7/14/2015
Hand Exercises Help Women With OA Get a Grip
by Nancy Walsh
Senior Staff Writer, MedPage Today
A simple, home-based program of exercises for women with hand osteoarthritis (OA) was effective for improving function and pain in this potentially disabling condition, a randomized trial found.
After 3 months, women who performed the exercises had a change in the Patient-Specific Functional Scale (PSFS) of 1.8 points compared with a change of 0.2 among controls, for a mean difference of 1.4 (95% CI 0.6-2.2, P<0.001) on this primary outcome measure, according to Ingvild Kjeken, PhD, of Diakonhjemmet Hospital in Oslo, and colleagues.
In the exercise group, mean pain after the exercises during study week 1 was 5.6 on a scale of 0-10. At the end of the study, this had decreased to 4.2, for a mean difference of 1.4 (95% CI 0.5-2.3, P=0.003), the researchers reported in the August Annals of the Rheumatic Diseases.
“Functional consequences of hand OA are pain, reduced mobility and grip strength, activity limitations and participation restrictions, including loss of income and increased dependency,” they explained.
The European League Against Rheumatism recommends that patients with hand OA be encouraged to perform strengthening and range of motion exercises, but cautions that evidence to support this recommendation is sparse.
To address this lack, Kjeken and colleagues enrolled 80 women with documented hand OA and at least three OA-related activity limitations on the PSFS, randomizing them to a specifically designed exercise program or to an information-only control group.
The exercise program was developed by the Norwegian Network for Occupational Therapists using an evidence-based approach, adapted according to the American College of Sports Medicine recommendations for the frail elderly.
Exercises included squeezing a rubber ball as hard as possible, spreading the fingers widely apart, and rolling the fingers into a fist. The exercise group was instructed to perform the program three times each week, beginning with 10 repetitions of each exercise and increasing to 15 repetitions.
“The aims of the program were to maximize a stable and pain-free functional range of motion of the finger joints, increase grip strength, maintain joint stability, and prevent or delay the development of fixed deformities,” they stated.
Participants’ mean age was 61 and mean symptom duration was 10 years. A total of 37 women in the exercise group and 34 in the control group completed the study.
On the criteria for response set by the Outcome Measures in Rheumatology-OA Research Society International of a change of 2.2 or more on the PSFS score, 16 patients in the exercise group were considered responders compared with only two of the controls.
Significant benefits were seen on a variety of secondary outcomes. On 0-10 scales, the difference in fatigue between the two groups was -1.1 (95% CI -2.3 to 0, P=0.05), and the difference for joint pain was also -1.1 (95% CI -2 to -0.2, P=0.02).
Change in thumb web space was 0.6 (95% CI 0.1-1.1, P=0.018) for the right hand and 0.7 (95% CI 0.2-1.2, P=0.007) for the left hand, and the difference on the Functional Index for Hand OA score was -3.2 (95% CI -5 to -1.4, P=0.001).
For maximum grip strength, the between-group difference in the right hand was 53.5 Newtons (95% CI 27.8-79.1, P<0.001) and 44.6 (95% CI 23.4-65.8, P<0.001) in the left hand.
It has traditionally been thought that exercises for patients with hand OA should be of low intensity and should not be associated with persistent pain. However, intensive exercise has been shown to be beneficial and well tolerated in knee OA and rheumatoid arthritis.
“The results from our study show that even if participants reported considerable pain after exercising, this pain decreased significantly during the study period, and general joint pain improved,” the authors observed.
“The high adherence to the program also indicates that the exercise program was safe and well tolerated,” they added.
Limitations of the study included the inclusion of women only, the lack of a placebo control group, and the possibility that there may have been differences in medication use by patients in the two groups.
“In summary, an evidence-based, low-cost hand-exercise program was well tolerated and significantly improved activity performance, grip strength, fatigue, and pain in women with hand OA.”
The study was funded by Martina Hansens Hospital, the Norwegian Association for Rheumatism, the Norwegian Association of Hand Therapists, and the Norwegian Association for Occupational Therapy.
Kjeken and co-authors disclosed no relevant relationships with industry.
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Primary Source
Annals of the Rheumatic Diseases