title: Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review.
abstract: OBJECTIVE
  To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc).
  
  
  METHODS
  Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ≥10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist.
  
  
  RESULTS
  Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life.
  
  
  CONCLUSIONS
  The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures.
authors.affiliation: Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Willems
authors.affiliation: Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Vriezekolk
authors.affiliation: Leiden University Medical Center, Leiden, and Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Anne A
authors.initials: AA
authors.lastname: Schouffoer
authors.affiliation: University of New Mexico, Albuquerque.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Poole
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Tanja A
authors.initials: TA
authors.lastname: Stamm
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Carina
authors.initials: C
authors.lastname: Boström
authors.affiliation: Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Kwakkenbos
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Theodora P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.affiliation: Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: Cornelia H M
authors.initials: CH
authors.lastname: van den Ende
mesh_terms: D018849:Controlled Clinical Trials as Topic; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000534:rehabilitation* / Q000628:therapy; D016896:Treatment Outcome