title: The efficacy of rehabilitation for patients with rheumatoid arthritis: comparison between a 4-week rehabilitation programme in a warm and cold climate.
abstract: OBJECTIVE
  To investigate the long-term effect (week 16) of a 4-week rehabilitation programme for patients with rheumatoid arthritis (RA) and to compare the effect of this intervention given in a Mediterranean or a Norwegian climate.
  
  
  METHODS
  A randomized, controlled, parallel group design, where 124 RA patients applying for rehabilitation were randomized to a rehabilitation programme either in Norway or in a Mediterranean climate. The participants were examined clinically immediately before (week 0) and after (week 4) the rehabilitation period as well as in week 16 and answered a mailed questionnaire in week 28. The 28-Joint Disease Activity Score (DAS28), American College of Rheumatology (ACR) response and physical tests were used to measure clinical response.
  
  
  RESULTS
  The baseline DAS28 value 4.45 (1.16) was reduced by -0.95 (1.05) in the Mediterranean climate and the baseline DAS28 value 4.18 (1.17) was reduced by -0.37 (0.92) in the Norwegian climate at week 16 (p = 0.003). An ACR20 improvement was achieved in 25% of the patients treated in the Mediterranean climate and in 15% of those treated in the Norwegian climate. Sustained improvement in all ACR core components at week 16 and in patient's assessment of health status at week 28 was found in the patients treated in the Mediterranean climate only. Tests of physical function, the 6-Minute Walk Test (6MWT) and the Timed Up and Go (TUG), showed comparable improvements in patients treated in both climates.
  
  
  CONCLUSIONS
  RA patients showed immediate positive effects with regard to disease activity, physical function, and symptoms during a 4-week rehabilitation programme. The effects on disease activity and symptoms were larger and better maintained at least 3 months after rehabilitation in a warm rather than in a cold climate.
authors: Section of Treatment of Abroad, Department of Rheumatology, Rikshospitalet-Radiumhospitalet Medical Centre, Sunnaas Rehabilitation Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Y A
authors: YA
authors: Staalesen Strumse
authors: B-Y
authors: BY
authors: Nordvag
authors: J K
authors: JK
authors: Stanghelle
authors: M
authors: M
authors: Røsland
authors: A
authors: A
authors: Winther
authors: P-A
authors: PA
authors: Pajunen
authors: T
authors: T
authors: Garen
authors: B
authors: B
authors: Flatø
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000534:rehabilitation*; D002980:Climate; D005260:Female; D006801:Humans; D008297:Male; D019083:Mediterranean Region; D008875:Middle Aged; D009664:Norway; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D012720:Severity of Illness Index; D016896:Treatment Outcome