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El Aoufy K, Melis MR, Magi CE, Bellando-Randone S, Tamburini M, Bandini G, Moggi-Pignone A, Matucci-Cerinic M, Bambi S, Rasero L. Evidence for telemedicine heterogeneity in rheumatic and musculoskeletal diseases care: a scoping review. Clin Rheumatol 2024; 43:2721-2763. [PMID: 38985235 PMCID: PMC11330403 DOI: 10.1007/s10067-024-07052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
Telemedicine and digital health represent alternative approaches for clinical practice; indeed, its potential in healthcare services for prevention, diagnosis, treatment, rehabilitation, and disease monitoring is widely acknowledged. These are all crucial issues to consider when dealing with chronic Rheumatic and Musculoskeletal Diseases (RMDs). The aim was to determine the current state of telemedicine in the field of rheumatology, considering the tools and devices in use as well as the Patient Reported Outcomes. A scoping review was performed following the PRISMA-ScR, retrieving articles through five databases from 1990 to 2022. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) original research papers in the English language with available abstracts, and (III) telehealth and telemedicine are provided as healthcare services. Within the 62 included studies, multiple tools of telemedicine were used: 21/62 websites/online platforms, 18/62 mobile applications, 16/62 telephone contacts, 5/62 video-consultations, and 1/62 wearable devices. Outcomes were classified based on the economic, clinical, and humanistic framework. Clinical outcomes assessed through digital tools were pain, disease activity, and serum uric acid levels. Humanistic outcomes have been grouped according to four categories (e.g., mental and physical function, health management, and health perception). The heterogeneity of digital tools in the field of rheumatology highlights the challenge of implementing reliable research into clinical practice. Effective telerehabilitation models have been presented, and the use of a tight control strategy has also been mentioned. Future research should focus on establishing studies on other RMDs as well as summarizing and formulating clinical guidelines for RMDs. Key Points • Evidence for the usefulness of telemedicine and digital health for managing and monitoring rheumatic and musculoskeletal diseases is progressively increasing. • Several digital tools effectively measure clinical and humanistic and patient reported outcomes in rheumatic and musculoskeletal diseases. • Integrating diverse digital tools in rheumatology is challenging yet promising. • Future research should focus on developing standardized recommendations for practical use of telemedicine in daily practice.
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Affiliation(s)
- Khadija El Aoufy
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Maria Ramona Melis
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Camilla Elena Magi
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology, Careggi University Hospital, Florence, Italy
| | - Matteo Tamburini
- University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
- Università Vita Salute San Raffaele, Milan, Italy
| | - Stefano Bambi
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Laura Rasero
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
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Sandri G, Spinella A, Sartini S, Caselgrandi F, Schiavi M, Bettelli V, Gherardini F, Amati G, Lumetti F, Mascia MT, Secchi O, Giuggioli D. Assessing hand grasp in patients with systemic sclerosis using the 16-grasp test: Preliminary results from a multidisciplinary study group. J Hand Ther 2024; 37:458-464. [PMID: 38342637 DOI: 10.1016/j.jht.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Reports on hand dysfunction and rehabilitation in SSc are quite scarce in the literature and mainly focus on functional assessment tools, such as the Duruoz Hand Index and the HAMIS test for evaluating hand mobility by simulating specific grasps with nine different objects. PURPOSE OF THE STUDY This study aimed to provide an adequate assessment methodology for hand grasp dysfunctions in patients suffering from systemic sclerosis (SSc) through the 16-grasp test. STUDY DESIGN Case-control study. METHODS Ninety-seven consecutive SSc patients were recruited at our Scleroderma Unit, where a 16-grasp test was performed by all patients and supervised by an experienced hand therapist. Sixteen different patterns of grasp have been divided into power grasps and precision pinch and two more modalities: static and dynamic prehension evaluation on scale from 0 to 4. We also compared previous evaluations on 19 of patients recruited. RESULTS The majority of SSc patients (84 females and 13 males; mean age 56.0±12.0 years; mean disease duration 8.0±6.0 years) displayed grasp dysfunctions; in particular 48% and 54% reported slight difficulty in the right and left grasps respectively, 6% medium difficulty in both hands, and only 3% and 1% experienced severe difficulty respectively, while 31.5% had no issues in either hand. Our results showed that the limited cutaneous subset (lcSSc) scored a lower deficit for either grasp compared to diffuse form (dcSSc). No statistically significant differences in total grasp deficit had been noticed when comparing patients having a disease duration < 5 years or longer. In the retrospective study on 19 of these patients, 8 out of 10 lcSSc patients showed no significant changes, while in 2 out of 10, slight improvements were observed in both hands. However, in the dcSSc group, 4 out of 9 worsened bilaterally while the grasp scores for 5 of them remained unchanged. CONCLUSION Our study reported hand involvement in both lcSSc and dcSSc forms, more significantly in dcSSc patients. This test is intended to be a more objective means of assessing grasp alterations linked to scleroderma hand deformities. Furthermore, thanks to its intuitiveness, the test may be useful for engineers designing personalized ergonomic assistive devices.
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Affiliation(s)
- Gilda Sandri
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy; Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Amelia Spinella
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Silvana Sartini
- Head of IOR-Argenta Rehabilitation Unit, IRCCS Rizzoli Bologna, Bologna, Italy
| | - Francesco Caselgrandi
- Hand Rehabilitation Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Margherita Schiavi
- Department of Health Professions, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Bettelli
- Rehabilitation Medicine, University Hospital of Modena, Baggiovara, Modena, Italy
| | - Francesco Gherardini
- Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriele Amati
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Federica Lumetti
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Maria Terasa Mascia
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy; Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Ottavio Secchi
- Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Dilia Giuggioli
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy; Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Parodis I, Girard-Guyonvarc'h C, Arnaud L, Distler O, Domján A, Van den Ende CHM, Fligelstone K, Kocher A, Larosa M, Lau M, Mitropoulos A, Ndosi M, Poole JL, Redmond A, Ritschl V, Alexanderson H, Sjöberg Y, von Perner G, Uhlig T, Varju C, Vriezekolk JE, Welin E, Westhovens R, Stamm TA, Boström C. EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Ann Rheum Dis 2024; 83:720-729. [PMID: 37433575 DOI: 10.1136/ard-2023-224416] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). METHODS A task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A-D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0-10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting. RESULTS Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc. CONCLUSIONS The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician-patient communication and improved outcomes.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Charlotte Girard-Guyonvarc'h
- Division of Rheumatology, Department of Medicine, University Hospital of Geneva, Geneve, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, Centre National de Référence (RESO), INSERM UMR-S 1109, Strasbourg, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Domján
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Cornelia H M Van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kim Fligelstone
- Federation of European Scleroderma Associations (FESCA), Brussels, Belgium
| | - Agnes Kocher
- Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medical Specialties, ASL3, Genoa, Italy
| | | | - Alexandros Mitropoulos
- Department of Nursing and Midwifery, College of Health Wellbeing and Life Science, Sheffield Hallam University, Sheffield, UK
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Janet L Poole
- Occupational Therapy Graduate Program, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Anthony Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Helene Alexanderson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Till Uhlig
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilia Varju
- Department of Rheumatology and Immunology, Medical School of University of Pécs, Pécs, Hungary
| | | | - Elisabet Welin
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - René Westhovens
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Carina Boström
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Parodis I, Tsoi A, Gomez A, Chow JW, Girard-Guyonvarc’h C, Stamm T, Boström C. Lifestyle interventions in the management of systemic sclerosis: a systematic review of the literature. Rheumatol Adv Pract 2024; 8:rkae037. [PMID: 38590950 PMCID: PMC11001494 DOI: 10.1093/rap/rkae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Objectives We aimed to investigate the efficacy of lifestyle interventions for the management of SSc. Methods We searched the MEDLINE, Embase, Web of Science and CINAHL databases in June 2021. We included studies conducted on five or more patients with SSc published between 1 January 2000 and the search date evaluating lifestyle interventions, excluding systematic reviews without meta-analyses. Critical appraisal was conducted using critical appraisal tools from the Joanna Briggs Institute. Thirty-six studies were included for full-text evaluation. Results A total of 17 studies evaluated the effect of physical exercise alone, whereas 14 studies evaluated educational interventions for mental health management, often with physical exercise as a central component. At an aggregated level, these studies support patient education and physical exercise for the improvement of physical function, in particular hand and mouth function. Studies on diet and nutrition were few (n = 5) and pertained to gastrointestinal as well as anthropometric outcomes; these studies were insufficient to support any conclusions. Conclusion Physical exercise and patient education should be considered for improving physical function in patients with SSc. These interventions can be provided alongside pharmacotherapy, but there is no evidence supporting that they can be a substitute. Further research should aim at assessing the effects of reductions of harmful exposures, including tobacco smoking and alcohol, improving sleep and enhancing social relations, three hitherto underexplored facets of lifestyle in the context of SSc.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard-Guyonvarc’h
- Division of Rheumatology, Department of Medicine, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Sheerin M, Morrissey AM, Galvin R, Ryan D, Carey L, Robinson K. Effectiveness of occupational therapy-led computer-aided interventions on function among adults with conditions of the hand, wrist, and forearm: A systematic literature review and meta-analysis. HAND THERAPY 2023; 28:133-143. [PMID: 38031572 PMCID: PMC10683713 DOI: 10.1177/17589983231209678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Introduction Upper extremity injuries are common, and often treated by occupational therapists. The need to evaluate the effectiveness of occupational therapy interventions to guide practice is pertinent. This systematic review and meta-analysis investigate the effectiveness of occupational therapy-led computer-aided interventions among adults with conditions of the hand, wrist, and forearm. Methods A systematic literature search of five databases was undertaken for randomized studies examining occupational therapy-led computer-aided interventions for the treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of pain, grip and pinch strength. The quality of the included studies was independently assessed using the Cochrane Risk of Bias V2 tool. Meta-analyses were completed. Results Three randomized controlled trials were included with 176 participants. One study reported on app use on a tablet and two studies reported on computer gaming. Participants had a variety of hand and wrist diagnoses, treated both conservatively and operatively. There is limited evidence demonstrating that computer-based interventions are as effective as other occupational therapy-led interventions in improving function, pain, grip and pinch strength post-intervention, including small effect size following meta-analysis: grip strength (Fixed Effects Model, SMD 0.13, 95% CI 2.63; -2.36, I2 = 0%) and pinch strength (Fixed Effects Model, SMD -0.12, 95% CI 1.25; -1.50, I2 = 11%). Conclusions Limited evidence was found to support the use of computer-aided interventions for adults with a hand, wrist or forearm injury. Further high-quality research is recommended inclusive of a broader range of technologies and a broader range of clinical and patient-reported outcome measures.
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Affiliation(s)
- Margo Sheerin
- Occupational Therapy, University of Limerick Hospitals Group, Tyone, Tipperary
- School of Allied Health, University of Limerick EHS, Limerick, Ireland
| | | | - Rose Galvin
- School of Allied Health, University of Limerick EHS, Limerick, Ireland
| | - Damien Ryan
- Occupational Therapy, University of Limerick Hospitals Group, Tyone, Tipperary
| | - Leonora Carey
- Occupational Therapy, University of Limerick Hospitals Group, Tyone, Tipperary
| | - Katie Robinson
- School of Allied Health, University of Limerick EHS, Limerick, Ireland
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Rogers B, Famenini S, Perin J, Danila MI, Wipfler K, Michaud K, McMahan ZH. Clinical Features Associated With Rate of Fractures in Patients With Systemic Sclerosis: A US Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:2379-2388. [PMID: 37093022 PMCID: PMC10836612 DOI: 10.1002/acr.25137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with several specific risk factors for fracture due to the complications of the disease and related medications. The present study was undertaken to examine the relationship between SSc-associated clinical features and fracture rate in a large US cohort. METHODS Participants with SSc in FORWARD, The National Databank for Rheumatic Diseases, were included (1998-2019). Age- and sex-matched individuals with osteoarthritis (OA) from the same database were included as comparators. The primary end point was self-reported major osteoporotic fracture. Cox proportional hazards models were used to study the associations between risk factors and fractures. RESULTS The study included 922 individuals (SSc patients, n = 154; OA patients, n = 768). Eighty-seven percent were female, with a mean age of 57.8 years. Fifty-one patients developed at least 1 fracture during a median of 4.2 years (0.5-22.0 years) of follow-up. Patients with SSc had more frequent fractures compared to OA comparators (hazard ratio [HR] 2.38 [95% confidence interval (95% CI) 1.47-3.83]). Among patients with SSc, a higher Rheumatic Disease Comorbidity Index score (HR 1.45 [95% CI 1.20-1.75]) and a higher Health Assessment Questionnaire disability index score (HR 3.83 [95% CI 2.12-6.93]) were associated with more fractures. Diabetes mellitus (HR 5.89 [95% CI 2.51-13.82]) and renal disease (HR 2.43 [95% CI 1.10-5.37]) were independently associated with fracture among SSc patients relative to SSc patients without these comorbidities. CONCLUSION Our findings highlight factors associated with fracture among patients with SSc. Disability as measured by the HAQ DI is a particularly strong indicator of fracture rate in SSc. Improving SSc patients' functional status, where possible, may lead to better long-term outcomes.
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Affiliation(s)
| | | | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland
| | - Maria I Danila
- University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham
| | - Kristin Wipfler
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
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Chen YT, Kruger G, Devine A, Khanna D, Murphy SL. Experiences of Exergaming for Upper Extremity Exercises in People With Systemic Sclerosis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:665-675. [PMID: 37162267 PMCID: PMC10527854 DOI: 10.1177/15394492231172934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Impaired upper extremity (UE) function has limited activities of daily living in people with systemic sclerosis (SSc). Exergaming, a combination of gaming and exercises, could be a novel way to improve UE exercise engagement. The objective of this study was to examine the usability of exergaming and to investigate participant experiences after exergaming among people with SSc. Both quantitative and qualitative data were collected. Participants completed questionnaires regarding the usability of exergaming. Semi-structured interviews were conducted directly after exergaming. Descriptive statistics and thematic content analysis were performed. Twenty participants with SSc participated. Exergaming was highly acceptable with a good System Usability Scale score (M = 71.6 ± 9.9). Participants described exergaming as motivating with potential physical and nonphysical benefits. Although results were generally positive, participants expressed some barriers and temporary side effects of using exergaming and needs for improvement. This work stands to inform future exergaming interventions in people with SSc.
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Chen YT, Lescoat A, Khanna D, Murphy SL. Perceived Cognitive Function in People With Systemic Sclerosis: Associations With Symptoms and Daily Life Functioning. Arthritis Care Res (Hoboken) 2023; 75:1706-1714. [PMID: 35997486 PMCID: PMC9947182 DOI: 10.1002/acr.25000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Perceived cognitive dysfunction is prevalent in patients with systemic sclerosis (SSc) but not well understood. This study aimed to examine potential factors associated with perceived cognitive function and to investigate the contributions of perceived cognitive function and symptoms to functional measures. METHODS A cross-sectional survey was conducted among patients with SSc (n = 106). Participants were mainly female (84%) and White (82%). Perceived cognitive function, symptoms, and functional measures were assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) measures. A multivariable regression was conducted to identify factors associated with perceived cognition. Hierarchical linear regressions examined the unique contributions of perceived cognitive function and symptoms to social participation and physical function. RESULTS Fifty-nine (56%) patients with SSc perceived mild-to-severe cognitive dysfunction. Being on work disability and having more fatigue were both significantly associated with perceived cognitive dysfunction. When examining the contributions of cognition and other symptoms to functional measures, self-reported cognition became nonsignificant after fatigue and pain were entered into the regression model. CONCLUSION Being on work disability and having more fatigue were most highly associated with perceived cognitive dysfunction in patients with SSc. Unlike fatigue and pain, perceived cognitive function was not independently associated with functional measures. Nonetheless, future research should disentangle cognitive function and other symptoms, as well as their effects on daily activities, in SSc.
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Affiliation(s)
- Yen T. Chen
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Alain Lescoat
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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9
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Parodis I, Gomez A, Tsoi A, Chow JW, Pezzella D, Girard C, Stamm TA, Boström C. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open 2023; 9:e003297. [PMID: 37532469 PMCID: PMC10401222 DOI: 10.1136/rmdopen-2023-003297] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard
- Division of Rheumatology, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Washington SE, Bollinger RM, Edwards E, McGowan L, Stephens S. Telehealth Delivery of Evidence-Based Intervention Within Older Adult Populations: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:467-477. [PMID: 37322873 PMCID: PMC10602794 DOI: 10.1177/15394492231180838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Telehealth services enable individuals to participate in meaningful occupations; however, the evidence on this topic has not been synthesized in older adult populations. This scoping review synthesized the evidence on interventions delivered through telehealth (and the mode of delivery) in occupational therapy for older adult populations. A search for studies on occupational therapy, older adults, and telehealth was performed in six research databases, and identified 536 articles. Four reviewers independently screened the titles and abstracts; and reviewed eligible full text. Ten articles were extracted into a table and summarized through narrative format. The studies focused on performance-based intervention (60%), cognition (10%), health (10%), occupation (10%), and the environment (10%) in older adult populations (N = 1 - 208); including those with Alzheimer's disease, chronic pain, cancer, and stroke. The interventions were delivered through electronic audio-visual platforms (e.g., zoom) (80%) and teleconference platforms (e.g., phone calls) (20%).
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11
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Kwakkenbos L, Carrier ME, Welling J, Levis B, Levis AW, Sauve M, Turner KA, Tao L, Aguila K, Carboni-Jiménez A, Cañedo-Ayala M, Harb S, van den Ende C, Hudson M, van Breda W, Nguyen C, Boutron I, Rannou F, Thombs BD, Mouthon L. Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people with systemic sclerosis: the Scleroderma Patient-centered Intervention Network Hand Exercise Program (SPIN-HAND) trial. Trials 2022; 23:994. [PMID: 36510233 PMCID: PMC9742661 DOI: 10.1186/s13063-022-06923-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Systemic sclerosis (scleroderma; SSc) is a rare autoimmune connective tissue disease. Functional impairment of hands is common. The Scleroderma Patient-centered Intervention Network (SPIN)-HAND trial compared effects of offering access to an online self-guided hand exercise program to usual care on hand function (primary) and functional health outcomes (secondary) in people with SSc with at least mild hand function limitations. METHODS The pragmatic, two-arm, parallel-group cohort multiple randomized controlled trial was embedded in the SPIN Cohort. Cohort participants with Cochin Hand Function Scale (CHFS) scores ≥ 3 and who indicated interest in using the SPIN-HAND Program were randomized (3:2 ratio) to an offer of program access or to usual care (targeted N = 586). The SPIN-HAND program consists of 4 modules that address (1) thumb flexibility and strength; (2) finger bending; (3) finger extension; and (4) wrist flexibility and strength. The primary outcome analysis compared CHFS scores 3 months post-randomization between participants offered versus not offered the program. Secondary outcomes were CHFS scores 6 months post-randomization and functional health outcomes (Patient-Reported Outcomes Measurement Information System profile version 2.0 domain scores) 3 and 6 months post-randomization. RESULTS In total, 466 participants were randomized to intervention offer (N = 280) or usual care (N = 186). Of 280 participants offered the intervention, 170 (61%) consented to access the program. Of these, 117 (69%) viewed at least one hand exercise instruction video and 77 (45%) logged into the program website at least 3 times. In intent-to-treat analyses, CHFS scores were 1.2 points lower (95% CI - 2.8 to 0.3) for intervention compared to usual care 3 months post-randomization and 0.1 points lower (95% CI - 1.8 to 1.6 points) 6 months post-randomization. There were no statistically significant differences in other outcomes. CONCLUSION The offer to use the SPIN-HAND Program did not improve hand function. Low offer uptake, program access, and minimal usage among those who accessed the program limited our ability to determine if using the program would improve function. To improve engagement, the program could be tested in a group format or as a resource to support care provided by a physical or occupational therapist. TRIAL REGISTRATION NCT03419208 . Registered on February 1, 2018.
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Affiliation(s)
- Linda Kwakkenbos
- grid.5590.90000000122931605Clinical Psychology, Radboud University, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marie-Eve Carrier
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Joep Welling
- grid.491384.30000 0004 9361 2881NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Brooke Levis
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada ,grid.9757.c0000 0004 0415 6205Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Alexander W. Levis
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T. H. Chan School of Public Health, Cambridge, MA USA
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, ON Canada ,Scleroderma Canada, Hamilton, ON Canada
| | - Kimberly A. Turner
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Lydia Tao
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Kylene Aguila
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Andrea Carboni-Jiménez
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Mara Cañedo-Ayala
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Sami Harb
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | | | - Marie Hudson
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada ,grid.14709.3b0000 0004 1936 8649Department of Medicine, McGill University, Montreal, QC Canada
| | - Ward van Breda
- grid.12380.380000 0004 1754 9227Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Christelle Nguyen
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Isabelle Boutron
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François Rannou
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Brett D. Thombs
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada ,grid.14709.3b0000 0004 1936 8649Department of Medicine, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Biomedical Ethics Unit, McGill University, Montreal, QC Canada
| | - Luc Mouthon
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France ,grid.411784.f0000 0001 0274 3893Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Paris, France
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12
