Background/Purpose: Individuals with systemic sclerosis (SSc) suffer from limited arm and hand function due to skin thickening and contractures. Evidence-based medical rehabilitation strategies for these issues remain limited. Standard treatments of heat massage, and exercise are recommended but are primarily focused on the hand, not taking into account wrist, elbow, and shoulder contractures. In addition the rehabilitation treatments do not often target the skin scarring that underlies contracture formation. The purpose of this study was to determine the feasibility and preliminary effects of a novel treatment approach to improve arm and hand function in patients with scleroderma with both arm and hand contractures.

Methods: Participants with early SSc with arm and hand contractures were recruited from our Scleroderma Clinic. The intervention involved eight in-person weekly sessions with an occupational therapist and involved heat, mobility and range of motion exercises, and the use of the Physiotouch®, a negative pressure device that is commonly used at our center in other patient populations for mobilizing tissue with positive effects on the lymphatic system and skin mobilization. Feasibility was assessed by determining participant flow through the trial including the number of people enrolled who were eligible, and the number of people that adhered to the entire treatment protocol. A secondary goal was to examine preliminary effects on arm and hand function using the QuickDASH disability measure. Primary outcomes were measured at baseline and 8 weeks with an intermediate assessment at 4 weeks post baseline.

Results: The sample (N = 16) had a mean age of 46 (range 22-67), was 88% female, and 44% indicated being from racial minority group. The sample are diffuse scleroderma subset with a mean Rodnan skin score of 17.9 (+/- 10.1), and a mean QuickDASH score was 53.4 (+/- 22.7), which is almost three standard deviations above the population mean. Of those screened in-person, 95% were eligible, and 90% were enrolled. 50% have currently adhered to the entire protocol. 50% of our sample who have so far completed treatment at 8 weeks had improvements on the QuickDASH (n = 8) which ranged between 6-13 points, the mean improvement was statistically significant (t=6.6, df=7, p = .0001). Participants reported positive outcomes of the treatment such as improved coordination, fluidity of movement, not dropping things, and pain improvement.

Conclusion: This intervention is feasible despite the burden of traveling to the center for 8 in-person visits and led to improvements in half of the participants. This study would benefit from bolstering home rehabilitation components and future work will need to compare those who receive this treatment to a control group.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/feasibility-and-preliminary-effects-of-a-novel-rehabilitation-strategy-to-improve-hand-and-arm-function-in-systemic-sclerosis/