The effectiveness of home hand exercise programmes in rheumatoid arthritis: A systematic review

Abstract

Introduction Rheumatoid arthritis (RA) commonly reduces hand function. We systematically reviewed trials to investigate effects of home hand exercise programmes on hand symptoms and function in RA. Sources of Data We searched: Medline (1946-), AMED, CINAHL, Physiotherapy Evidence Database, OT Seeker, the Cochrane Library, ISI Web of Science from inception to January 2016. Areas of Agreement Nineteen trials were evaluated. Only three were randomized controlled trials with a low risk of bias (n = 665). Significant short-term improvements occurred in hand function, pain and grip strength, with long-term improvements in hand and upper limb function and pinch strength. Areas of Controversy Heterogeneity of outcome measures meant meta-analysis was not possible. Growing Points Evaluation of low and moderate risk of bias trials indicated high-intensity home hand exercise programmes led to better short-term outcomes than low-intensity programmes. Such programmes are cost-effective. Areas Timely for Developing Research Further research is required to evaluate methods of helping people with RA maintain long-term home hand exercise.