OBJECTIVE: To study the short-term effects of physical therapy (ice massage or wax packs, thermal baths, and faradic hand baths) and exercise therapy on the rheumatoid hand.
METHODS: The effect of individual physical therapy and exercise therapy programs was evaluated in 50 randomly selected rheumatoid arthritis inpatients (38 women and 12 men). Mean patient age (+/- SD) was 47.94 +/- 11.22 years, and mean disease duration was 5.04 +/- 4.80 years. The control group consisted of 50 randomly selected rheumatoid arthritis outpatients (37 women and 13 men; mean age 48.46 +/- 10.65 years, mean duration of disease 5.23 +/- 4.89 years) who at the time of the investigation were not receiving any physical or exercise therapy. The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate (ESR), pain intensity, proximal interphalangeal (PIP) joint size, and Ritchie articular index. Hand grip strength, palmar tip-to-tip and key pinch finger strength, finger range of motion, and activities of daily living (ADL) were the parameters used to assess the functional hand status. The study was single-blinded and of 3 weeks duration.
RESULTS: In the physical therapy treated group, there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance (P < 0.01 and P < 0.005) after the 3-week study period. ESR and PIP joint size improved clinically but failed to reach statistical significance. Patients had a more significant improvement in hand pain, joint tenderness, and ADL score (P < 0.005) than in range of motion (P < 0.01). All parameters in the control group slightly deteriorated over the study period.
CONCLUSION: At least in the short term, physical and, particularly, exercise therapy produce a favorable improvement in the functional status of the rheumatoid hand.
A computer-controlled MCP joint arthrograph was developed to measure the stiffness of finger joints objectively. This was used to study the short-term (one application) and long-term (multiple applications over 6 weeks) effects of several physiotherapeutic methods on the reduction in joint stiffness. The techniques used were hot wax baths, pulsed ultrasound alone, wax baths plus pulsed ultrasound and exercise. In the short-term (i.e. after each application) wax plus ultrasound produced a statistically significant reduction in elastic torque range (P < 0.01) and dissipated energy (P < 0.05). However, the reductions in these stiffness parameters were temporary. Long-term no significant reductions in stiffness were measured. In other words, stiffness was reduced by each therapy session, but it then increased again before the next session. Wax, ultrasound alone or exercise produced no short- or long-term effects.
Forty-four female patients with sero-positive active RA participated in a 48-month trial to assess the effect of simple hand exercises. Twenty-two patients in the test group were given a daily exercise regime of six exercises. The control group were not given any exercises. At the end of 48 months there was a statistically significant improvement in grip strength (P < 0.0001) and pincer grip strength (P < 0.0005) in the test group. There was a significant deterioration in the control group (P < 0.0000). A simple exercise programme is beneficial for the rheumatoid hand as far as grip and pincer grip strength are concerned.
OBJECTIVE: To study differing home hand exercise interventions to determine effects on grip strength, and secondarily any immediate or short term effects on range of motion, pain, deformities, hand disease activity, and dexterity. METHODS: Randomized controlled trial of 12 weeks of home hand exercise performed for 10-20 min twice daily. Study exercise interventions were range of motion exercises, balanced resistive exercises, and range of motion plus balanced resistive exercises. RESULTS: Aside from transient, mild to moderate discomfort, exercises were well tolerated. Range of motion exercises were associated with improved right hand joint count. Range of motion plus balanced resistive exercises were associated with increased left hand dexterity. Home hand exercise (exercise groups combined) significantly increased left grip strength. CONCLUSIONS: Temporary use of home hand exercise has acceptable side effects and is an effective means of increasing grip strength.
The effect of active hand exercise and warm wax treatment was evaluated in 52 rheumatoid arthritis patients randomized into four groups: (1) both exercise and wax bath, (2) exercise only, (3) wax bath only, and (4) controls. Treatment was given three times a week for 4 weeks. Deficits in flexion and extension in digits II-V bilaterally, grip function, grip strength, pain, and stiffness were measured before and after the treatment period. The control group was measured at corresponding times. Wax bath treatment followed by active hand exercise resulted in significant improvements of range of motion (ROM) and grip function. Active hand exercise alone reduced stiffness and pain with nonresisted motion and increased ROM. Wax bath alone had no significant effect.
Thirty in-patients with rheumatoid arthritis were treated with wax baths, ultrasound, and ultrasound followed by a faradic hand bath. Routine exercises were added to each technique. The patients were recruited for a 3 week period. All had pain, swelling and limited movements. A randomisation code allocated patients into one of three treatment groups. Seven assessments were carried out before entry to the study, and at the end of weeks 1, 2 and 3, by an independent observer. Statistically significant improvement in grip strength and articular index was seen after one week independently of treatment. There was no difference in performance between the dominant and non-dominant hand. All seven measurements showed significant improvement by the end of the third week of treatment in all treatment groups. Ultrasound in the dose used was no better than wax baths in improving the patients.
The effects of evening exercises on arthrographic measures of elastic stiffness, subjective ratings of stiffness, and graphic goniometric measures of mobility were examined in 30 patients with rheumatoid arthritis. Measures were obtained on 2 consecutive mornings, one of which was randomly determined to be preceded by evening exercise. Each morning, elastic stiffness and mobility were measured before and after morning exercise. After the final measurements of elastic stiffness and mobility on the second day, patients compared stiffness on the 2 days. Elastic stiffness and subjective ratings of stiffness were less and mobility was greater when evening exercises were performed (p less than 0.001). The relationships between elastic stiffness and subjective ratings of stiffness indicated that the effect of evening exercise was perceived as greater when elastic stiffness was greater, and 21 patients reported less stiffness with evening exercise (p less than .05).
To improve function and to delay the tendency toward deformities of the rheumatoid arthritic hand, a new device was evaluated which enables patients to perform range of motion and isometric exercises in their home. Eighteen patients (35 hands) exercised daily for four months. Strength and range of motion showed statistically significant gains. Grip strength increased in 28 hands, volar pinch in 22 hands, lateral pinch in 21 hands. Of 140 PIP joints, 77% increased in range, indicating loosening of intrinsic muscles. Improvement in hand function was reported by most of the patients.
To study the short-term effects of physical therapy (ice massage or wax packs, thermal baths, and faradic hand baths) and exercise therapy on the rheumatoid hand.
METHODS:
The effect of individual physical therapy and exercise therapy programs was evaluated in 50 randomly selected rheumatoid arthritis inpatients (38 women and 12 men). Mean patient age (+/- SD) was 47.94 +/- 11.22 years, and mean disease duration was 5.04 +/- 4.80 years. The control group consisted of 50 randomly selected rheumatoid arthritis outpatients (37 women and 13 men; mean age 48.46 +/- 10.65 years, mean duration of disease 5.23 +/- 4.89 years) who at the time of the investigation were not receiving any physical or exercise therapy. The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate (ESR), pain intensity, proximal interphalangeal (PIP) joint size, and Ritchie articular index. Hand grip strength, palmar tip-to-tip and key pinch finger strength, finger range of motion, and activities of daily living (ADL) were the parameters used to assess the functional hand status. The study was single-blinded and of 3 weeks duration.
RESULTS:
In the physical therapy treated group, there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance (P < 0.01 and P < 0.005) after the 3-week study period. ESR and PIP joint size improved clinically but failed to reach statistical significance. Patients had a more significant improvement in hand pain, joint tenderness, and ADL score (P < 0.005) than in range of motion (P < 0.01). All parameters in the control group slightly deteriorated over the study period.
CONCLUSION:
At least in the short term, physical and, particularly, exercise therapy produce a favorable improvement in the functional status of the rheumatoid hand.
