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Background: Although exercise is known to be important in treating systemic sclerosis (SSc) patients, studies on the methods by which exercise should be performed are limited.
Objectives: This study aimed to compare the effects of telerehabilitation and home-based exercise treatments for hand rehabilitation in patients with SSc.
Methods: Patients diagnosed with SSc were randomized into two groups. While patients in the telerehabilitation group did their exercises under the supervision of a physiotherapist using the Zoom application, patients in the home-based exercise group did the exercises in the brochure given to them on their own. The treatment of both groups was three days a week for a total of eight weeks and included similar exercises. Hand mobility, thumb mobility, finger motion, gross and pinch grip strength, pain intensity, hand functions, health status, and quality of life of the patients were evaluated before and after treatment.
Results: Thirty-four patients were included in the study. No significant difference was detected between the groups due to baseline evaluation. After 8-week treatment, telerehabilitation group demonstrated better hand mobility (p=0.010, p=0.015), thumb mobility (p<0.001, p<0.001), finger motion (p=0.005, p=0.005), gross grip strength (p<0.001, p=0.007), triple (p=0.002, p=0.011) and lateral pinch grip strength (p=0.008, p=0.024) scores for right and left hands, respectively.
Conclusion: The present research indicated that telerehabilitation is more effective than self-management in hand rehabilitation in patients with SSc. Based on these findings, telerehabilitation is a quality practice that has the potential to increase hand mobility and grip strength in patients with SSc.
Change in primary and secondary outcomes
| Variable | Telerehabilitation group (n=16) | Home-based exercise group (n=18) | Differences in mean | p value | ||||
|---|---|---|---|---|---|---|---|---|
| Pre
| Post
| Mean differences 95% CI | Pre
| Post
| Mean differences 95% CI | 95% CI | ||
| mHAMIS | ||||||||
| Right | 5.5 ± 3.08 | 2.50 ± 2.19 | 3.00 [1,82, 4.18] | 4.72 ± 2.49 | 4.61 ± 2.28 | 0.11 [-0.40, 0.62] | -2.11 [-3.68, -0.54] | 0.010 |
| Left | 5.25 ± 2.77 | 2.25 ± 2.18 | 3.00 [1.74, 4.26] | 4.44 ± 2.57 | 4.28 ± 2.40 | 0.17 [-0.35, 0.69] | -2.03 [-3.63, -0.42] | 0.015 |
| Kapandji | ||||||||
| Right | 7.19 ± 1.42 | 8.31 ± 1.20 | -1.13 [-1.70, 0.55] | 6.89 ± 1.41 | 6.61 ± 1.14 | 0.28 [-0.05, 0.61] | 1.70 [0.88, 2.52] | <0.001 |
| Left | 7.13 ± 1.54 | 8.38 ± 1.15 | -1.25 [-1.91, -0.59] | 7.11 ± 1.53 | 6.62 ± 1.20 | 0.50 [-0.07, 1.07] | 1.76 [0.94, 2.58] | <0.001 |
| ΔFTP, cm | ||||||||
| Right | 3.14 ± 1.17 | 1.22 ± 0.82 | 1.92 [1.25, 2.59] | 2.51 ± 1.14 | 2.23 ± 1.10 | 0.28 [-0.11, 0.67] | -1.01 [-1.69, -0.32] | 0.005 |
| Left | 2.82 ± 1.12 | 1.12 ± 0.96 | 1.70 [1.03, 2.37] | 2.26 ± 1.04 | 2.24 ± 1.19 | 0.01 [-0.59, 0.61] | -1.13 [-1.89, -0.36] | 0.005 |
| Gross grip strength, kg | ||||||||
