Hand exercises improve function in rheumatoid arthritis patients

The study was led by Professor Sallie Lamb of the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University and the University of Warwick, and has recently been published in hard copy in The Lancet.

RA affects more than 400,000 people in the UK, of whom about 80% have hand and wrist problems, and this has a substantial impact on quality of life, function and productivity. The new strengthening and stretching exercise programme developed for the study is a worthwhile, low cost intervention to adopt alongside medication.

The Strengthening And Stretching For Rheumatoid Arthritis of the Hand (SARAH) trial evaluated the effectiveness and cost-effectiveness of adding an individually tailored, progressive exercise programme for the hands and upper limbs in addition to usual care.

Approximately 80% of the patients using the SARAH programme alongside their medication, reported improvement of hand function a year after starting the programme. Significant improvements in strength and dexterity were also seen for patients performing the exercise programme.

Associate Professor and professional lead for Occupational Therapy at the University of Southampton, Jo Adams, said: “This robust and successful trial was delivered by NHS clinical colleagues and included recruitment of patients from seven of our local southern hospitals. The trial ran to very high standards and produced clear evidence that hand therapy, provided by occupational therapy and physiotherapy, was effective in helping people with RT have less hand pain and more function.

“Simple strategies to support people to carry out hand therapy advice was shown to help people carry out the daily hand exercises as part of this trial”

Professor Karen Middleton, chief executive of the Chartered Society of Physiotherapy, added: "This study demonstrates the significant improvement physiotherapy can make to the quality of life of people with long-term conditions.

“Growing numbers of people are living with at least one of these conditions, so new interventions such as this will be invaluable as the NHS looks to address that rising demand within restrained budgets. This proactive approach enables people to manage their own condition and lead full and active lives while cutting costs for the NHS and social care."

Julia Scott, Chief Executive Officer of the College of Occupational Therapists commented: "Nearly three-quarters of hand therapists in the UK are occupational therapists (OTs) who a key part in undertaking this research.

“I'm delighted that the findings have produced evidence of an effective functionally-based exercise regime for people with RA of their hands; this will enhance the existing occupational therapy role in providing splinting, joint protection, the use of adaptive equipment and education to improve people's functional ability."

As part of the study, the team developed a manual that describes the treatment programme developed for the SARAH trial. The manual is designed to guide hand therapists through the SARAH exercise programme with detailed descriptions of the different elements. Whilst patients are welcome to have a look at this, the next step is for the team to work on how the exercise programme can be implemented into clinical practice and for patients to have easy access to this treatment.

Over 450 patients from 17 NHS trusts were part of the Strengthening And Stretching For Rheumatoid Arthritis of the Hand (SARAH) trial. All people who entered the trial received joint protection advice, with half of all people in the study also undertaking the daily exercise programme for the hands and arms.

The SARAH trial was funded by the National Institute of Health Research Health Technology Assessment Programme (NIHR HTA), and was a collaboration between several higher education institutions including the Universities of Warwick, Oxford, Southampton, Brunel and University College London. Professor Sallie Lamb is supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust.