Session Information
Date: Tuesday, October 23, 2018
Title: Systemic Sclerosis and Related Disorders – Clinical Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Involvement of the skin and musculoskeletal system is associated with impaired quality of life in patients with systemic sclerosis (SSc). Data on efficacy of non-pharmacological care in SSc is limited due to the heterogeneity in studied interventions/outcomes. The aim of our study was to minimalize the limitations of available studies and to determine the effect of intensive physical-occupational therapy on hand/face function and on the quality of life in cohorts with a substantial number of SSc patients.
Methods: All patients were non-selectively consecutively recruited into an intervention (IG) and control (CG) group. They fulfilled the ACR/EULAR 2013 criteria for SSc, and had skin involvement of the hands and face. Patients from both groups received educational material for home exercises, but only the IG underwent a six-month intervention with a subsequent six-month follow-up period. All patients were evaluated by a physician and physiotherapist blinded to intervention at 0, 3, 6 and 12 months. Patients also filled out patient reported outcomes/questionnaires and provided blood for routine laboratory analysis and biobanking. Data analysis was performed between groups and within the group.
Results: In total 25 patients were included in the IG and 30 into the CG. Compared to the observed statistically significant deterioration in CG, we found a statistically significant improvement in IG in objectively assessed function and strength of hand, distance between incisors and lips and also subjectively assessed functional ability (SHAQ). During the follow-up period there was a significant deterioration or stagnation of the achieved results in the IG. Only numerical improvements in IG compared to numerical deterioration in CG, but not statistically significant, were observed, during the intervention period, in subjectively evaluated parameters (hand/face function (CHFS/MHISS), functional ability (HAQ), and some domains of (SF-36).
Conclusion: Our program led to a significant improvement in the observed parameters that were clinically relevant in a substantial proportion of patients with SSc (in the IG) and prevented the natural course of progressive deterioration in hand/face function (observed in the CG).
Acknowledgments: The project was supported by AZV-16-33574A, MHCR 023728 and SVV for FTVS UK 2019-260466.
|
Parameter (unit) |
Intervention group Mean ± SEM |
Control group Mean ± SEM |
Intra-group analysis (Friedman+Dunn) |
Inter-group analysis (2WA) |
|
|
Interevention gr. |
Control group |
||||
|
dFTP, dominant hand (cm) |
m0: 5.7 ± 0.5 |
m0: 6.8 ± 0.5 |
m0-3: p<0.01 |
m0-3: NS |
p<0.0001 |
|
m3: 6.2 ± 0.5 |
m3: 6.2 ± 0.4 |
m3-6: p<0.05 |
m3-6: NS |
||
|
m6: 6.8 ± 0.6 |
m6: 5.9 ± 0.4 |
m0-6: p<0.0001 |
m0-6: p<0.0001 |
||
|
m12: 6.0 ± 0.6 |
m12: 5.6 ± 0.4 |
m6-12: p<0.0001 |
m6-12:NS |
||
|
Hand grip strength, dominant hand (kg) |
m0: 17.2 ± 1.8 |
m0: 16.5 ± 1.2 |
m0-3: p<0.05 |
m0-3: NS |
p<0.0001 |
|
m3: 19.2 ± 1.9 |
m3: 14.9 ± 1.3 |
m3-6: NS |
m3-6: NS |
||
|
m6: 19.7 ± 1.9 |
m6: 13.8 ± 1.2 |
m0-6: p<0.001 |
m0-6: p<0.01 |
||
|
m12: 17.5 ± 2.0 |
m12: 14.2 ± 1.3 |
m6-12: p<0.05 |
m6-12: NS |
||
|
HAMIS, dominant hand |
m0: 9.8 ± 1.3 |
m0: 3.9 ± 1.1 |
m0-3: p<0.01 |
m0-3: NS |
p<0.0001 |
|
m3: 7.1 ± 1.3 |
m3: 6.3 ± 1.2 |
m3-6: p<0.001 |
m3-6: p<0.001 |
||
|
m6: 4.1 ± 0.9 |
m6: 8.9 ± 1.1 |
m0-6: p<0.0001 |
m0-6: p<0.0001 |
||
|
m12: 7.2 ± 1.2 |
m12: 9.8 ± 1.2 |
m6-12: p<0.001 |
m6-12: NS |
||
|
Inter-lip distance (cm) |
m0: 3.92 ± 0.16 |
m0: 4.18 ± 0.11 |
m0-3: p<0.01 |
m0-3: NS |
p<0.0001 |
|
m3: 4.24 ± 0.17 |
m3: 4.03 ± 0.12 |
m3-6: NS |
m3-6: NS |
||
|
m6: 4.46 ± 0.18 |
m6: 4.02 ± 0.13 |
m0-6: p<0.0001 |
m0-6: NS |
||
|
m12: 4.25 ± 0.20 |
m12: 3.88 ± 0.13 |
m6-12: NS |
m6-12: NS |
||
|
Inter-incisor distance (cm) |
m0: 2.9 ± 0.2 |
m0: 3.3 ± 0.1 |
m0-3: p<0.01 |
m0-3: p<0.01 |
p<0.0001 |
|
m3: 3.2 ± 0.2 |
m3: 3.1 ± 0.1 |
m3-6: NS |
m3-6: NS |
||
|
m6: 3.5 ± 0.2 |
m6: 3.0 ± 0.1 |
m0-6: p<0.0001 |
m0-6: p<0.001 |
||
|
m12: 3.2 ± 0.2 |
m12: 3.0 ± 0.1 |
m6-12: p<0.01 |
m6-12: NS |
||
|
SHAQ (mm) |
m0: 28.8 ± 3.9 |
m0: 21.5 ± 2.1 |
m0-3: NS |
m0-3: NS |
p=0.0015 |
|
m3: 21.5 ± 3.4 |
m3: 24.6 ± 2.6 |
m3-6: NS |
m3-6: NS |
||
|
m6: 22.0 ± 3.5 |
m6: 24.9 ± 2.9 |
m0-6: p<0.05 |
m0-6: NS |
||
|
m12: 23.4 ± 3.7 |
m12: 27.5 ± 3.3 |
m6-12: NS |
m6-12: 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 the intervention period); m6, month 6 (= at the end of intervention); m12, month 12 (= at the end of the 6-month follow up period); 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, Hermankova B, Cesak P, Rathouska A, Ruzickova O, Pavelka K, Šenolt L, Vencovsky J, Becvar R, Tomcik M. The Effect of an Intensive Controlled 6-Moth Physical-Occupational Therapy Program with Subsequent 6-Month Follow-up Period in Patients with Systemic Sclerosis – Preliminary Data [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-effect-of-an-intensive-controlled-6-moth-physical-occupational-therapy-program-with-subsequent-6-month-follow-up-period-in-patients-with-systemic-sclerosis-preliminary-data/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-an-intensive-controlled-6-moth-physical-occupational-therapy-program-with-subsequent-6-month-follow-up-period-in-patients-with-systemic-sclerosis-preliminary-data/