Session Information
Date: Sunday, November 5, 2017
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's – Clinical Aspects and Therapeutics Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Systemic sclerosis (SSc) represents a heterogeneous autoimmune disease characterized by fibrosis of skin and internal organs. In particular, thickening of the skin, puffy hands, digital ulcers, calcinosis and joint contractures has contributed to disease prognosis by decreasing function of the hand and quality of life. The present study aims to investigate the effectiveness of the hand exercise program and demonstrate its influence on quality of life, as well as anxiety and depression in SSc patients.
Methods: Thirty female patients with SSc who fulfilled the 2013 ACR/EULAR classification criteria for systemic sclerosis were included in the study. Patients with neurological disorders, arthritis, myositis, amputation of fingers, serious contracture resisting hand grip and history of undergoing hand surgery were excluded. Patients were randomized into an exercise (n=16) and a control (n=14) group. Each group were informed of their disease and given recommended advice such as avoiding cold and trauma. The exercise group participated in a single hand exercise training applied by a medical doctor. Hereafter, they were given instructions for the home exercise program. The 8-week intervention consisted of isometric hand exercise and self-administered stretching repeated 10 times/2 set of training exercises per a day. Each group’s hand functions were assessed by Hand Mobility in Scleroderma (HAMIS) and Duruöz Hand Index (DHI). Additionally, all patients were estimated by Short Form 36 (SF-36), The Health Assessment Questionnaire (HAQ), Beck Anxiety and Beck Depression Inventory. Each group were evaluated at baseline and reassessed after 4 (V1) and 8 (V2) weeks.
Results: The baseline demographics and disease characteristics between the groups were similar. When comparing V1 and V2, we established a statistically significant amelioration from baseline measurement of handgrip strength in the exercise group (p<0.001). Accordingly, values of HAMIS, DHI, HAQ and Beck Depression Inventory were also significantly improved at V2 (p=0.002, 0.001, 0.001, 0.071, respectively) (Table). The assessment between the two groups at V1 and V2 indicated significant improvement in the exercise group with respect to the controls.
Conclusion: Exercise therapy showed a greater amelioration in the patients’ measurements of handgrip strength, quality of life and depression in SSc patients, indicating improvement in their hand function when compared to the control group.
Table: Outcome measurement changes in between the two groups at baseline, after 4 week and 8 week.
|
Outcome |
Baseline mean±SD median (min-max) |
Week 4 mean±SD median (min-max) |
Week 8 mean±SD median (min-max) |
ptime |
||
|
Modified Rodnan Skin Score |
E |
15.4±8.1 14 (4-33) |
14.3±7.2 12.0 (5-32) |
13.6±6.6 11.5 (5-30) |
0.026* |
|
|
C |
15.1±8.8 13.5 (3-34) |
14.7±8.0 13.5 (3-30) |
14.9±8.1 14.0 (4-30) |
0.830 |
||
|
pgroup |
0.697 |
0.728 |
0.667 |
|||
|
HAMIS |
E |
5.3±6.0 4.5 (0-18) |
2.5±4.8 0 (0-14) |
1.9±3.5 0 (0-13) |
0.002¶ |
|
|
C |
4.0±5.2 3.0 (0-19) |
4.0±4.6 2.5 (0-13) |
4.0±5.2 2.5 (0-18) |
0.968 |
||
|
pgroup |
0.608 |
0.208 |
0.257 |
|||
|
DHI |
E |
8.0±6.0 5.0 (0-29) |
5.3±6.8 3.5 (0-22) |
4.1±6.7 1.0 (0-18) |
<0.001§ |
|
|
C |
13.7±13.4 7.0 (0-35) |
14.9±13.3 15.0 (0-32) |
15.1±11.7 16.5 (0-30) |
0.734 |
||
|
pgroup |
0.525 |
0.101 |
0.013 |
|||
|
Valentini activity score |
E |
2.4±1.4 2.0 (0.5-5) |
1.5±1.4 1.0 (0-4.5) |
1.2±1.0 1.3 (0-3.5) |
<0.001§ |
|
|
C |
3.4±1.5 3.3 (1-6) |
2.3±0.9 2.0 (0.5-4) |
2.3±1.8 2.0 (0-6) |
0.048* |
||
|
pgroup |
