OP0123-HPR INVESTIGATION OF THE EFFECTS OF UPPER EXTREMITY HOME EXERCISES ON GRIP STRENGTH, RANGE OF MOTION, ACTIVITY PERFORMANCE AND FUNCTIONALITY IN INDIVIDUALS WITH SCLERODERMA

Abstract

BackgroundScleroderma is an autoimmune disease that affects the skin and internal organs such as joints, muscles, and heart and lungs. Hand involvement in individuals with scleroderma leads to functional disability. Loss of grasping ability and impaired hand mobility may be one of the important factors affecting the daily living activities of patients with scleroderma. Although hand rehabilitation is not supported by strong levels of evidence, it has been the subject of studies, and a number of interventions have been described in patients with scleroderma, but no established guidelines for rehabilitation have been established. Passive and active stretching has been shown to help the patient maintain joint range of motion and lengthen tendons and muscles, especially when fibrotic retraction is present. Literature has been shown that self-administered home programs to be benefical. In addition, evidence-based rehabilitation interventions for the upper extremity in scleroderma are limited.ObjectivesThe aim of the study is to examine the effects of upper extremity exercises on joint range of motion, grip strength, activity performance and functionality in patients with scleroderma.Methods46 SSc patients (42 female, 4 male) with an average age of 55.52±11.54 were included in the study. Patients were randomized into intervention (group 1) and control (group 2) groups. Group 1 received upper extremity home exercise for 5 days a week for 8 weeks. Group 2 received principles of joint protection education program. Goniometric measurement was used to evaluate the upper extremity range of motion. Dinamometer and pinchmeter was used to evaluate the hand grip and pinch strength. Canadian Occupational Performance Measure (COPM) was used to evaluate the activity performance and satisfaction. Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Duruöz Hand Index (DHI), and Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SACRAH) was used to evaluate the upper extremity and hand functionality. All evaluations were performed at baseline and at the end of the 8th week.ResultsWhen the groups were compared before training, there was no significant difference (p> 0.05). In post-training comparisons, there was a significant difference in shoulder, elbow, forearm, wrist and fingers range of motion (p: 0.00-0.04); hand grip and pinch strength (p: 0.00-0.02); COPM performance-satisfaction (p: 0.00); SACRAH total and subparameters (p: 0.00), DASH and DHI (p: 0.00) in Group 1. There was a significant difference in shoulder, elbow and fingers range of motion (p: 0.00-0.04); pinch strength (p: 0.00); SACRAH total and subparameters (p: 0.00); DASH and DHI (p: 0.00) in Group 2. Comparing the groups for post-training, Group 1 was found to be superior in terms of shoulder flexion and rotations, elbow extention and deviations, fingers flexion, extention and abduction (p: 0.00-0.04); pinch strength (p: 0.00-0.04); SACRAH total and subparameters (p: 0.00-0.04).ConclusionAs a result of our study, upper extremity home exercise program has a positive effect on ROM, hand grip and pinch strength, activity performance and functionality. In rehabilitation programs, upper extremity exercises -not only hand exercises- may be effective to increase ROM, grip strength, activity performance and functionality.