Arthritis patients show long-term benefits from 3 weeks intensive exercise training directly following hospital discharge.
OBJECTIVE
To examine the efficacy of short-term intensive exercise training (IET) directly following hospital discharge.


METHODS
In the Disabled Arthritis Patients Post-hospitalization Intensive Exercise Rehabilitation (DAPPER) study, patients with rheumatoid arthritis or osteoarthritis were eligible when they needed hospitalization for either a flare-up in disease, elective hip or knee arthroplasty. The intervention group received IET for 3 weeks immediately after discharge; the control group was treated with the usual care (UC). The intensive exercise was provided in a resort. Outcomes were assessed at baseline, after 3, 13, 26 and 52 weeks. Range of motion was measured using the Escola Paulista de Medicina-Range of Motion scale (EPM-ROM), disability was measured using the HAQ and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), and for health-related quality of life (HRQoL), the Research and Development 36-Item Health Survey (RAND-36) was used.


RESULTS
The IET showed a better and faster improvement than UC on all outcome measures except for HRQoL. Up to 52 weeks after baseline, the EPM-ROM and the MACTAR remained favourable in IET compared with UC. At 3 weeks, the MACTAR improved significantly more in the IET compared with the UC: mean difference -5.5 (95% CI -8.4 to -2.2). At 26 weeks, the mean difference remained significant (-5.2; 95% CI -10.0 to -0.34). At 52 weeks, the effect was not significant; however, the mean difference in improvement between the groups can be considered clinically relevant. At 3 weeks, the IET had improved significantly more on the HAQ walking and rising subscales.


CONCLUSIONS
Intensive short-term exercise training of arthritis patients, immediately after hospital discharge results in improved regain of function. The DAPPER programme has a direct effect, which lasts up to 52 weeks.
Bulthuis
Y
Y
Institute for Behavioral Research, University of Twente, Enschede, The Netherlands.
Drossaers-Bakker
K W
KW
Taal
E
E
Rasker
J
J
Oostveen
J
J
van't Pad Bosch
P
P
Oosterveld
F
F
van de Laar
M
M
D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D010351:Patient Discharge; D011788:Quality of Life; D016059:Range of Motion, Articular; D016896:Treatment Outcome