title: Hand exercise intervention in patients with polymyositis and dermatomyositis: a pilot study.
abstract: OBJECTIVE
  The aim of the present study was to develop a 12-week hand exercise intervention for patients with polymyositis (PM) and dermatomyositis (DM) and evaluate adherence, patients' opinions of the programme design and overall feasibility, and the effect on hand function and activity limitation after the intervention.
  
  
  METHODS
  A pilot hand exercise intervention was conducted on a convenience sample of 15 patients with reduced handgrip strength and established, inactive PM and DM. Acceptable adherence was set at 75%. The programme was evaluated based on patients' opinions regarding exertion, the movements involved and overall feasibility. Hand- and pinch-grip strength, grip ability, dexterity and activity limitation were assessed.
  
  
  RESULTS
  Eleven of 15 patients completed the intervention, with acceptable adherence of 78-100%. Measures of handgrip strength, dexterity and activity limitation were reduced at baseline compared with normative data from the literature. Throughout the intervention, rates of perceived exertion were scored between 'moderate' and 'fairly strong'. Finger abduction and adduction were excluded from the hand exercise programme because they were not feasible to perform. Repetitions of the exercise increased gradually to a maximum of 30 per movement. Patients regarded this as too time-consuming and suggested ten repetitions daily or 10-20 repetitions 2-4 times per week. There were some individual, clinically meaningful improvements in hand function and activity limitation. A comparison between baseline and after the intervention showed that the three-jaw (tripod) pinch-grip strength (left hand) had increased (p < 0.007; z = -2.7).
  
  
  CONCLUSIONS
  A hand exercise programme was found to be feasible to perform by patients with established PM or DM. The effect was limited, with few individual improvements in hand function and activity limitation, indicating a need to increase the resistance in the movements and to limit the duration of each exercise session.
authors.affiliation: Department of Occupational Therapy, Karolinska University Hospital, Solna, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Regardt
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Schult
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Axelsson
authors.forename: Anna
authors.initials: A
authors.lastname: Aldehag
authors.forename: Helene
authors.initials: H
authors.lastname: Alexanderson
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
authors.forename: Elisabet Welin
authors.initials: EW
authors.lastname: Henriksson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003882:Dermatomyositis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006225:Hand; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D010865:Pilot Projects; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: activity limitation; dermatomyositis; hand exercise; occupational therapy; polymyositis