A dynamic exercise programme to improve patients' disability in rheumatoid arthritis: a prospective randomized controlled trial.
OBJECTIVE
To evaluate the functional, clinical, radiological and quality of life outcomes of a 4-week dynamic exercise programme (DEP) in RA.


METHODS
Patients matched on the principal medico-social parameters were randomly assigned to either the DEP or the conventional joint rehabilitation group. Primary end point for judging effectiveness was functional status assessed by HAQ. Secondary outcomes included Nottingham Health Profile (NHP), Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF) and radiological worsening measured by Simple Narrowing Erosion Score (SENS). Clinical evaluation consisted of disease activity score (DAS 28), cycling aerobic fitness and dexterity. Dexterity was measured using Sequential Occupational Dexterity Assessment (SODA) and Duruoz Hand Index (DHI). Data were collected at baseline 1, 6 and 12 months.


RESULTS
Fifty patients were enrolled. HAQ improved throughout the length of the trial in the DEP group. This improvement was greater in DEP than in the standard joint rehabilitation group at 1 month (-0.2 vs no variation from baseline, P = 0.04), but not at 6 months (-0.2 vs -0.1 in control group, P = 0.25) or 12 months (-0.1 vs no variation in control group, P = 0.51). DEP improved NHP (-23 vs + 7% in control group, P = 0.01) and aerobic fitness (+0.3 vs + 0.1 km per 5 min in control group, P = 0.02) at 1 month but the progress was not statistically significant thereafter. DEP also improved DHI, SODA, DAS 28 and AIMS2-SF, although not significantly.


CONCLUSIONS
DEP was effective on functional status assessed by HAQ, quality of life and aerobic fitness at 1 month.
Baillet
Athan
A
1Clinic of Rheumatology, Hôpital Sud, Echirolles, Hôpital A Michallon, Grenoble, France. abaillet@chu-grenoble.fr
Payraud
Elodie
E
Niderprim
Virginie-Aurélie
VA
Nissen
Michael J
MJ
Allenet
Benoit
B
François
Patrice
P
Grange
Laurent
L
Casez
Pierre
P
Juvin
Robert
R
Gaudin
Philippe
P
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001175:Arthrography; D006233:Persons with Disabilities; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007596:Joints / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D013997:Time Factors; D016896:Treatment Outcome