AB0877-HPR EXERCISE COMPLIANCE AND DISEASE STATUS IN PATIENTS WITH RHEUMATIC DISEASES DURING COVID-19 PANDEMIC

Background:

The COVID-19 pandemic affects the whole world in many ways. In an effort to slow down the infection, physical distancing and isolation policies have been implemented in Turkey, likewise the rest of the world. Thereby, rheumatic diseases require to obey the self-isolation recommendations strictly due to general vulnerability to infections in those patients. Due to the precautions taken for isolation, the physical inactivity level of the patients which would affect the disease activity has increased (1).

Objectives:

The primary purpose of this study was to assess the exercise compliance and clinical status of the patients with rheumatic diseases during the COVID-19 pandemic. The secondary aim of the study was to evaluate the physical activity level and quality of life of the patients during the pandemic.

Methods:

The research is a cross-sectional study. Seventy-nine patients with various rheumatic diseases were included in the study. Standard questions were used to evaluate the exercise habits, the level of pain and morning stiffness and severity of exacerbations. Pain and morning stiffness levels and attack severity were scored on a numerical rating scale (NRS) (0-10; with 0 indicating no pain/stiffness and 10 severe pain/stiffness). Attack duration was recorded in number of exacerbated days. Parameters were compared before and after the pandemic with Paired Samples T Test. The International Physical Activity Questionnaire-Short Form (IPAQ) and Nottingham Health Profile (NHP) Questionnaire were filled to assess the physical activity level and quality of life.

Results:

Twenty-eight percent of the patients were diagnosed with Familial Mediterranean Fever (FMF), 37% were Ankylosing Spondylitis (AS), 14% were Systemic Sclerosis (ScS) 14% were Systemic Lupus Erythematosus (SLE), 6% were Rheumatoid Arthritis, 1% were Primary Sjogren Syndrome (PSS). Less than half of the patients (46%) did continue exercising regularly during the pandemic and 30 (81%) of them performed only the exercises given by the therapist while 7 (9%) of them tried different exercise types from another source. The reason for discontinuation to exercising expressed by the incompliant patients were mostly “unwillingness” (17 of 37 patients). Pain, morning stiffness and number of attacks were better during the pandemic compared to before however, a statistically significant difference was found only for morning stiffness (p = .036). The results of IPAQ showed that the majority of the patients (n: 48) were physically inactive, while only 2 patients were active during the pandemic. The most deteriorated quality of life subcategory was energy level of the patients according to the NHP scores.

Conclusion:

This study results showed that patients with rheumatic diseases stayed physically inactive during the pandemic and the disease status has also been affected negatively. As the duration of the pandemic prolongs, levels of physical inactivity would increase and the progressive physical inactivity is expected to worsen patients’ symptoms more. However, as the pandemic appears to continue, face-to-face exercise therapy should still be avoided. For all those reasons above, alternative ways of therapy like tele-rehabilitation would come onto stage to cope with the increasing physical inactivity of the rheumatic patients.

References:

[1]Pinto AJ, Dunstan DW, Owen N, Bonfá E, Gualano B. Combating physical inactivity during the COVID-19 pandemic. Nature Reviews Rheumatology. 2020; 16(7):1-2.

Disclosure of Interests:

None declared

Does earlier splint removal truly affect functional recovery and kinesiophobia after tendon repair?

Splinting how the hand can be used in daily life. Therefore, earlier splint removal is thought to improve functional recovery. The aim of our study was to assess the outcomes of patients who removed their splint and started using their hand earlier and compare them to patients who received routine care. Patients with tendon repairs were divided into two groups: Group 1 (Early) started daily use of their hand at the 5th postoperative week and Group 2 (Later) at the 6th week. Patients received regular therapy consisting of an early motion protocol. Assessments were performed at three consecutive time points. Grip and pinch strength was measured and Nine-Hole Peg Test (9HPT) was performed. Disabilities of the Arm, Shoulder and Hand (DASH) and Tampa Scale for Kinesiophobia (TSK) were filled out. Both within-group and between-group analyses were performed. A total of 58 patients with flexor or extensor tendon repairs were analyzed. All parameters improved significantly over time within both groups (P<0.05). When the time effect was ignored, kinesiophobia, disability and functional results - except grip strength - were statistically better in Group 2 group than in Group 1 (P<0.05). Our results showed that, despite the clinically observed recovery, earlier splint removal and start of daily hand use did not truly improve the functional results. To us, this means that the remarkable advances in surgical techniques do not accelerate the physiological healing process. Therefore, clinical recommendations should always be supported with evidence-based data.

Validity and reliability study of the Turkish version of SACRAH (Score for Assessment and quantification of Chronic Rheumatic Affections of the Hands)

Rheumatic diseases cause deformities in the hands and affect daily living activities. Therefore, assessment of hand disabilities is important in rheumatic disease. The aim of this study was to test the validity and reliability of the Turkish version of the A Score For Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SACRAH). A translation and back-translation of the SACRAH were performed, according to the Beaton guidelines. Patients who were between 18-65 years old, who were literate in Turkish, who had rheumatic disease diagnosis and whose hands were affected, were included in the study. Patients who were using a splint during daytime were excluded from the study. They completed the Turkish version of Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH-T) once and the final version of the SACRAH Questionnaire twice with a 7 days' interval. The internal consistency (Cronbach's α) and reliability (test-retest reliability) of the questionnaire were assessed. Besides, correlations between SACRAH and DASH-T scores were analyzed using the Spearman correlation coefficient. One hundred and twenty patients participated in the study. The Turkish version of the SACRAH met set criteria of reliability and validity. Internal consistency was excellent (Cronbach's α=0.88) and test-retest reliability were very good (r=0.73). SACRAH showed a positive and statistically significant correlation with DASH-T scores (r=0.83, p<0.001). Our results show that the Turkish version of the SACRAH has excellent test-retest reliability and validity. As a result of this study we determined that SACRAH is a valid and reliable instrument for assessing functional status and subjective manual function in Turkish-speaking patients.

Fear of movement and its effects on hand function after tendon repair

After tendon injuries, it has been observed clinically that patient-reported disability is more severe than the patient's actual performance. This is thought to result from a fear of movement (kinesiophobia) after surgery. The aim of this study was to investigate the presence of kinesiophobia in this patient population and its effects on the clinical outcomes. Patients (n=118) with tendon repairs were included. All the participants received early passive mobilization and were assessed at the end of the 8th week. Grip and pinch strengths were measured and the Nine-Hole Peg Test (9HPT) was conducted. Patients also filled out the Michigan Hand Outcomes Questionnaire (MHOQ) and Tampa Scale for Kinesiophobia (TSK). Patients were divided according to their kinesiophobia: Group 1 with low kinesiophobia (TSK<37) and Group 2 with high kinesiophobia (TSK≥37). The groups were compared on the assessed parameters. Fifty-nine percent of the patients had a high kinesiophobia level. The performance-based test results were similar between the groups (P>0.05). Patient-reported MHOQ and TSK scores were significantly lower in the high kinesiophobic group (P=0.001 and P=0.000, respectively). Patients with tendon repairs often develop kinesiophobia, which may contribute to difficulty when starting to re-use their hand in daily life. None of the objective results were affected by this fear of movement-only patient-reported disability. Clinicians should be aware that clinical outcomes may be affected by the patient's kinesiophobic thinking and must be cautious during treatment.

Relationship between patient-reported and objective measurements of hand function in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) often results in impairments in upper extremities, especially in the small joints of hand. Involvement of hand brings limitations in activities of daily living. However, it is commonly observed that patient-reported functional status of hand does not always corresponds to their actual physical performance in the clinical setting. The aim of this pilot study is to investigate the relationship between patient self-reported and objectively measured hand functions in patients with RA. Twenty-six patients (51±13 years) with RA diagnosis participated in the study. Hand grip and pinch (lateral, bipod, tripod) strengths were measured and Jebsen Hand Function Test (JHFT) was performed for objective functional performance. Duruöz Hand Index and Beck Depression Inventory - Turkish version were completed by patients. Grip and all three-pinch strength results significantly correlated with Duruöz Hand Index scores (p&lt;0.05). JHFT results except the sentence writing also correlated with the Duruöz scores (p&lt;0.05). Our results showed that self-reported outcome scales might be used for determining functional level of hand in patients with RA in rheumatology practice. Objective quantitative functional tests are the best methods in evaluating functional level of hand, but require valid and reliable equipment with accurate calibration. Therefore, in case of unavailability of objective assessment tools, patient-reported scales may also reflect the real status of hand functions.