Tests with Hand Function Tasks Better for Assessing Scleroderma Progression, Treatment Response, Study Finds

Women with scleroderma take longer to perform daily living tasks, especially those that require hand strength and gripping objects, such as moving things between shelves, a new study found.

These findings suggest that incorporating the Glittre Activities of Daily Living test (GA-T) in clinical evaluations may help better assess treatment responses and disease progression, the researchers said.

The study, “The Glittre Activities of Daily Living Test in women with scleroderma and its relation to hand function and physical capacity,” was published in the journal Clinical Biomechanics.

Symptoms resulting from joint damage are often observed in people with scleroderma, and may lead to loss of motor function. Hand function impairment is seen in 90% of the cases and is the top reason for a patient’s poor performance in daily activities.

Yet, hand function has been poorly evaluated in the clinic. Current assessment tools include the Cochin Hand Function Scale (CHFS) of functional disability, as well as performance tests like the pinch grip and grip strength tests. However, these have been recognized as insufficient for making a good evaluation of overall motor performance.

Another common assessment, the 6 Minute Walk Test of exercise capacity, has been questioned in its usefulness for scleroderma evaluations because of poor correlations between distance walked, clinical measures, lung function parameters, and disease extent.

The GA-T evaluates multiple parameters that require the use of upper and lower limb muscles, including walking, sitting down, standing up, walking up and down stairs — and, notably, reaching objects, hand gripping, and weight shifting.

Patients are asked to go through a sequence of tasks on a 10-meter circuit and their timing is recorded. The test has been used with success to assess functional status in several conditions, including chronic obstructive pulmonary disease and cystic fibrosis.

Now, a team from Brazil investigated whether the results of the GA-T test better correlate with physical capacity and hand function in 33 women with scleroderma. The researchers also included 30 healthy women as controls.

Among the patients (median age 48 years), 25 had diffuse scleroderma — with extensive skin fibrosis on the arms, legs, and trunk — and eight had limited scleroderma, which is milder and more common.

The results showed that women with scleroderma had significantly higher scores, meaning poorer physical capacity, on the Scleroderma Health Assessment Questionnaire-Disability Index (1.38 vs. 0) and the CHFS of hand function (13 vs. 0), compared with controls.

Their scores in the isometric handgrip strength test were significantly lower — and therefore, worse — than those of the healthy controls (18 vs 29.5). In this test, the participants sit comfortably on a chair with no armrests, and the elbow flexed at 90°. They are then instructed to perform three maximum contractions separated by a 1-minute interval. The  score is the highest of the three assessments.

Women with scleroderma took significantly longer to perform the tasks in the GA-T test compared with the controls (253 vs. 181 seconds). Manual activities also took significantly longer in those with scleroderma than in the control group (143 vs. 88 seconds).

According to the predicted times of the GA-T for healthy women with the same weight and height as those with scleroderma, the women with the disease took about 44% longer time to finish the test.

“We observed that women with scleroderma had greater difficulty completing the GA-T, requiring more time to perform the tasks than the controls,” the researchers said.

The GA-T manual time results were associated with hand function. In particular, the researchers observed that taking longer to move objects between shelves correlated with higher CHFS scores. Most women with scleroderma (84.8%) reported that the shelf task was the most difficult of the assessment tasks.

Although GA-T outcomes were not significantly associated to pulmonary function parameters, the investigators observed a 4% drop of oxygen saturation in the blood during the test. That correlated with forced vital capacity and diffusing capacity for carbon monoxide, two measures of respiratory function.

Disease duration did not seem to affect the results in the GA-T, but higher total time and manual time were associated with older age.

“Our results indicate that patients with scleroderma need more time to perform the GA-T tasks, largely due to greater difficulty performing the shelves manual task,” the scientists said, noting the women had difficulty with “hand function, grip strength, and physical capacity.”

“Because hand disability markedly contributes to overall disability in scleroderma, incorporating the GA-T into the clinical evaluation of scleroderma patients may be important for assessing treatment responses and disease progression” the researchers concluded.