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)
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 Scalex 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