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Safikhani M, Rezaieyazdi Z, Khodashahi M. Evaluation of assessable telemedicine in patients with rheumatoid arthritis: A systematic review. Int J Rheum Dis 2024; 27:e15007. [PMID: 38287561 DOI: 10.1111/1756-185x.15007] [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: 07/20/2022] [Revised: 10/08/2023] [Accepted: 11/29/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Nowadays, the use of telemedicine diagnosis and treatment of various diseases has been considered by physicians, especially in such diseases as rheumatoid arthritis (RA), where patients have more weakness and inability to move. This systematic review aimed to evaluate the extent of measurable and nonmeasurable factors in patients with RA and their satisfaction with this method of care. METHODS The articles published by March 3, 2022, were searched in four databases, including Web of Sciences, Medline, PubMed, and Scopus. This research was conducted using the seven steps of the Cochrane Handbook as a guide. The searched keywords included telemedicine, tele-rheumatoid, rheumatoid arthritis, and immune diseases. RESULTS A total of 18 articles were included in the present study. In most of these studies, physicians and patients were satisfied with this approach. Nonetheless, there was a dearth of studies on the measurement of evaluable and nonevaluable factors. CONCLUSION Studies on the benefits of telemedicine for rheumatology are still limited. The effectiveness of this new healthcare approach in diagnosing and evaluating disease activity is still unclear. Some studies demonstrated patient and physician satisfaction with this treatment. In some cases, there is a tendency to show a high risk of bias. In addition, it is unclear to what extent the use of rheumatology traps affects the establishment of medical relationships. It is recommended that more clinical trials be conducted to examine this relationship.
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Affiliation(s)
- Morteza Safikhani
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Rezaieyazdi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mandana Khodashahi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Civi Karaaslan T, Tarakci E, Keles O, Aslan Keles Y, Ugurlu S. Comparison of telerehabilitation methods for patients with systemic sclerosis in the COVID-19 Era: A randomized controlled study. J Hand Ther 2023; 36:751-769. [PMID: 37574373 DOI: 10.1016/j.jht.2023.02.008] [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: 11/16/2021] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 08/15/2023]
Abstract
STUDY DESIGN This was a single-blinded randomized clinical trial. INTRODUCTION Systemic sclerosis (SSc) is an autoimmune connective tissue disease that progresses with fibrosis. Patients with SSc need to be protected against epidemic diseases and provided for in terms of rehabilitation needs. PURPOSE OF THE STUDY To compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT) on individuals with SSc. METHODS Forty-two participants with SSc with a mean age of 44.17 ± 11.05 years were included in the study. The patients were randomly divided into three groups, RTT (n = 16), AT (n = 16), and control (n = 16) groups. A structured rehabilitation program was performed in real-time (RTT group) and asynchronously (AT group) for 40 minutes per day, in three sessions per week for 8 weeks. The participants' finger and wrist joint range of motion (ROM), upper extremity functions, grip strength, superficial sense of touch, activities of daily living (ADL), and general health status were assessed at baseline and after treatment. RESULTS After 8 weeks, there were improvements in finger ROM (effect size [ES] = 0.23 to 0.60), wrist ROM (ES = 0.45 to 0.83), upper extremity functions (ES = 0.61 to 1.00), and ADL parameters (ES = 0.74) in the RTT group (p < 0.05). Also, there were improvements in finger ROM (ES = 0.16 to 0.45) and hand functions (ES = 0.54 to 0.55) in the AT group (p < 0.05). The RTT and AT groups had better hand functions and finger ROM than the control group in (p < 0.05). In addition, the RTT group had better wrist ROM than the control group (p = 0.008). RTT was superior to AT only in lateral pinch strength (p = 0.025). DISCUSSION Experimental groups achieved a statistically significant change in ROM, upper extremity functions and ADL over time in concordance with prior investigations. Changes in grip strength, superficial sense of touch, and general health status scores differed from previous investigations and the between-group comparison was not statistically significant. CONCLUSIONS Both RTT and AT may be effective in individuals with SSc, and RTT has additional benefits.
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Affiliation(s)
- Tugba Civi Karaaslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozal Keles
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey
| | - Yasemin Aslan Keles
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Therapy and Rehabilitation, Physiotherapy Program, Vocational School, Biruni University, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Sahin EI, Cetin SY, Ayan A. Investigation of the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis: a randomized controlled trial. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230252. [PMID: 37729360 PMCID: PMC10508901 DOI: 10.1590/1806-9282.20230252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE This study aimed to investigate the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis and to compare with patient education. METHODS A total of 46 individuals with systemic sclerosis (55.52±11.54 years) were included. Individuals were randomly assigned into intervention (n=23) and control (n=23) groups. Dynamometer, goniometer, Canadian Occupational Performance Measurement, Disabilities of the Arm, Shoulder, and Hand, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index were used for evaluation. RESULTS Post-treatment, in terms of delta (Δ) values, hand grip and pinch strengths (p: 0.000-0.016), active (p: 0.000-0.032) and passive (p: 0.000-0.043) total range of motions, Canadian Occupational Performance Measurement performance and satisfaction, Disabilities of the Arm, Shoulder, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index (p: 0.000) were in favor of the intervention group. CONCLUSION Upper extremity home exercises increase grip strength, range of motion, activity performance, and functionality in patients with systemic sclerosis. We recommend that rehabilitation programs include not only hand exercises but also upper extremity exercises.
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Affiliation(s)
- Emine Irem Sahin
- Akdeniz University, Institue of Health Sciences, Department of Physiotherapy and Rehabilitation – Antalya, Turkey
| | - Sebahat Yaprak Cetin
- Akdeniz University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation – Antalya, Turkey
| | - Ayse Ayan
- Health Sciences University, Department of Rheumatology – Antalya, Turkey
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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: 11] [Impact Index Per Article: 11.0] [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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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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Moulaei K, Sheikhtaheri A, Nezhad MS, Haghdoost A, Gheysari M, Bahaadinbeigy K. Telerehabilitation for upper limb disabilities: a scoping review on functions, outcomes, and evaluation methods. Arch Public Health 2022; 80:196. [PMID: 35999548 PMCID: PMC9400266 DOI: 10.1186/s13690-022-00952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Upper limb (UL) disabilities have attracted worldwide attention due to the high economic costs of health care and the negative effects on the quality of life of patients with these disabilities. Telerehabilitation technologies are one of the most important ways to reduce rehabilitation costs and increase the quality of life of patients. Therefore, the aim of this study was to investigate the role of telerehabilitation in improving the health status of patients with upper limb disabilities.
Methods
This scoping review was conducted by searching the Web of Science, PubMed, and Scopus until July 30, 2021. We used a data extraction form with 18 fields to extract data from primary studies. The selection of articles and data extraction was made by four researchers using a data collection form based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth and sixth researchers.Inclusion criteria were studies published in English, studies on upper limb disability, and telerehabilitation based on any technology (synchronous telerehabilitation, asynchronous, or both). Exclusion criteria were articles that did not focus on telerehabilitation and upper limb disabilities. Also, books, book chapters, letters to the editor, and conference abstracts were also removed.
Results
A total of 458 articles were retrieved, and after removing irrelevant and duplicate articles, 29 articles were finally included in this review. Most telerehabilitation was performed for patients with stroke (65%). Among the 15 different services provided with telerehabilitation technologies, "Evaluation of exercises and also a musculoskeletal function of patients by the therapist","Recording of patients' rehabilitation exercises and sending them to the therapist” and "Prescribing new rehabilitation exercises by the therapist" were the most widely used services, respectively. Virtual reality technologies, smart wearables, and robots were used to provide telerehabilitation services. Among the 13 types of evaluation used for telerehabilitation systems, “Evaluation and measurement of upper limb function” was the most used evaluation in the studies. "Improvement in musculoskeletal functions”, "Increasing patients' interest and motivation to perform rehabilitation exercises", and "Increasing adherence to rehabilitation exercises and greater participation in treatment processes" were the most important outcomes, respectively.
Conclusion
Our findings indicate that telerehabilitation provides individuals with equitable access to rehabilitation services, improves musculoskeletal function, and empowers individuals by providing a variety of rehabilitation capabilities.
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Gokcen N, Badak SO, Sarpel T, Sertdemir Y, Erken E. The Efficacy of a Home-Based, Self-Administered Hand Exercise Program for Patients With Systemic Sclerosis: A Randomized Controlled, Evaluator-Blind, Clinical Trial. J Clin Rheumatol 2022; 28:e422-e429. [PMID: 34030163 DOI: 10.1097/rhu.0000000000001752] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc. METHODS This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire-Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status. RESULTS Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m2. The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength. CONCLUSIONS The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.
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Affiliation(s)
- Neslihan Gokcen
- From the Division of Rheumatology, Department of Physical Medicine and Rehabilitation
| | | | - Tunay Sarpel
- Department of Physical Medicine and Rehabilitation
| | - Yasar Sertdemir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Eren Erken
- Division of Rheumatology, Department of Internal Medicine
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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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Madenidou AV, Yeoh S. Telerheumatology during the COVID-19 pandemic: Impact on clinical practice, education, and research. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_229_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study. RMD Open 2021; 7:rmdopen-2021-001783. [PMID: 34475248 PMCID: PMC8413951 DOI: 10.1136/rmdopen-2021-001783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Head Office of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing & Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine Blatter
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jasmina Bogdanovic
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Diana Dan
- Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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11
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Pettersson H, Alexanderson H, Poole JL, Varga J, Regardt M, Russell AM, Salam Y, Jensen K, Mansour J, Frech T, Feghali-Bostwick C, Varjú C, Baldwin N, Heenan M, Fligelstone K, Holmner M, Lammi MR, Scholand MB, Shapiro L, Volkmann ER, Saketkoo LA. Exercise as a multi-modal disease-modifying medicine in systemic sclerosis: An introduction by The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis (G-FoRSS). Best Pract Res Clin Rheumatol 2021; 35:101695. [PMID: 34217607 PMCID: PMC8478716 DOI: 10.1016/j.berh.2021.101695] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis (SSc) is a heterogeneous multisystem autoimmune disease whereby its main pathological drivers of disability and damage are vascular injury, inflammatory cell infiltration, and fibrosis. These mechanisms result in diffuse and diverse impairments arising from ischemic circulatory dysfunction leading to painful skin ulceration and calcinosis, neurovascular aberrations hindering gastrointestinal (GI) motility, progressive painful, incapacitating or immobilizing effects of inflammatory and fibrotic effects on the lungs, skin, articular and periarticular structures, and muscle. SSc-related impairments impede routine activities of daily living (ADLs) and disrupt three critical life areas: work, family, social/leisure, and also impact on psychological well-being. Physical activity and exercise are globally recommended; however, for connective tissue diseases, this guidance carries greater impact on inflammatory disease manifestations, recovery, and cardiovascular health. Exercise, through myogenic and vascular phenomena, naturally targets key pathogenic drivers by downregulating multiple inflammatory and fibrotic pathways in serum and tissue, while increasing circulation and vascular repair. G-FoRSS, The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis recognizes the scientific basis of and advocates for education and research of exercise as a systemic and targeted SSc disease-modifying treatment. An overview of biophysiological mechanisms of physical activity and exercise are herein imparted for patients, clinicians, and researchers, and applied to SSc disease mechanisms, manifestations, and impairment. A preliminary guidance on exercise in SSc, a research agenda, and the current state of research and outcome measures are set forth.
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Affiliation(s)
- Henrik Pettersson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Malin Regardt
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Russell
- University of Exeter, College of Medicine and Health, Exeter, UK; National Institute of Health Research, Senior Nurse Research Leader, London, UK
| | - Yasser Salam
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kelly Jensen
- Oregon Health and Science University, Portland, OR, USA; New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Jennifer Mansour
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Tracy Frech
- Vanderbilt University, Division of Rheumatology, Nashville, TN, USA
| | | | - Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | | | - Matty Heenan
- Scleroderma Foundation/Pulmonary Hypertension Association, Tucson, AZ, USA
| | - Kim Fligelstone
- Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Monica Holmner
- The Swedish Rheumatism Association National Association for Systemic Sclerosis, Sweden
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA
| | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA.
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12
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Santos Cardozo Roque LC, Tenório ADS, de Aquino LT, Ferreira RDS, Duarte ALBP, Dantas AT. Joint mobilization and therapeutic exercises in the hands of patients with systemic sclerosis: A preliminary randomized controlled trial. Clin Rehabil 2021; 36:113-124. [PMID: 34414814 DOI: 10.1177/02692155211038728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effectiveness of Maitland's joint mobilization and therapeutic exercises on the functionality of the hands in patients with systemic sclerosis. DESIGN Randomized controlled trial. SETTING Tertiary university hospital. SUBJECTS Twenty-four patients diagnosed with systemic sclerosis according to ACR/EULAR 2013 criteria; age ⩾18 years and Cochin Hand Functional Scale (COCHIN) score ⩾10. They were randomized to physical therapy group (n = 12) or control group (n = 12). INTERVENTIONS The physical therapy group received joint mobilization and undertook therapeutic exercises, twice a week, for 12 weeks, and received a booklet with information about the disease. The control group only received the booklet about the disease. MAIN MEASURES The primary outcome measure was functionality of the hands (COCHIN). The secondary outcomes measures were disability (SHAQ), pain (visual analogic scale), range of motion (HAMIS and Delta finger-to-palm), grip strength (JAMAR dynamometer), and quality of life (SF12). RESULTS Twenty-two patients were female, with a mean age of 47.4 ± 11.1 years and 18 had limited cutaneous form. The physical therapy group showed a decrease of 11.33 points in the COCHIN in comparison with the control group (P = 0.09). There was a significant increase in range of motion by HAMIS (3.00 ± 1.48 vs 5.42 ± 2.64, P = 0.008), reduction in pain VAS (3.42 ± 2.78 vs 7.75 ± 2.53, P < 0.001), and increase in the physical component of SF12 (38.51 ± 9.60 vs 32.65 ± 9.10, P = 0.038). CONCLUSION Maitland's joint mobilization and therapeutic exercises improved the functionality of the hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life in patients with systemic sclerosis.
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Affiliation(s)
| | | | | | | | | | - Andréa Tavares Dantas
- Graduate Program in Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil.,Rheumatology Department of Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
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13
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Ritschl V, Ferreira RJO, Santos EJF, Fernandes R, Juutila E, Mosor E, Santos-Costa P, Fligelstone K, Schraven L, Stummvoll G, Salvador M, Poole JL, van den Ende C, Boström C, Stamm TA. Suitability for e-health of non-pharmacological interventions in connective tissue diseases: scoping review with a descriptive analysis. RMD Open 2021; 7:rmdopen-2021-001710. [PMID: 34326205 PMCID: PMC8323400 DOI: 10.1136/rmdopen-2021-001710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Non-pharmacological interventions support patients with connective tissue diseases to better cope with and self-manage their diseases. This study aimed to map existing evidence on non-pharmacological interventions in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and mixed connective tissue diseases regarding content, feasibility and potential suitability in an e-health setting. Methods A literature search was performed in eight different databases in July 2020. The intervention’s content was extracted using the ‘Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide’. A Sankey diagram and descriptive statistics were used to analyse the data and illustrate the relationships between the interventions. Results Of 8198 identified records, 119 papers were eligible. One hundred and four of them (87.4%) were conducted between 2000 and 2020, mainly in the USA (SLE n=24 (21.2%), SSc n=16 (14.2%)), Brazil (SLE n=8 (7.1%), SSc n=5 (4.4%)) and Italy (SLE n=0 (0%), SSc n=12 (10.6%)). Fifty-two studies (SLE n=24 (21.2%), SSc n=28 (24.8%)) used multicomponent interventions. The single interventions were physical exercises (SLE n=16 (14.2%), SSc n=17 (15.0%)), coaching/counselling (SLE n=11 (18.0%), SSc n=0 (0%)) and education (SLE n=2 (1.8%), SSc n=3 (2.7%)). Primary outcomes focused on physical function (SLE n=1 (0.9%), SSc n=15 (13.3%)), mouth opening in SSc (n=4 (5.9%)) and physical capacity (SLE n=2 (1.8%), SSc n=1 (0.9%)). No interventions for mixed connective tissue disease were found. Conclusion There was a great variety in the intervention’s content due to differences in body structure, activity limitations and participation restrictions in SLE and SSc. These results highlight the need for personalised, multicomponent, non-pharmacological interventions, which could be delivered as e-health interventions.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rúben Fernandes
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Essi Juutila
- Metropolia University of Applied Sciences, Helsinki, Finland
| | - Erika Mosor
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | | | - Linda Schraven
- Federation of European Scleroderma Associations, Amsterdam, The Netherlands
| | | | - Maria Salvador
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria .,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
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14
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Dias JF, Oliveira VC, Borges PRT, Dutra FCMS, Mancini MC, Kirkwood RN, Resende RA, Sampaio RF. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med 2020; 55:155-162. [PMID: 33060156 DOI: 10.1136/bjsports-2019-101375] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Investigate whether exercise-based telerehabilitation improves pain, physical function and quality of life in adults with physical disabilities. DESIGN Systematic review of randomised controlled trials. DATA SOURCES Searches were performed in AMED, MEDLINE, CINAHL, SPORTDiscus, Embase, PEDro, Cochrane Library and PsycINFO. ELIGIBILITY CRITERIA Trials were considered if they evaluated exercise by telerehabilitation. The population included adults with physical disability. Comparisons were control and other interventions. The outcomes were pain, physical function and quality of life. Study selection, data extraction and analysis followed the protocol registered in PROSPERO (CRD42019122824). GRADE determined the strength of evidence. RESULTS Forty-eight trials were included in the quantitative analysis. When compared with other interventions, there was high-quality evidence that telerehabilitation was not different to other interventions for pain (95% CI: -0.4 to 0.1), physical function (95% CI: -0.2 to 0.2) and quality of life (95% CI: -0.1 to 0.5) at long-term. There was moderate-quality evidence that telerehabilitation was not different to other interventions for physical function (95% CI: -0.1 to 0.5) and quality of life (95% CI: -0.2 to 0.5) at short-term. However, due to the low-quality evidence and the small number of trials comparing exercise protocols offered by telerehabilitation with control groups, it is still not possible to state the efficacy of telerehabilitation on pain, function and quality of life at short-term and long-term. CONCLUSIONS Exercise by telerehabilitation may be an alternative to treat pain, physical function and quality of life in adults with physical disabilities when compared with other intervention.
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Affiliation(s)
- Jane Fonseca Dias
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vinicius Cunha Oliveira
- Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | | | - Marisa Cotta Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renata Noce Kirkwood
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renan Alves Resende
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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15
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Macis S, Loi D, Ulgheri A, Pani D, Solinas G, Manna SL, Cestone V, Guerri D, Raffo L. Design and Usability Assessment of a Multi-Device SOA-Based Telecare Framework for the Elderly. IEEE J Biomed Health Inform 2020; 24:268-279. [DOI: 10.1109/jbhi.2019.2894552] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Liem SIE, Vliet Vlieland TPM, Schoones JW, de Vries-Bouwstra JK. The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review. Rheumatol Adv Pract 2019; 3:rkz044. [PMID: 31858074 PMCID: PMC6913710 DOI: 10.1093/rap/rkz044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/21/2019] [Indexed: 01/08/2023] Open
Abstract
Given the shortcomings of previous literature reviews evaluating the effect and safety of exercise therapy in SSc, we aimed to carry out a systematic review of the literature specifically on this topic. A structured search strategy was performed in Medline (via PubMed) and other electronic databases from 1990 to 3 September 2019. Randomized controlled trials, observational designs, conference abstracts and trial registrations were included if they concerned SSc patients ≥18 years of age, exercise therapy and reported outcomes related to physical functioning. Nine articles were included. Four randomized controlled trials compared (a) hand exercises, (b) orofacial exercises, (c) aerobic exercises or (d) aerobic exercises plus resistance training with no exercise, demonstrating effects on hand function (a), maximum mouth opening (b), peak oxygen uptake (c + d) and quality of life. All five observational studies concerning hand, orofacial, aerobic and/or strengthening exercises reported improvements of hand function, mouth opening, aerobic capacity and/or muscle strength. In conclusion, the evidence on the effect and safety of exercise therapy in SSc is scanty.
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Affiliation(s)
| | | | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
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17
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Williams MA, Srikesavan C, Heine PJ, Bruce J, Brosseau L, Hoxey‐Thomas N, Lamb SE. Exercise for rheumatoid arthritis of the hand. Cochrane Database Syst Rev 2018; 7:CD003832. [PMID: 30063798 PMCID: PMC6513509 DOI: 10.1002/14651858.cd003832.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rheumatoid arthritis is an inflammatory polyarthritis that frequently affects the hands and wrists. Hand exercises are prescribed to improve mobility and strength, and thereby hand function. OBJECTIVES To determine the benefits and harms of hand exercise in adults with rheumatoid arthritis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, Embase, CINAHL, AMED, Physiotherapy Evidence Database (PEDro), OTseeker, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to July 2017. SELECTION CRITERIA We considered all randomised or quasi-randomised controlled trials that compared hand exercise with any non-exercise therapy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as outlined by the Cochrane Musculoskeletal Group. MAIN RESULTS We included seven studies involving 841 people (aged 20 to 94 years) in the review. Most studies used validated diagnostic criteria and involved home programmes.Very low-quality evidence (due to risk of bias and imprecision) from one study indicated uncertainty about whether exercise improves hand function in the short term (< 3 months). On a 0 to 80 points hand function test (higher scores mean better function), the exercise group (n = 11) scored 76.1 points and control group (n = 13) scored 75 points.Moderate-quality evidence (due to risk of bias) from one study indicated that exercise compared to usual care probably slightly improves hand function (mean difference (MD) 4.5, 95% confidence interval (CI) 1.58 to 7.42; n = 449) in the medium term (3 to 11 months) and in the long term (12 months or beyond) (MD 4.3, 95% CI 0.86 to 7.74; n = 438). The absolute change on a 0-to-100 hand function scale (higher scores mean better function) and number needed to treat for an additional beneficial outcome (NNTB) were 5% (95% CI 2% to 7%); 8 (95% CI 5 to 20) and 4% (95% CI 1% to 8%); 9 (95% CI 6 to 27), respectively. A 4% to 5% improvement indicates a minimal clinical benefit.Very low-quality evidence (due to risk of bias and imprecision) from two studies indicated uncertainty about whether exercise compared to no treatment improved pain (MD -27.98, 95% CI -48.93 to -7.03; n = 124) in the short term. The absolute change on a 0-to-100-millimetre scale (higher scores mean more pain) was -28% (95% CI -49% to -7%) and NNTB 2 (95% CI 2 to 11).Moderate-quality evidence (due to risk of bias) from one study indicated that there is probably little or no difference between exercise and usual care on pain in the medium (MD -2.8, 95% CI - 6.96 to 1.36; n = 445) and long term (MD -3.7, 95% CI -8.1 to 0.7; n = 437). On a 0-to-100 scale, the absolute changes were -3% (95% CI -7% to 2%) and -4% (95% CI -8% to 1%), respectively.Very low-quality evidence (due to risk of bias and imprecision) from three studies (n = 141) indicated uncertainty about whether exercise compared to no treatment improved grip strength in the short term. The standardised mean difference for the left hand was 0.44 (95% CI 0.11 to 0.78), re-expressed as 3.5 kg (95% CI 0.87 to 6.1); and for the right hand 0.46 (95% CI 0.13 to 0.8), re-expressed as 4 kg (95% CI 1.13 to 7).High-quality evidence from one study showed that exercise compared to usual care has little or no benefit on mean grip strength (in kg) of both hands in the medium term (MD 1.4, 95% CI -0.27 to 3.07; n = 400), relative change 11% (95% CI -2% to 13%); and in the long term (MD 1.2, 95% CI -0.62 to 3.02; n = 355), relative change 9% (95% CI -5% to 23%).Very low-quality evidence (due to risk of bias and imprecision) from two studies (n = 120) indicated uncertainty about whether exercise compared to no treatment improved pinch strength (in kg) in the short term. The MD and relative change for the left and right hands were 0.51 (95% CI 0.13 to 0.9) and 44% (95% CI 11% to 78%); and 0.82 (95% CI 0.43 to 1.21) and 68% (95% CI 36% to 101%).High-quality evidence from one study showed that exercise compared to usual care has little or no benefit on mean pinch strength of both hands in the medium (MD 0.3, 95% CI -0.14 to 0.74; n = 396) and long term (MD 0.4, 95% CI -0.08 to 0.88; n = 351). The relative changes were 8% (95% CI -4% to 19%) and 10% (95% CI -2% to 22%).No study evaluated the American College of Rheumatology 50 criteria.Moderate-quality evidence (due to risk of bias) from one study indicated that people who also received exercise with strategies for adherence were probably more adherent than those who received routine care alone in the medium term (risk ratio 1.31, 95% CI 1.15 to 1.48; n = 438) and NNTB 6 (95% CI 4 to 10). In the long term, the risk ratio was 1.09 (95% CI 0.93 to 1.28; n = 422).Moderate-quality evidence (due to risk of bias) from one study (n = 246) indicated no adverse events with exercising. The other six studies did not report adverse events. AUTHORS' CONCLUSIONS It is uncertain whether exercise improves hand function or pain in the short term. It probably slightly improves function but has little or no difference on pain in the medium and long term. It is uncertain whether exercise improves grip and pinch strength in the short term, and probably has little or no difference in the medium and long term. The ACR50 response is unknown. People who received exercise with adherence strategies were probably more adherent in the medium term than who did not receive exercise, but with little or no difference in the long term. Hand exercise probably does not lead to adverse events. Future research should consider hand and wrist function as their primary outcome, describe exercise following the TIDieR guidelines, and evaluate behavioural strategies.
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Affiliation(s)
- Mark A Williams
- Oxford Brookes UniversityDepartment of Sport and Health SciencesJack Straws LaneOxfordOxonUKOX3 0FL
| | - Cynthia Srikesavan
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Windmill roadOxfordUKOX3 7LD
| | - Peter J Heine
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Windmill roadOxfordUKOX3 7LD
| | - Julie Bruce
- University of WarwickWarwick Clinical Trials UnitGibbet Hill RdCoventryUKCV4 7AL
| | - Lucie Brosseau
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Nicolette Hoxey‐Thomas
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Windmill roadOxfordUKOX3 7LD
| | - Sarah E Lamb
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Windmill roadOxfordUKOX3 7LD
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Noah B, Keller MS, Mosadeghi S, Stein L, Johl S, Delshad S, Tashjian VC, Lew D, Kwan JT, Jusufagic A, Spiegel BMR. Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ Digit Med 2018; 1:20172. [PMID: 31304346 PMCID: PMC6550143 DOI: 10.1038/s41746-017-0002-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022] Open
Abstract
Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (-0.73; 95% CI: -1.84, 0.38), weight (-1.29; -3.06, 0.48), waist circumference (-2.41; -5.16, 0.34), body fat percentage (0.11; -1.56, 1.34), systolic blood pressure (-2.62; -5.31, 0.06), and diastolic blood pressure (-0.99; -2.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.
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Affiliation(s)
- Benjamin Noah
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Michelle S Keller
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Sasan Mosadeghi
- 4Department of Medicine, University of Arizona, College of Medicine Tucson, Tucson, AZ USA
| | - Libby Stein
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sunny Johl
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sean Delshad
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Vartan C Tashjian
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Daniel Lew
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - James T Kwan
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Alma Jusufagic
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Brennan M R Spiegel
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA.,American Journal of Gastroenterology, Bethesda, USA
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de Oliveira NC, Portes LA, Pettersson H, Alexanderson H, Boström C. Aerobic and resistance exercise in systemic sclerosis: State of the art. Musculoskeletal Care 2017; 15:316-323. [PMID: 28378937 DOI: 10.1002/msc.1185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Patients with systemic sclerosis (SSc) experience reduced exercise capacity and muscle strength compared with healthy subjects. There are also indications of reduced levels of physical activity. OBJECTIVE To present the current knowledge of physical exercise in SSc. RESULTS Most studies presently available [three case studies, one single subject experimental design, one study comparing patients with healthy controls, one quasi experimental design (pre-post), two clinical trials and two random controlled trials] have included small samples of patients, mostly composed of patients with and without pulmonary involvement. It seems that patients with SSc without pulmonary involvement are able to perform and benefit from aerobic exercises of at least moderate intensity. Exercise tolerance, aerobic capacity, walking distance, muscle strength and muscle function as well as health-related quality of life (HRQL) have been found to be improved after participation in programmes including aerobic exercise and aerobic exercise combined with resistance exercises. Improvements seem to be only partially retained at follow up. Patients with pulmonary involvement may also experience improved muscle strength, physical and aerobic capacity, as well as HRQL following exercise. CONCLUSIONS Patients with SSc without pulmonary involvement can be recommended to be as physically active as the general population. Patients with mild pulmonary involvement can be recommended to be physically active by engaging in exercises of moderate intensity and to participate in moderate-load resistance exercises. Health professionals should inform patients with SSc about the importance of physical activity and avoidance of a sedentary lifestyle.
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Affiliation(s)
- Natália Cristina de Oliveira
- Research Group in Physical Exercise, Lifestyle and Health Promotion. Health Promotion Master Program, UNASP - Adventist University of São Paulo, São Paulo, SP, Brazil
| | - Leslie Andrews Portes
- Research Group in Physical Exercise, Lifestyle and Health Promotion. Health Promotion Master Program, UNASP - Adventist University of São Paulo, São Paulo, SP, Brazil
| | - Henrik Pettersson
- Unit of Rheumatology, Department of Medicine Solna, Karolinska Institutet, and, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, and, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, and, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, and, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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Piga M, Cangemi I, Mathieu A, Cauli A. Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda. Semin Arthritis Rheum 2017; 47:121-128. [PMID: 28420491 DOI: 10.1016/j.semarthrit.2017.03.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/17/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically review the scientific literature regarding tele-rheumatology and draw conclusions about feasibility, effectiveness, and patient satisfaction. METHODS PubMed, Scopus, and Cochrane database searches were performed (April 2016) using relevant MeSH and keyword terms for telemedicine and rheumatic diseases. Articles were selected if reporting outcomes for feasibility, effectiveness, and patient satisfaction and methodologically appraised using the Cochrane Collaboration's tool for assessing risk of bias and a modified version of CONSORT 2010 Statement. RESULTS A total of 177 articles were screened, 23 were selected for the present review but only 9 were RCTs. Five studies reported on feasibility, 14 effectiveness, and 9 satisfaction rates for different tele-rheumatology interventions grouped in synchronous (remotely delivered consultation) and asynchronous (remote disease activity assessment; tele-monitoring of treatment strategies or rehabilitation; and remotely delivered self-management programs). Seven studies (30.4%) were on rheumatoid arthritis, 2 (8.7%) were on systemic sclerosis (1 including also rheumatoid arthritis patients), 5 (21.7%) on fibromyalgia, 2 (8.7%) on osteoarthritis, 3 (13.0%) on juvenile idiopathic arthritis and 4 (17.4%) on mixed disease cohorts. Interventions and outcomes heterogeneity prevented meta-analysis of results. Overall, feasibility and patient satisfaction rates were high or very high across intervention types. Effectiveness was equal or higher than standard face-to-face approach in controlled trials which, however, were affected by small sample size and lack of blinding participants according to appraisal tools. CONCLUSION Telemedicine may provide a well-accepted way to remotely deliver consultation, treatment and monitoring disease activity in rheumatology. Higher quality RCTs demonstrating effectiveness of different tele-rheumatology interventions are needed.
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Affiliation(s)
- Matteo Piga
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy.
| | - Ignazio Cangemi
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
| | - Alessandro Mathieu
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
| | - Alberto Cauli
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
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Worboys T, Brassington M, Ward EC, Cornwell PL. Delivering occupational therapy hand assessment and treatment sessions via telehealth. J Telemed Telecare 2017; 24:185-192. [PMID: 29278981 DOI: 10.1177/1357633x17691861] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction. Methods Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%. Results Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high. Discussion Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.
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Affiliation(s)
- Tess Worboys
- Occupational Therapy Department, Charleville Hospital, South West Hospital and Health Service, Queensland, Australia
| | - Melinda Brassington
- Occupational Therapy Department, Charleville Hospital, South West Hospital and Health Service, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland, Australia
- The University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Petrea L Cornwell
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Queensland, Australia
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Hammond A, Prior Y. The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review. Br Med Bull 2016; 119:49-62. [PMID: 27365455 DOI: 10.1093/bmb/ldw024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) commonly reduces hand function. We systematically reviewed trials to investigate effects of home hand exercise programmes on hand symptoms and function in RA. SOURCES OF DATA We searched: Medline (1946-), AMED, CINAHL, Physiotherapy Evidence Database, OT Seeker, the Cochrane Library, ISI Web of Science from inception to January 2016. AREAS OF AGREEMENT Nineteen trials were evaluated. Only three were randomized controlled trials with a low risk of bias (n = 665). Significant short-term improvements occurred in hand function, pain and grip strength, with long-term improvements in hand and upper limb function and pinch strength. AREAS OF CONTROVERSY Heterogeneity of outcome measures meant meta-analysis was not possible. GROWING POINTS Evaluation of low and moderate risk of bias trials indicated high-intensity home hand exercise programmes led to better short-term outcomes than low-intensity programmes. Such programmes are cost-effective. AREAS TIMELY FOR DEVELOPING RESEARCH Further research is required to evaluate methods of helping people with RA maintain long-term home hand exercise.
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Affiliation(s)
- Alison Hammond
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Yeliz Prior
- Centre for Health Sciences Research, University of Salford, Salford, UK
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Alberti G, Campodonico F. Case Studies of Technology-aided Interventions to Promote Hand Reaching and Standing or Basic Ambulation in Persons with Multiple Disabilities. Percept Mot Skills 2016; 122:200-19. [PMID: 27420316 DOI: 10.1177/0031512516630017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts.
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Pani D, Piga M, Barabino G, Crabolu M, Uras S, Mathieu A, Raffo L. Home tele-rehabilitation for rheumatic patients: impact and satisfaction of care analysis. J Telemed Telecare 2016; 23:292-300. [DOI: 10.1177/1357633x16632950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction In this paper, we evaluated patients’ perspectives on the use of a system for home tele-rehabilitation, designed for subjects with low computer literacy suffering hand impairment due to rheumatic diseases. Methods After a clinical trial assessing device effectiveness, the Psychosocial Impact of Assistive Devices Scale (PIADS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and Individually Prioritised Problem Assessment (IPPA) questionnaires were administered to evaluate the system’s impact on each patient’s life, and the results were correlated with clinical indices. Patients were asked to continue self-administered rehabilitation with common objects. One year later, a semi-structured telephone interview gathered data on their experience. Results The system received a positive QUEST score (4.5 ± 0.3) and a modest PIADS score (0.84 ± 0.8) due to the small impact on adaptability and self-esteem. The IPPA (3.7 ± 3.4) revealed improvement in the ability to perform tasks considered important, which was significantly correlated ( r = 0.60; p < 0.02) with the clinical Health Assessment Questionnaire (HAQ) index improvement. The interviews revealed a positive engagement effect, enhanced by the need to develop skills to be able to use the device (technological challenge) and by the perception of more attention by the medical staff. This may explain the significant dropout rate (80%) from the post-trial rehabilitation of the patients who used the device. Discussion The system was largely accepted by the patients. The results suggest that the need for information on their rehabilitation progress and the technological challenge deserves further study to make patients more autonomous in cases of continuous rehabilitation.
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Affiliation(s)
- D Pani
- DIEE – Department of Electrical and Electronic Engineering, University of Cagliari, Italy
| | - M Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Italy
| | - G Barabino
- DIEE – Department of Electrical and Electronic Engineering, University of Cagliari, Italy
| | - M Crabolu
- DIEE – Department of Electrical and Electronic Engineering, University of Cagliari, Italy
| | | | - A Mathieu
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Italy
| | - L Raffo
- DIEE – Department of Electrical and Electronic Engineering, University of Cagliari, Italy
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Vegesna A, Tran M, Angelaccio M, Arcona S. Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review. Telemed J E Health 2016; 23:3-17. [PMID: 27116181 PMCID: PMC5240011 DOI: 10.1089/tmj.2016.0051] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND We conducted a systematic literature review to identify key trends associated with remote patient monitoring (RPM) via noninvasive digital technologies over the last decade. MATERIALS AND METHODS A search was conducted in EMBASE and Ovid MEDLINE. Citations were screened for relevance against predefined selection criteria based on the PICOTS (Population, Intervention, Comparator, Outcomes, Timeframe, and Study Design) format. We included studies published between January 1, 2005 and September 15, 2015 that used RPM via noninvasive digital technology (smartphones/personal digital assistants [PDAs], wearables, biosensors, computerized systems, or multiple components of the formerly mentioned) in evaluating health outcomes compared to standard of care or another technology. Studies were quality appraised according to Critical Appraisal Skills Programme. RESULTS Of 347 articles identified, 62 met the selection criteria. Most studies were randomized control trials with older adult populations, small sample sizes, and limited follow-up. There was a trend toward multicomponent interventions (n = 26), followed by smartphones/PDAs (n = 12), wearables (n = 11), biosensor devices (n = 7), and computerized systems (n = 6). Another key trend was the monitoring of chronic conditions, including respiratory (23%), weight management (17%), metabolic (18%), and cardiovascular diseases (16%). Although substantial diversity in health-related outcomes was noted, studies predominantly reported positive findings. CONCLUSIONS This review will help decision makers develop a better understanding of the current landscape of peer-reviewed literature, demonstrating the utility of noninvasive RPM in various patient populations. Future research is needed to determine the effectiveness of RPM via noninvasive digital technologies in delivering patient healthcare benefits and the feasibility of large-scale implementation.
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Affiliation(s)
- Ashok Vegesna
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania.,2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey
| | - Melody Tran
- 2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey.,3 Scott & White Health Plan , Temple, Texas
| | | | - Steve Arcona
- 2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey
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Salaffi F, Carotti M, Ciapetti A, Di Carlo M, Gasparini S, Farah S, Gutierrez M. Effectiveness of a telemonitoring intensive strategy in early rheumatoid arthritis: comparison with the conventional management approach. BMC Musculoskelet Disord 2016; 17:146. [PMID: 27038788 PMCID: PMC4818962 DOI: 10.1186/s12891-016-1002-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 03/30/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Telemonitoring patients with rheumatoid arthritis (RA) is an emerging concept to guide the collaborative management treatment and improve outcomes in patients. The objective of this study was to investigate whether an intensive treatment strategy, according to a telemonitoring protocol, is more effective than conventional management strategy in reaching remission and comprehensive disease control (CDC) after 1 year in early rheumatoid arthritis (ERA) patients. METHODS Forty-four ERA patients were randomly allocated into two groups: the telemonitoring intensive strategy (TIS) group (group 1) or the conventional strategy (CS) group (group 2). Three patients refused to participate. In group 1 (n = 21), a remote monitoring system of disease activity, in combination with protocolised treatment adjustments aiming for remission was applied. In group 2 (n = 20), patients were treated according to daily clinical practice, with regular evaluation of disease activity, but without protocolised treatment adjustments. A telemedical care called "REmote TElemonitoring for MAnaging Rheumatologic Condition and HEaltcare programmes" (RETE-MARCHE), was developed to perform the remote monitoring. RESULTS A higher percentage of patients in the TIS group achieved CDAI remission vs patients in the CS group (38.1 % vs 25 % at year 1, p <0.01). Time to achieve remission was significantly shorter in the group 1 than in the group 2, with a median of 20 weeks vs a median over 36-weeks (p <0.001). Concordantly, the patients in group 1 showed a greater improvement (p <0.001), compared with group 2 in terms of functional impairment (71.4 % vs 35 %) and radiological damage progression (23.8 % vs 10 %), resulting in a greater rate of CDC (19.4 % vs 5 %). CONCLUSIONS According to our results, an intensive treatment strategy by telemonitoring leads to more effective disease remission and more rapid CDC than treatment according to conventional management strategy in ERA. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER ISRCTN13142685 Date of registration: March, 17(th) 2016.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy. .,Clinica Reumatologica, Università Politecnica delle Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro, 25, 60035, Jesi, AN, Italy.
| | - Marina Carotti
- Radiology Department, Polytechnic University of the Marche, Ancona, Italy
| | - Alessandro Ciapetti
- Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.,Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, Wales
| | - Marco Di Carlo
- Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy
| | - Stefania Gasparini
- Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy
| | - Sonia Farah
- DII, Department of Information Engineering, Politechnic University of Marche, Ancona, Italy
| | - Marwin Gutierrez
- Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.,Musculoskeletal Department, National Rehabilitation Institute, Mexico City, Mexico
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Abstract
PURPOSE OF REVIEW To review pharmacologic and nonpharmacologic therapies in the treatment of systemic sclerosis (SSc) from 2011 to 2014 through a systematic review. RECENT FINDINGS Our systematic review identifies randomized controlled trials, meta-analyses, systematic reviews, case series, and observational studies which support organ-based therapy with known immunosuppressive agents, novel agents, and hematopoietic stem cell transplantation, and also includes nonpharmacologic therapies improving visceral and physical function. SUMMARY SSc is an orphan autoimmune disorder with significant morbidity and mortality. Although there has been significant progress over the years in therapeutic options for SSc, the mainstays of treatment are organ-based and primarily symptom management. Our systematic review of the last 4 years of treatment emphasizes known treatment strategies already in practice, but also identifies new therapeutic approaches with additional biologic agents and hematopoietic stem cell transplantation.
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