Physio findings: Rheumatoid arthritis

SARAH gives patients a helping hand

Tailored exercises can significantly improve hand function for patients with rheumatoid arthritis, a study published in the Lancet shows.

Physiotherapist Sallie Lamb, of Oxford University’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, and colleagues note that drugs can slow the progress of the disease. But that doesn’t necessarily improve patients’ ability to move or their quality of life.

So the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) trial set out to see if it was worth adding an individually tailored, progressive exercise programme for the hands and arms.

‘We recruited people who were stable on a drug regimen before exercises, recognising that patients can find exercises very difficult when experiencing pain and poor symptom control,’ the authors point out.

‘However, participants were not patients with burnt-out quiescent disease,’ they add.

Working at 17 English NHS trusts, the team selected 490 participants with painful, swollen hands. They were randomly assigned into two groups, one of which learned a tailored exercise programme. Both groups also received high-quality usual care, including education and splinting where necessary.

Members of the exercise group had six sessions with a physio or an occupational therapist. They were taught seven mobility exercises and four strength or endurance exercises against resistance provided by bands, balls or therapeutic putty. They were asked to do their exercises at home every day.

At the end of a year, the exercise group’s improvement was more than double that of the other group. Their hand-muscle strength and dexterity were significantly better, and they reported more improvements in other outcomes such as coping with everyday activities.   The course had cost £156 per person.

‘We have shown that a tailored hand exercise programme is a worthwhile, low-cost intervention to provide as an adjunct to various drug regimens,’ say the authors.

Osteoarthritis patients have also been shown to benefit from hand exercises: see Physio Findings 21 May 2014; Lamb S et al. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. Lancet 2014.

Neurology : Confidence lags behind improved balance

A physio-led programme of balance exercises significantly reduced the risk of falling among people with multiple sclerosis (MS). Yet that did not increase the patients’ confidence, Swedish researchers have found.

Ylva Elisabet Nilsagård, of Örebro University’s School of Medicine and Health, and colleagues studied 32 people with mild-to-moderate MS.

All the participants lived in the community and could walk 100 metres, but had difficulty with their balance when standing.  

The patients attended hour-long group sessions twice a week for seven weeks, doing a programme worked out by physiotherapists. The exercises targeted core stability, dual tasking (such as walking while counting backwards) and sensory strategies (such as stepping on an uneven surface).

The team measured patients’ performance before, during and after the exercise programme. In the seven weeks before it started they recorded 166 falls compared with just 43 in the same amount of time afterwards. The number of people who had a fall went down from 17 to 10.

‘The results are in line with previously published research providing evidence that targeted physiotherapy interventions can positively affect falls in people with MS,’ say the authors.

‘Still, the intervention did not alter balance confidence,’ they add. This may be because the programme took place in safe indoor surroundings, they suggest, whereas falls often happen outside. Or it may simply not have lasted long enough for participants to develop confidence in their improved abilities.

Nilsagård YE et al. Balance Exercise Program Reduced Falls in People With Multiple Sclerosis: A Single-Group, Pretest-Posttest Trial. Archives of Physical Medicine and Rehabilitation 2014.

Comments & Conclusions

Encouraging people with long-term conditions to book outpatient appointments when they need them rather than having fixed follow-up appointments can cut costs without reducing the quality of care, say researchers in the Netherlands. They tried the new system with respiratory patients. Berkhof FF et al. Respiratory Medicine 2014.
 
Married women are 28 per cent less likely to die of heart disease than women single or co-habiting women, even though all are equally likely to develop the condition, a study shows. Floud S et al. BMC Medicine 2014.
 
High-intensity interval training is safe for heart-transplant patients, and improves their exercise capacity and blood-pressure control more effectively than moderate-intensity training, according to a study of 26 stable long-term transplant recipients. Dall CH et al. American Journal of Transplantation 2014.
 
Men can reduce their bowel-cancer risk by 22 per cent and women by 11 per cent if they are physically active, don’t smoke, keep to a healthy weight with little abdominal fat, and eat a wholesome diet with plenty of fruit and veg with little alcohol or processed meat. Aleksandrova K et al. BMC Medicine 2014.
 
A review of seven trials covering 805 middle-aged patients with knee pain but little or no arthritis suggests that those who underwent meniscal debridement fared no better than those having non-surgical treatment. Khan M et al. CMAJ 2014.

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