dziedzic
K
K
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation*; D026241:Exercise Movement Techniques / Q000379:methods; D005260:Female; D050823:Hand Joints / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology