Telerehabilitation improves hand mobility in scleroderma women
Study found it more effective than self-managed exercises at home
Physiotherapist-guided telerehabilitation is more effective than self-managed at-home exercises in improving hand mobility and function in women with scleroderma, according to a study conducted in Turkey.
“Based on these findings, physiotherapist-guided telerehabilitation is a quality practice that has the potential to increase hand mobility and grip strength in patients with scleroderma,” researchers wrote.
The study, “Which physiotherapy method is more effective for hand rehabilitation in patients with scleroderma: Physiotherapist-guided telerehabilitation or independent home-based exercise program?” was published in the Journal of Hand Therapy.
Skin thickening, joint damage in hands common in scleroderma
Scleroderma is characterized by thick and hardened skin due to the excessive accumulation of scar tissue. The disease affects the connective tissue, which supports and holds organs together, and may also impact internal organs.
People with scleroderma commonly experience skin thickening and joint damage in their hands, which may cause deformities and limit hand mobility, contributing to a decrease in quality of life.
Hand rehabilitation is important for these patients to help them remain independent. However, many face limitations in adhering to hand rehabilitation treatment, in addition to challenges such as traveling long distances, transportation issues, or a lack of social support.
In this study, researchers compared the impact of physiotherapist-guided telerehabilitation and independent home-based exercise on hand function and mobility in 34 women with scleroderma.
Almost all participants had diffuse cutaneous scleroderma, a disease type characterized by extensive skin scarring. The telerehabilitation group included 16 women, with a mean age of 48.6 years and a disease duration of 8.1 years. They attended treatment sessions via Zoom meetings. Exercises were demonstrated on a screen, followed by instructions from a physiotherapist.
In the home-based exercise group, 18 participants with a mean age of 52.7 years and a disease duration of 7.9 years received a brochure with images of exercises and instructions on how to perform them. In both groups, participants underwent treatment sessions three times a week for eight weeks.
Telerehabilitation group experienced improvement in hand mobility
Results showed that the telerehabilitation group experienced an improvement in hand mobility after treatment, as evaluated by the physiotherapist using the Modified Hand Mobility in Scleroderma Test. These participants also experienced better thumb mobility, finger motion, and grip strength with treatment.
Improvements were also noted in a subscale of the Scleroderma Health Assessment Questionnaire (SHAQ) that assesses the severity of Raynaud’s phenomenon, which limits blood flow to the fingers and toes due to cold or stress, causing them to become numb or prickly.
No improvements were detected in the home-based exercise group. This indicated “that physiotherapist-guided telerehabilitation was superior to independent home-based exercise in improving hand mobility, thumb mobility, finger motion, [grip strength], and Raynaud’s phenomenon,” the researchers wrote.
They added that having a therapist explain how to perform the exercises in the telerehabilitation group “prevented patients from doing the exercises as they initially understood them,” and “may have caused patients in the telerehabilitation group to do the exercises more accurately.”
In both groups, no differences were found before and after treatment in the severity of hand pain or in general health status, as assessed with the SHAQ.
According to the researchers, this study demonstrated that “rehabilitation programs used in clinics can be applied via telerehabilitation to patients who have limited access to in-person treatment.”
Study limitations, they noted, include having a female-only group and being conducted at a single center, which may limit the applicability of the conclusions to the overall scleroderma population.
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