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Chen YT, Lescoat A, Devine A, Khanna D, Murphy SL. Cognitive difficulties in people with systemic sclerosis: a qualitative study. Rheumatology (Oxford) 2022; 61:3754-3765. [PMID: 35015836 PMCID: PMC9259752 DOI: 10.1093/rheumatology/keac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study used a qualitative approach to explore how people with SSc experience cognitive changes and how cognitive difficulties impact their functioning. METHODS Four 90-min focus groups of adults with SSc and self-reported changes in cognition were recruited from a SSc research registry and targeted social media. A focus group guide elicited information from participants via open-ended questions. Content analysis was conducted using grounded theory methodology. RESULTS There were 20 participants (mean age = 55.5 (11.4) years) comprising 16 (80%) females, 14 (70%) Caucasians, and 11 (55%) people with diffuse cutaneous SSc. Study themes included cognitive difficulties as part of daily life experience, impact of cognitive difficulties on daily life functioning, coping strategies and information seeking. Participants used different terms to describe their experience of cognitive difficulties, and most encountered deficits in short-term memory, language difficulties, decreased executive function, difficulties with concentration and focus, and slow processing speed. Participants expressed frustration with their cognitive difficulties and used coping strategies to lessen their impact. Participants were uncertain about the causes and wanted to understand factors contributing to cognitive difficulties as well as how to manage them. CONCLUSION Participants with SSc reported cognitive difficulties that had a substantial negative impact on their lives. Improved understanding of cognitive changes could subsequently facilitate development of relevant therapeutic interventions or educational programmes for symptom self-management to reduce impact of cognitive difficulties in people with SSc.
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Affiliation(s)
- Yen T Chen
- Department of Physical Medicine & Rehabilitation
- Division of Rheumatology, Scleroderma Program, Univerisity of Michigan, Ann Arbor, MI, USA
| | - Alain Lescoat
- Division of Rheumatology, Scleroderma Program, Univerisity of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital
- Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Anita Devine
- Division of Rheumatology, Scleroderma Program, Univerisity of Michigan, Ann Arbor, MI, USA
| | - Dinesh Khanna
- Division of Rheumatology, Scleroderma Program, Univerisity of Michigan, Ann Arbor, MI, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Susan L Murphy
- Department of Physical Medicine & Rehabilitation
- Division of Rheumatology, Scleroderma Program, Univerisity of Michigan, Ann Arbor, MI, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
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13
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Herrick AL, Assassi S, Denton CP. Skin involvement in early diffuse cutaneous systemic sclerosis: an unmet clinical need. Nat Rev Rheumatol 2022; 18:276-285. [PMID: 35292731 PMCID: PMC8922394 DOI: 10.1038/s41584-022-00765-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 12/23/2022]
Abstract
Diffuse cutaneous systemic sclerosis (dcSSc) is associated with high mortality resulting from early internal-organ involvement. Clinicians therefore tend to focus on early diagnosis and treatment of potentially life-threatening cardiorespiratory and renal disease. However, the rapidly progressive painful, itchy skin tightening that characterizes dcSSc is the symptom that has the greatest effect on patients' quality of life, and there is currently no effective disease-modifying treatment for it. Considerable advances have been made in predicting the extent and rate of skin-disease progression (which vary between patients), including the development of techniques such as molecular analysis of skin biopsy samples. Risk stratification for progressive skin disease is especially relevant now that haematopoietic stem-cell transplantation is a treatment option, because stratification will inform the balance of risk versus benefit for each patient. Measurement of skin disease is a major challenge. Results from clinical trials have highlighted limitations of the modified Rodnan skin score (the current gold standard). Alternative patient-reported and other potential outcome measures have been and are being developed. Patients with early dcSSc should be referred to specialist centres to ensure best-practice management, including the management of their skin disease, and to maximize opportunities for inclusion in clinical trials.
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Affiliation(s)
- Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Shervin Assassi
- McGovern Medical School, The University of Texas, Houston, TX, USA
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14
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Murphy SL, Poole JL, Chen YT, Lescoat A, Khanna D. Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions. Arthritis Care Res (Hoboken) 2022; 74:59-69. [PMID: 34165263 PMCID: PMC8695630 DOI: 10.1002/acr.24737] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. METHODS Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. RESULTS A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. CONCLUSION Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.
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Affiliation(s)
- Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC, Ann Arbor, MI USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Janet L. Poole
- Department of Occupational Therapy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yen T. Chen
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Alain Lescoat
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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