0.110 |
0.028* |
0.064 |
|||
|
Beck Depression Inventory |
E |
19.8±11.6 18.0 (2-46) |
18.0±11.3 18.5 (3-39) |
15.0±11.2 12.5 (2-45) |
0.035* |
|
|
C |
23.1±10.3 22.5 (3-40) |
23.0±11.6 24.5 (4-50) |
23.7±11.9 25.0 (0-42) |
0.910 |
||
|
pgroup |
0.294 |
0.240 |
0.034* |
|||
|
Beck Anxiety Inventory |
E |
16.3±9.2 15.0 (3-36) |
17.0±10.1 14.5 (6-41) |
13.4±10.2 9.5 (1-40) |
0.071 |
|
|
C |
25.9±10.3 27.5 (6-39) |
23.4±11.9 22.5 (4-50) |
22.1±11.7 23.0 (1-46) |
0.233 |
||
|
pgroup |
0.010* |
0.093 |
0.034* |
|||
|
Dominant handgrip strength (kg) |
E |
18.6±6.7 18.0 (10-32) |
22.3±7.1 20.5 (14-36) |
24.6±6.8 23.5 (14-38) |
<0.001§ |
|
|
C |
15.5±6.4 18.0 (11-30) |
18.7±6.8 18.0 (9-30) |
18.4±6.4 17.5 (9-30) |
0.843 |
||
|
pgroup |
0.984 |
0.244 |
0.013* |
|||
|
HAQ |
E |
10.5±7.7 9.0 (0-26) |
6.3±7.8 2.5 (0-23) |
4.1±6.2 0 (0-18) |
<0.001§ |
|
|
C |
13.6±13.3 8.0 (0-40) |
13.8±12.5 7.0 (0-35) |
13.7±11.7 8.5 (0-32) |
0.967 |
||
|
pgroup |
0.822 |
0.093 |
0.007¶ |
|||
|
SF-36 |
Physical function |
E |
43.8±25.0 42.5 (5-90) |
53.4±21.9 50.0(20-100) |
67.8±17.1 67.5(30-100) |
<0.03* |
|
C |
46.8±31.4 45.0 (0-100) |
39.6±34.5 35.0 (0-100) |
37.9±30.8 40.0 (0-100) |
0.312 |
||
|
pgroup |
0.886 |
0.257 |
0.003¶ |
|||
|
Role physical |
E |
20.3±32.0 0 (0-100) |
40.6±38.6 25.0 (0-100) |
55.0±38.1 50.0 (0-100) |
<0.001§ |
|
|
C |
14.3±27.2 0 (0-100) |
17.9±28.5 0 (0-100) |
25.0±39.2 0 (0-100) |
0.343 |
||
|
pgroup |
0.759 |
0.077 |
0.038* |
|||
|
Body pain |
E |
56.8±32.3 60.5 (0-100) |
56.3±19.7 56.0 (30-84) |
60.0±21.0 60.0 (22-90) |
0.853 |
|
|
C |
52.7±29.6 50.5 (0-90) |
53.5±26.0 60.0 (10-90) |
55.0±29.0 61.0 (0-100) |
0.881 |
||
|
pgroup |
0.728 |
0.822 |
0.749 |
|||
|
General health |
E |
44.7±20.5 50.0 (0-67) |
45.1±17.0 45.0 (10-70) |
46.1±18.3 50.0 (15-75) |
0.917 |
|
|
C |
44.4±24.5 47.5 (0-80) |
39.7±23.9 47.5 (0-65) |
34.8±22.7 46.0 (0-60) |
0.016* |
||
|
pgroup |
0.886 |
0.759 |
0.224 |
|||
|
Vitality |
E |
45.9±17.7 50.0 (10-70) |
43.4±17.5 40.0 (15-75) |
48.4±15.0 50.0 (20-75) |
0.488 |
|
|
C |
34.3±18.6 37.5 (0-60) |
39.6±18.1 42.5 (5-65) |
38.6±21.0 45.0 (0-70) |
0.281 |
||
|
pgroup |
0.093 |
0.728 |
0.257 |
|||
|
Social functioning |
E |
44.5±20.9 50.0 (0-75) |
42.9±14.6 50.0 (12-63) |
46.7±21.0 50.0(13-100) |
0.842 |
|
|
C |
37.4±22.5 37.5 (0-75) |
43.0±19.5 50.0 (0-75) |
37.0±14.4 37.0 (12-62) |
0.524 |
||
|
pgroup |
0.142 |
0.142 |
0.142 |
|||
|
Role emotional |
E |
33.2±36.5 33.0 (0-100) |
43.7±20.3 33.0 (0-67) |
47.8±21.2 33.0(33-100) |
0.214 |
|
|
C |
33.1±34.5 33.0 (0-100) |
30.7±27.5 33.0 (0-100) |
40.4±32.6 33.0 (0-100) |
0.426 |
||
|
pgroup |
0.951 |
0.101 |
0.400 |
|||
|
Mental health |
E |
54.5±16.8 54.0 (16-80) |
51.3±18.1 50.0 (28-96) |
48.4±17.5 54.0 (36-96) |
0.256 |
|
|
C |
47.4±16.3 46.0 (16-72) |
49.4±8.7 50.0 (36-68) |
47.4±15.4 50.0 (20-68) |
0.905 |
||
|
pgroup |
0.240 |
0.886 |
0.208 |
|||
*p<0.05, ¶p<0.01, §p<0.001
E: Exercise group, C: Control group, HAMIS: Hand Mobility in Scleroderma, DHI: Duruöz Hand Index, HAQ: The Health Assessment Questionnaire, SF-36: Short Form 36.
To cite this abstract in AMA style:
Gokcen N, Badak SO, Sarpel T, Sertdemir Y, Erken E. How Effective Is the Home Exercise Program for Hands in Patients with Systemic Sclerosis: Preliminary Results from a Randomized Controlled, Single-Blind, Clinical Trial [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/how-effective-is-the-home-exercise-program-for-hands-in-patients-with-systemic-sclerosis-preliminary-results-from-a-randomized-controlled-single-blind-clinical-trial/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-effective-is-the-home-exercise-program-for-hands-in-patients-with-systemic-sclerosis-preliminary-results-from-a-randomized-controlled-single-blind-clinical-trial/