Concise self-management hand program effective for SSc patients
medwireNews: Research indicates that a home-based, self-management program that promotes easy hand exercises and gives direction on moisturizing and warming effectively reduces pain and improves function in the hands of patients with systemic sclerosis (SSc).
“Due to the rarity of SSc, scleroderma hand care – especially occupational therapy – is not often available and is generally restricted to specialized centers, usually far from patients’ residences, which limits enrolment and adherence,” say Eduardo Magalhães (University of Campinas-Unicamp, São Paulo, Brazil) and colleagues.
Instead, their home-based program “can be offered during routine medical appointments without the need for face-to-face sessions or a specialized team,” they emphasize.
The program, which the researchers say is “written in simple language,” is delivered in the form of a booklet and DVD, and comprises brief directions about warming and moisturizing habits along with 10 easy-to-perform exercises involving active motions and stretching.
A total of 40 patients enrolled in the program and participated in evaluations at 4, 8, and 24 weeks. By this final follow-up, mean levels of VAS-measured pain had significantly reduced, from 4.82 points at baseline to 1.93 points. By comparison, pain scores increased in the control group of 17 patients who did not wish to enroll in the program or were unable to return for the scheduled appointments, from an average of 3.47 to 4.35 points, giving a large effect size as calculated by the Cohen’s test of 1.48.
Hand function, according to the Cochin Hand Function Scale, also significantly improved in the patients during the program, with scores decreasing from 24.30 to 11.00 points, whereas they increased from 24.12 to 27.76 points in those not participating in the program, with an effect size of 1.06.
In addition to these improvements, significant benefits of similar effect size were reported for fingertip and key pinch strength, HAQ-measured disability, grip strength, and finger motion.
Improvements for all outcomes generally occurred within the first 4 weeks and persisted throughout follow-up, note the researchers.
They add that patients following the program were more likely than the control group to moisturize their hands multiple times a day (75.0 vs 58.8%) and their body once a day (87.5 vs 56.2%), as well as always warming their hands (82.5 vs 23.5%) and body (85.0 vs 47.1%).
And they saw concurrent decreases in the impact of Raynaud’s phenomenon and digital ulcers on the daily activities of those participating in the program.
Magalhães and team conclude in Rheumatology: “The intervention is a simple and useful adjuvant programme to guide patients and reduce hand disease impact, especially when a regular rehabilitation programme is not possible or available.”
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