Conservative hand therapy treatments in rheumatoid arthritis--a randomized controlled trial

Rheumatology (Oxford). 2006 May;45(5):577-83. doi: 10.1093/rheumatology/kei215. Epub 2005 Nov 30.


Objective: To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the rheumatoid hand.

Methods: In a randomized controlled trial, participants with rheumatoid arthritis (RA) recruited from a rheumatology department in Mid-Staffordshire, UK (February 1999 to January 2001) were randomized to three groups. All received joint protection (JP) information delivered by a therapist at baseline. Group 1 participants received a set of additional hand-strengthening and mobilizing home exercises, group 2 a different set of additional hand-stretching exercises and group 3 the JP information alone. The primary outcome was the Arthritis Impact Measurement Scales II (AIMS II) (upper limb; hand and finger function subscales). Outcomes were assessed at baseline and 1, 3 and 6 months. Analysis was by intention to treat.

Results: Sixty-seven participants (mean age 59.6 yr) were recruited: group 1 n = 21, group 2 n = 24 and group 3 n = 22. A 78% follow-up was achieved at 6 months. There was a mean fall (SD) in AIMS II upper limb function 0-6 month change scores in group 1 of 1.00 (1.07). In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 (1.54) and 0.30 (1.22), respectively. The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant (P = 0.007) and remained so after adjustment for multiple testing (P = 0.012).

Conclusion: Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening hand exercises in RA patients compared with simple stretches or advice alone.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthritis, Rheumatoid / physiopathology
  • Arthritis, Rheumatoid / rehabilitation*
  • Exercise Movement Techniques / methods
  • Female
  • Hand Joints / physiopathology*
  • Hand Strength
  • Humans
  • Male
  • Middle Aged
  • Physical Therapy Modalities*
  • Severity of Illness Index
  • Single-Blind Method
  • Treatment Outcome
  • Upper Extremity / physiopathology