| Right | 16.87 ± 5.88 | 23.31 ± 4.68 | -6.44 [-9.00, -3.87] | 19.01 ± 5.19 | 17.44 ± 3.98 | 1.57 [0.34, 2.79] | 5.87 [2.84, 8.89] | <0.001 |
| Left | 15.65 ± 4.4 | 20.96 ± 3.67 | -5.31 [-6.97, -3.66] | 17.74 ± 5.03 | 17.03 ± 4.21 | 0.71 [-0.34, 1.76] | 3.93 [1.15, 6.70] | 0.007 |
| Pinch grip strength, kg | ||||||||
| Right double | 3.7 ± 1.06 | 4.3 ± 0.92 | -0.6 [-1.14, -0.06] | 3.77 ± 0.99 | 3.7 ± 0.95 | 0.07 [-0.16, 0.29] | 0.59 [-0.06, 1.26] | 0.073 |
| Left double | 3.47 ± 0.98 | 3.69 ± 0.88 | -0.22 [-0.71, 0.27] | 3.49 ± 1 | 3.28 ± 1.01 | 0.2 [-0.1, 0,51] | 0.40 [-0.26, 1.07] | 0.228 |
| Right triple | 4.99 ± 1.62 | 6.02 ± 0.97 | -1.03 [-1.85, -0.22] | 5.08 ± 1.61 | 4.66 ± 1.28 | 0.42 [-0.01, 0.83] | 1.35 [0.55, 2.15] | 0.002 |
| Left triple | 4.77 ± 1.24 | 5.48 ± 0.92 | -0.71 [-1.36, -0.06] | 4.84 ± 1.4 | 4.46 ± 1.23 | 0.37 [-0.03, 0.77] | 1.08 [0.24, 1.77] | 0.011 |
| Right lateral | 6.24 ± 1.47 | 6.76 ± 1.44 | -0.52 [-1.31, 0.27] | 6.39 ± 1.61 | 5.47 ± 1.23 | 0.92 [0.28, 1.55] | 1.29 [0.36, 2.22] | 0.008 |
| Left lateral | 5.55 ± 1.21 | 6.27 ± 1.50 | -0.72 [-0.19, -0.09] | 5.78 ± 1.36 | 5.23 ± 1.05 | 0.56 [-0.19, 1.30] | 1.04 [0.14, 1.94] | 0.024 |
| Pain intensity | 2.31 ± 2.30 | 2.25 ± 3.02 | 0.06 [-1.63, 1.75] | 2.94 ± 2.99 | 3.39 ± 3.01 | -0.44 [-1.81, 0.92] | -1.14 [-3.25, 0.97] | 0.280 |
| Cochin Hand Function | 12.88 ± 15.62 | 7.81 ± 11.06 | 5.06 [-0.19, 10.32] | 10.78 ± 12.64 | 11.61 ± 14.83 | -0.83 [-4.33, 2.67] | -3.79 [-13.04, 5,44] | 0.408 |
| HAQ-DI | 0.66 ± 0.55 | 0.5 ± 0.53 | 0.16 [-0.01, 0.33] | 0.48 ± 0.44 | 0.48 ± 0.37 | 0.01 [-0.14, 0.14] | 0.02 [-0.29, 0.33] | 0.902 |
| SHAQ-Raynaud’s phenomenon | 1.03 ± 1.1 | 1.11 ± 1.17 | -0.08 [-0.86, 0.71] | 0.5 ± 0.73 | 0.34 ± 0.64 | 0.16 [-0.23, 0.55] | 0.77 [0.12, 1.42] | 0.022 |
| SHAQ-digital ulcer | 0.66 ± 0.9 | 0.41± 0.84 | 0.24 [-0.21, 0.7] | 0.22 ± 0.65 | 0.47 ± 0.87 | -0.25 [-0.78, 0.28] | -0.05 [-0.66, 0.55] | 0.855 |
| SHAQ-digestive | 0.73 ± 0.81 | 1.2 ± 1.14 | -0.47 [-1.01, 0.08] | 0.97 ± 1.19 | 0.9 ± 1.08 | 0.07 [-0.56, 0.7] | 0.30 [-0.48, 1.08] | 0.437 |
| SHAQ-pulmonary | 1.14 ± 0.9 | 0.66 ± 0.71 | 0.49 [0.07, 0.9] | 0.75 ± 0.9 | 1.13 ± 0.93 | -0.38 [-0.84, 0.08] | -0.48 [-1.06, 0.11] | 0.106 |
| SHAQ-overall disease severity | 1.22 ± 0.96 | 1.01 ± 0.94 | 0.21 [-0.34, 0.75] | 0.97 ± 0.86 | 0.83 ± 0.63 | 0.13 [-0.21, 0.47] | 0.18 [-0.37, 0.73] | 0.513 |
| SHAQ-global | 0.92 ± 0.7 | 0.81 ± 0.64 | 0.11 [-0.26, 0.49] | 0.64 ± 0.55 | 0.73 ± 0.67 | -0.09 [-0.43, 0.26] | 0.08 [-0.38, 0.54] | 0.722 |
| EQ-5D-3L | 0.75 ± 0.12 | 0.76 ± 0.11 | -0.02 [-0.09, 0.06] | 0.76 ± 0.11 | 0.85 ± 0.38 | -0.1 [-0.29, 0.1] | -0.09 [-0.29, 0.11] | 0.381 |
n: Number, CI: Confidence interval, SD: Standard deviation, mHAMIS: Modified Hand Mobility in Scleroderma Test, ΔFTP: Delta finger to palm distance, cm: Centimeter, kg: Kilogram, HAQ-DI: Health Assessment Questionnaire – Disability Index, SHAQ: Scleroderma Health Assessment Questionnaire, EQ-5D-3L: European Quality of Life 5 Dimensions 3 Level Version
Bold = p<0.05
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (