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Background: Systemic sclerosis (SSc) is characterized by stiffness and contraction of tissues, which leads to a limitation in the execution of day-to-day activities. The aim of our study was to investigate the impact of specialized physical-occupational therapy (POT) focused on the hands/face and QoL of SSc patients.
Objectives: Fifty five patients fulfilled the EULAR/ACR criteria for SSc and had skin involvement leading to hand/face function impairment. 25 patients were recruited into the intervention group (IG) and 30 patients into the control group (CG). Both groups received an educational material for home exercise, but only the IG underwent a 6-month intervention with a subsequent 6-month follow-up period.
Methods: Patients were assessed by a physician and a physiotherapist blinded to intervention at months 0, 3, 6, and 12. Patients also filled out patient reported outcomes questionnaires and provided blood for routine laboratory analysis and bio-banking. Data analysis was done between groups and within the group.
Results: Compared to the observed statistically significant deterioration in the CG, we found a statistically significant improvement in the IG in objectively assessed function and strength of hand, distance between incisors and functional ability (SHAQ) (Table). Only numerical improvements in the IG during the intervention compared to numerical deterioration in CG that did not reach statistical significance were observed in subjectively assessed hand function and mouth handicap, functional ability (HAQ) and in some domains of QoL (SF-36) and fatigue (FIS – cognitive function). During the follow-up period, there was a significant deterioration or stagnation of the achieved positive results in the IG.
| Parameter(unit) | Intervention groupMean ± SEM | Control groupMean ± SEM | Intra-group analysis (Friedman+Dunn) | Inter-group analysis (2WA) | |
|---|---|---|---|---|---|
| Interevention gr. | Control group | ||||
| dFTP, dominant hand (cm) | m0: 5.7 ± 0.5m3: 6.2 ± 0.5m6: 6.8 ± 0.6m12: 6.0 ± 0.6 | m0: 6.8 ± 0.5m3: 6.2 ± 0.4m6: 5.9 ± 0.4m12: 5.6 ± 0.4 | m0-3: p<0.01m3-6: p<0.05m0-6: p<0.0001m6-12: p<0.0001 | m0-3: NS m3-6: NS m0-6: p<0.0001m6-12:NS | p<0.0001 |
| Hand grip strength, dominant hand (kg) | m0: 17.2 ± 1.8m3: 19.2 ± 1.9m6: 19.7 ± 1.9m12: 17.5 ± 2.0 | m0: 16.5 ± 1.2m3: 14.9 ± 1.3m6: 13.8 ± 1.2m12: 14.2 ± 1.3 | m0-3: p<0.05m3-6: NS m0-6: p<0.001m6-12: p<0.05 | m0-3: NS m3-6: NS m0-6: p<0.01m6-12: NS | p<0.0001 |
| HAMIS, dominant hand | m0: 9.8 ± 1.3m3: 7.1 ± 1.3m6: 4.1 ± 0.9m12: 7.2 ± 1.2 | m0: 3.9 ± 1.1m3: 6.3 ± 1.2m6: 8.9 ± 1.1m12: 9.8 ± 1.2 | m0-3: p<0.01m3-6: p<0.001m0-6: p<0.0001m6-12: p<0.001 | m0-3: NS m3-6: p<0.001m0-6: p<0.0001m6-12: NS | p<0.0001 |
| Inter-incisor distance (cm) | m0: 2.9 ± 0.2m3: 3.2 ± 0.2m6: 3.5 ± 0.2m12: 3.2 ± 0.2 | m0: 3.3 ± 0.1m3: 3.1 ± 0.1m6: 3.0 ± 0.1m12: 3.0 ± 0.1 | m0-3: p<0.01m3-6: NS m0-6: p<0.0001m6-12: p<0.01 | m0-3: p<0.01m3-6: NS m0-6: p<0.001m6-12: NS | p<0.0001 |
| SHAQ (mm) | m0: 28.8 ± 3.9m3: 21.5 ± 3.4m6: 22.0 ± 3.5m12: 23.4 ± 3.7 | m0: 21.5 ± 2.1m3: 24.6 ± 2.6 m6: 24.9 ± 2.9m12: 27.5 ± 3.3 | m0-3: NS m3-6: NS m0-6: p<0.05m6-12: NS | m0-3: NS m3-6: NS m0-6: NS m6-12: NS | p=0.0015 |
Conclusion: Our program led to a significant improvement in the observed parameters that was clinically significant in a substantial proportion of patients, and prevention of the expected worsening of hand/face handicap and QoL.
Acknowledgement: Supported by AZV-16-33574A, SVV for FTVS UK 2019-260466, MHCR 023728.
Disclosure of Interests: Maja Špiritović: None declared, Hana Smucrova: None declared, Sabina Oreska: None declared, Hana Štorkánová: None declared, Barbora Heřmánková: None declared, Petr Česák: None declared, Adéla Rathouská: None declared, Olga Růžičková: None declared, Karel Pavelka: None declared, Ladislav Šenolt Grant/research support from: AbbVie, Consultant for: AbbVie, Bristol-Myers Squibb, Celgene Corporation, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Amgen, Takeda, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Jiří Vencovský Consultant for: Samsung, Speakers bureau: AbbVie, Novartis, Pfizer, Sanofi, Eli Lilly, Biogen, UCB, MSD, Werfen, Roche, Radim Bečvář Consultant for: consultancy Actelion, Michal Tomčík: None declared
DOI: 10.1136/annrheumdis-2019-eular.4630