Session Information
Date: Monday, November 6, 2017
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's – Clinical Aspects and Therapeutics Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Involvement of skin and musculoskeletal system in systemic sclerosis (SSc) leads to loss of function, disability and reduced quality of life. Data on efficacy of non-pharmacologic care in SSc is very limited due to variety in studied interventions/outcomes. The aim of our study was to address the limitations of existing studies, and evaluate the effect of a controlled, long-term (24-week intervention, 24-week follow-up), intensive (1h physiotherapy + 0.5h occupational therapy twice weekly, and home-exercise for 0.5h 5x weekly), tailored physiotherapy programme on function/impairment of hands/face, and quality of life/disability in cohorts with a substantial number of SSc patients.
Methods: All patients fulfilled ACR/EULAR 2013 criteria, had skin involvement of hands/mouth, and were consecutively recruited from 2014 to 2016 at the Institute of Rheumatology in Prague. Both groups received educational materials and instructions for home exercise at baseline, however, only intervention group underwent the intensive physiotherapy programme. At months 0,3,6,12 all patients were assessed by a physician (physical examination, mRSS, EUSTAR SSc activity score, Medsger SSc severity score), and a physiotherapist blinded to intervention [validated measurements (dFTP-delta finger to palm, inter-incisor/inter-lip distance, grip strength using Baseline dynamometer); tests (HAMIS-Hand Mobility In Scleroderma)], patients filled out patient reported outcomes/questionnaires (CHFS-Cochin Hand Function Scale, MHISS-Mouth Handicap In SSc Scale, HAQ, SHAQ, SF-36) and provided blood for routine laboratory analysis and biobanking. Normality of data was tested, inter-group analysis was performed with 2-way ANOVA, and intra-group analysis by Friedman’s test with Dunn’s post hoc test.
Results: 25 SSc patients (22 female/3 male, 14 limited cutaneous (lc)SSc/11 diffuse cutaneous (dc)SSc, median of age 54.0 and disease duration 7.0 years, mRSS 12) were recruited into the intervention group (IG) and 29 patients into the control group (CG) (25 female/4 male, 16 lcSSc/13 dcSSc, median of age 49.0 and disease duration 5.0 years, mRSS 11). Compared to observed statistically significant deterioration in CG over the period of m0-m6, we found statistically significant improvement in dFTP, grip strength, HAMIS, inter-incisor and inter-lip distance (Table 1). Only numerical improvement in IG compared to numerical deterioration in CG, which have not reached statistical significance, were observed in patient reported outcomes (CHFS, MHISS, HAQ, SHAQ, SF-36).
Conclusion: Our physiotherapy program not only prevented the natural course of progressive deterioration of function of hands/mouth (observed in the control group), but led to a significant improvement in monitored parameters, which was clinically meaningful in a substantial proportion of patients.
Acknowledgement: Supported by AZV-16-33574A.
|
Parameter (unit) |
Intervention group Mean ± SEM |
Control group Mean ± SEM |
Intra-group analysis (Friedman+Dunn) |
Inter-group analysis (2WA) |
|
|
Interevention gr. |
Control group |
||||
|
dFTP (cm) |
m0: 5.7 ± 0.5 |
m0: 6.6 ± 0.5 |
m0-m3: p<0.001 |
m0-m3: p<0.01 |
p<0.0001 |
|
m3: 6.2 ± 0.5 |
m3: 6.1 ± 0.4 |
m3-m6: p<0.05 |
m3-m6: p<0.05 |
||
|
m6: 6.8 ± 0.6 |
m6: 5.8 ± 0.4 |
m0-m6: p<0.001 |
m0-m6: p<0.001 |
||
|
Hand grip strength (kg) |
m0: 17.2 ± 1.8 |
m0: 16.6 ± 1.3 |
m0-m3: p<0.05 |
m0-m3: p=NS |
p<0.0001 |
|
m3: 19.2 ± 1.9 |
m3: 14.9 ± 1.4 |
m3-m6: p=NS |
m3-m6: p=NS |
||
|
m6: 19.7 ± 1.9 |
m6: 13.9 ± 1.9 |
m0-m6: p<0.001 |
m0-m6: p<0.01 |
||
|
HAMIS |
m0: 9.8 ± 1.3 |
m0: 3.9 ± 1.1 |
m0-m3: p<0.01 |
m0-m3: p<0.01 |
p<0.0001 |
|
m3: 7.1 ± 1.2 |
m3: 6.4 ± 1.2 |
m3-m6: p<0.01 |
m3-m6: p<0.001 |
||
|
m6: 4.1 ± 0.9 |
m6: 9.3 ± 1.1 |
m0-m6: p<0.001 |
m0-m6: p<0.001 |
||
|
Inter-incisor distance (mm) |
m0: 30.6 ± 1.6 |
m0: 32.9 ± 1.3 |
m0-m3: p<0.01 |
m0-m3: p<0.001 |
p<0.0001 |
|
m3: 33.3 ± 1.6 |
m3: 30.2 ± 1.4 |
m3-m6: p=NS |
m3-m6: p=NS |
||
|
m6: 36.2 ± 2.0 |
m6: 29.8 ± 1.4 |
m0-m6: p<0.001 |
m0-m6: p<0.001 |
||
|
Inter-lip distance (mm) |
m0: 39.2 ± 1.6 |
m0: 41.7 ± 1.1 |
m0-m3: p<0.01 |
m0-m3: p<0.05 |
p<0.0001 |
|
m3: 42.4 ± 1.7 |
m3: 39.9 ± 1.2 |
m3-m6: p=NS |
m3-m6: p=NS |
||
|
m6: 44.6 ± 1.8 |
m6: 40.0 ± 1.3 |
m0-m6: p<0.001 |
m0-m6: p=NS |
||
|
Acronyms: SEM, standard error of the mean; Friedman, Friedman’s test; Dunn, Dunn’s post hoc test; 2WA, two way ANOVA, dFTP, delta finger to palm; HAMIS, Hand Mobility in Scleroderma; m0, month 0 (= at the baseline); m3, month (= in the middle of intervention period); m6, month 6 (= at the end of intervention); p, p-value; NS, not significant |
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To cite this abstract in AMA style:
Spiritovic M, Smucrova H, Oreska S, Storkanova H, Cesak P, Rathouska A, Ruzickova O, Mann HF, Pavelka K, Senolt L, Vencovsky J, Becvar R, Tomcik M. Efficacy of an Intensive 24-Week Physiotherapy Programme in Scleroderma Patients – Preliminary Data from a Single-Center Controlled Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/efficacy-of-an-intensive-24-week-physiotherapy-programme-in-scleroderma-patients-preliminary-data-from-a-single-center-controlled-study/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-an-intensive-24-week-physiotherapy-programme-in-scleroderma-patients-preliminary-data-from-a-single-center-controlled-study/