Physical Therapy for Systemic Sclerosis: Systematic Review and Meta-Analysis

Madhavi Peddi¹, Maria A. Lopez-Olivo², Prashanth Peddi¹, Gisela Espinosa Cuervo³ and Maria E. Suarez-Almazor⁴, ¹Good Shepherd Medical Center, The University of Tyler Texas, Tyler, TX, ²Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, ³Instituto Mexicano del Seguro Social, Mexico City, Mexico, ⁴The Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: exercise, physical therapy, rehabilitation and systemic sclerosis

Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics: Systemic Sclerosis, Diagnostic and Therapeutic Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose

Physical therapy and rehabilitation are often recommended to improve function in patients with systemic sclerosis (SSc), but a systematic review of the evidence supporting these interventions has not been performed. We conducted a systematic review to evaluate the efficacy of physical therapy alone or in combination with exercise in patients with SSC.

Methods

We searched electronic databases (MEDLINE, EMBASE, the Cochrane Collaboration library, and Web of Science) up to April, 2013. The reference lists from reviews were also searched. Two independent reviewers selected controlled trials (randomized or not) evaluating the efficacy of any physical therapy modality either alone or in combination with exercise in patients with SSc. Data was appraised and collected independently by two reviewers. Outcomes of interest were functional status, health-related quality of life, and hand mobility (measured by Health Assessment Questionnaire, Short Form-36 items, and Hand Mobility in Scleroderma, respectively). Meta-analysis was performed when data was available for 2 or more studies with the same outcome.

Results

Six studies with 221 patients were included. Five were randomized controlled trials and one was a controlled clinical trial. None of the studies were blinded; therefore, the risk of performance bias was judged to be high. All studies were conducted at single center in an outpatient setting. The weighted mean age of patients assigned to the treatment group was 57.6 years and 55.9 years for the control group. Disease duration was 9.0 years and 8.7 years, respectively. There were substantial variations in the interventions and duration of physical therapy across trials. Therapy modalities included connective tissue massage, Manual Lymphatic drainage, and Mc Mennell joint manipulation, among others. Patients treated with any modality of physical therapy had higher scores in functional status (mean difference, MD, -0.33; 95% CI -0.46, -0.19), physical component of health-related quality of life (MD 3.3; 95% CI 1.1, 5.5) and hand mobility (MD -0.22; 95% CI -0.37, -0.06) at 2 to12 weeks compared with standard of care. However, this improvement was not sustained for hand mobility, 12 weeks after stopping treatment (at 24 weeks ) (MD -2.6; 95% CI -6.3, 1.0). No differences were observed by type of therapy modality.

Conclusion

Rehabilitation in patients with SSc improves functional status, ability to perform physical activities, and hand mobility 2 to12 weeks after therapy. However, loss of improvement in had mobility at 24 weeks suggests continuation of therapy is important to preserve the benefits of physical therapy.

Disclosure:

M. Peddi,
None;

M. A. Lopez-Olivo,
None;

P. Peddi,
None;

G. Espinosa Cuervo,
None;

M. E. Suarez-Almazor,
None.

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