Whirlpool Plus Exercise, Hand Massage Aids Function in SSc

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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NVC | Scleroderma News | illustration of person's hands

Supervised rehabilitation combining a whirlpool bath with active exercises and hand and elbow massages may improve hand and overall function in people with scleroderma, a study from Poland reported.

Its findings suggest that a four-week rehabilitation program may be enough for these benefits to last up to six months — but not much beyond then. Patients also reported diminished pain for a shorter number of months.

As such, “the regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function,” the scientists wrote.

The study, “Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients—one-year follow-up study,” was published in the journal Scientific Reports.

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As a disorder of the connective tissue supporting and binding the body’s tissues and organs, scleroderma (or systemic sclerosis, SSc) is marked by hardened and thickened skin. The disease can affect many parts, including the hands, limiting a patient’s ability to perform daily tasks.

Current treatment focuses on skin lesions and internal organ complications, rather than issues affecting the musculoskeletal system — comprising bones, muscles, tendons, ligaments, and soft tissues.

“Proper, well-organized rehabilitation of hand function combined with other therapies may play an important role in treating the musculoskeletal complications of scleroderma,” the researchers wrote.

The team focused on a specific protocol in which a whirlpool bath is combined with active exercising of the hand and elbow joints, manual massage of the soft tissues of the hand and forearm, and passive manipulation of the hand joints and wrists.

To understand its long-term outcomes, the scientists provided four weeks of supervised rehabilitation to 27 patients (25 women) with a mean age of 54.5. The program consisted of three sessions per week, with each session lasting 1.5 hours.

After completing the program, these patients were prescribed a daily, 30-minute home exercise program for the fingers, wrists, and forearms.

Instructions for a similar at-home program were given to 24 other patients (22 women) with a mean age of 55.2, serving as a non-supervised control group.

The two groups were evaluated at the study’s beginning and at again one, three, six, and 12 months later. The primary outcome measure was the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, which assesses disability affecting the upper limb.

Other tools included a visual analog scale to assess pain, the Cochin Hand Function Scale, the Scleroderma Health Assessment Questionnaire (SHAQ)  to measure overall disease status, and the Health Assessment Questionnaire Disability Index, capturing degree of global disability.

Results showed that people in the supervised rehabilitation group, but not those in the control group, experienced significant improvements in all these measures at the end of the rehabilitation program (one-month follow-up). Benefits in DASH continued for up to six months, while improvements in pain, hand function, and overall disease status, as seen in SHAQ responses, lasted for up to three months.

Global disability, as measured through the disability index questionnaire, did not improve significantly past the one-month point.

No significant gains were seen in the control patient group.

Patient responses to supervised rehabilitation also showed a correlation between pain and hand disability measures, and between pain and global disability, and hand function and global disability.

No complications or adverse events were associated with this rehabilitation program.

“Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term,” the researchers concluded.

Among the study’s limitations, they mentioned its relatively small size and not having randomly assigned the participants to either group.