Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. (2015)

PICO

Patient/Population

Adults with rheumatoid arthritis who had pain and dysfunction of the hands and had been on a stable drug regimen for at least 3 months (N=490)

Intervention

  • Usual care
  • Exercise program – tailored strengthening and stretching (SARAH)

Comparison

  • Usual care

Outcomes

  • Overall hand function
  • Strengthening and Stretching for activities of daily living
  • Pain
  • Work performance
  • Satisfaction
  • Aesthetics

    Translatability:   (3/3) Easy                                    

    Comments: “…a tailored hand exercise programme is a worthwhile, low-cost intervention to provide as an adjunct to various drug regimens. Maximisation of the benefits of biological and DMARD regimens in terms of function, disability, and health-related quality of life should be an important treatment aim.”
    Limitations: participant and clinician masking is impossible with exercise interventions.

    Appraisals:

    PEDro Scale  – (8/10) Blind subjects: No; Blind therapists: No. (by PEDro – confirmed)

    Trustworthiness – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. (by CAT)

    Metrics and
    Journal Details:

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    BTB

    Intervention – 1

    • Mobility exercise

    Dose

    • 1 set of 5 repetions
      Initial 5 seconds hol
      Step 1: Increase up to 10 repetitions
      Step 2: Increase up to 10 seonds holds

    Periodicity

    • Daily – minimum of 12 weeks

    Local/Technic:

    MCP flexion. Tendon gliding. Finger radial walking. Wrist circumduction. Finger abduction. Hand-behind-head. Hand-behind-back

      Intervention – 2

      • Strength

      Dose

      • Initial load: between
        3 to 4 on modified 10 pt Borg Scale

      • x 10 (minimum 8 repetitions; maximum 12 repetitions)
        Step 1: 2 x 10 repetitions
        Step 2: 4 – 5 on Borg Scale
        Step 3: 5 – 6 on Borg Scale
        Step 4: 3 x 10 repetitions

      Periodicity

      • Daily – minimum of 12 weeks

      Local/Technic:

      Eccentric wrist extension. Gross grip. Finger adduction. Pinch grip. More about SARAH.

      Citation: Lamb, S. E., Williamson, E. M., Heine, P. J., Adams, J., Dosanjh, S., Dritsaki, M., Glover, M. J., Lord, J., McConkey, C., Nichols, V., Rahman, A., Underwood, M., Williams, M. A., & Strengthening and Stretching for Rheumatoid Arthritis of the Hand Trial (SARAH) Trial Team. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial.Lancet (London, England),385(9966), 421–429. https://doi.org/10.1016/S0140-6736(14)60998-3

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