Follow-up study finds that hand exercises elicit lasting improvements in rheumatoid arthritis
Initial trial did not include long-term follow-up
Therapeutic exercises are commonly recommended to address hand dysfunction in rheumatoid arthritis (RA), and the Stretching and Strengthening for Rheumatoid Arthritis of the Hand (SARAH) randomized controlled trial (RCT) was conducted to investigate their effectiveness. It demonstrated that individually tailored, progressive stretching and strengthening hand exercises improved hand function and was cost-effective compared to usual care over 12 months, but the study did not evaluate long-term effects. Noting this, an extended follow-up of the SARAH trial was performed to determine if the initial benefits lasted beyond 12 months and to gauge patients’ adherence to the exercises.
Two-thirds of original cohort provides extended follow up data
The original cohort consisted of 490 adults with RA affecting their hands that were randomly assigned to either a control or intervention group. The control intervention was best practice usual care that featured joint protection education, exercise advice, and functional splinting. Participants in the intervention group received this usual care plus an individually tailored exercise program consisting of moderate-to-high-intensity strengthening and stretching exercises. All participants were assessed at 4- and 12-month follow-ups with a primary outcome of hand function and several secondary outcomes. For the extended follow-up, original participants were contacted by mail and asked to complete updated questionnaires on their current status and exercise adherence, and 328 of this cohort (67%) responded.
Although exercise adherence rates were low, many benefits remained
On average, participants completed the extended follow-up 26 months after initial randomization. Exercise group participants reported substantially reducing the frequency of performing hand exercises over time, with 71.4% exercising 3 times/week at 4 months and only 31.4% at 12 months. The control group experienced small but statistically significant improvements in hand function at 4 and 12 months, but the extended follow-up values were not statistically significant. Moreover, the differences between the control and exercise groups at the 4- and 12-month follow-ups were statistically and clinically significant in favor of exercise, and exercise was still associated with significant within-group improvements in hand function at the extended follow-up. This finding is encouraging, as it shows that although many exercise group participants didn’t continue exercising, benefits of the initial intervention still persisted. Taken together, it appears that a hand exercise program can be an effective adjunct to current drug management in improving hand function in RA patients, and that patients’ original functional gains may last for up to two years. Clinicians should take note and recommend hand exercise interventions and long-term adherence to RA patients to help them better manage their symptoms.
-Summarized by Greg Gargiulo
-As reported in the April ’17 issue of BMJ Open