Wednesday, October 15, 2014 Exercise Regimen Significantly Decreases Disability in Individuals With RA of the Hand Tailored hand exercise used as an adjunct to drug regimens can make a significant, cost-effective difference in function and quality of life for individuals with rheumatoid arthritis (RA) of the hand, according to a new randomized controlled trial from the United Kingdom (UK). In the Strengthening and Stretching for Rheumatoid Arthritis of the Hand study (SARAH), 438 participants representing "the population of people with rheumatoid arthritis in the UK in terms of age and sex" were divided into 2 groups, 1 receiving usual care and the other receiving usual care plus special strengthening and stretching exercises overseen by a physiotherapist or occupational therapist. More than 90% of participants in both groups had been placed on a stable regimen of disease modifying drugs (DMARDs) for at least 3 months before the study, and all continued to take the drugs. Results of the study were e-published ahead of print in the October 10 issue of The Lancet. Currently only the study's abstract is available for free; however, APTA members will have access to the full article in 2 months via PTNow ArticleSearch. More detailed data on the trial have been posted online. Researchers administered the Michigan Hand Outcome Questionnaire (MHQ) at 4 and 12 months after a 20-day baseline to both groups, and found that the exercise group's reported level of improvement was "more than double" the usual care group's ratings. The usual-care group's ratings on the 1-100 MHQ scale averaged 3.56 after 12 months, compared with the exercise group's 7.93 average. Other indicators were equally significant. "Changes in secondary outcomes mirrored these trends," authors write, "with significant differences in … activities of daily living, work, and satisfaction subscales, MHQ summed score, and self-efficacy." Global ratings of change in the exercise group improved for 45% of the participants, compared with 21% reporting improved ratings in the usual-care group. The 12-week exercise program included 7 mobility exercises and 4 strength training or endurance exercises using bands, balls, or putty, and was tailored to the individual after assessment for baseline strength, pain, and flexibility. Physiotherapists or occupational therapists conducted 6 sessions with each participant, and participants were instructed to perform the exercises daily. The mean cost per participant for the exercise therapy was approximately $165 higher than usual care; however, authors noted that "the costs of the intervention were small compared with the annual cost of providing drug regimens." Authors speculate that they may have actually underestimated cost-effectiveness "because the analysis was limited to a time horizon of 1 year." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.