Hand Therapy helps patients with Rheumatoid Arthritis achieve significant improvements in hand function
Treating patients with rheumatoid arthritis improved dramatically since introduction of the first biologic agent, etanercept (Enbrel). However, adjunctive modalities, such as hand exercises and occupational therapy, which were used aggressively by rheumatologists in the pre-biologic era, are no longer used extensively.
In this multicenter study, researchers evaluated 490 U.K. patients who had received stable medical regimens for ≥3 months. Patients were randomized to usual care or to usual care plus a hand-strengthening and hand-exercise program. The intervention involved six sessions with a therapist who promoted patient-directed goal-setting and instructed participants in mobility and strength-and-endurance exercises that were to be performed at home daily. At 4 and 12 months, the exercise group achieved significant improvements in overall hand function, activities of daily living, satisfaction, and confidence to self-manage symptoms (especially in the first 4 months), compared with the usual-care group.
An editorialist notes that the feasibility of strengthening regimens for RA patients has been questioned. In this U.K. study, only 20% of patients were receiving biologic disease-modifying antirheumatic drugs (DMARDs); in many U.S. centers, at least twice that percentage receives DMARDs. However, appropriate hand therapy should become more of a standard of care, even in the U.S., as it provides clear benefits at marginal cost.
Source: Coblyn, Jonathan S . NEJM Journal Watch. General Medicine (Oct 30, 2014).