Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients\u2014one-year follow-up study

Michał Waszczykowski,Arleta Waszczykowska,Jarosław Fabiś,Bożena Dziankowska-Bartkowiak,Michał Podgórski

doi:10.1038/s41598-021-94549-y

Michał Waszczykowski, Arleta Waszczykowska + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-94549-y

Copy DOI

Abstract

The aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. 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 regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

Highlights

The aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients
Systemic sclerosis is divided into two basic categories based on the extent of pathological changes: limited cutaneous systemic sclerosis, in which the hardened skin lesions do not exceed 1/3 of the forearm length and can occur on the face, and diffuse cutaneous systemic sclerosis, which is characterized by generalized hardening that affects a large area of the skin
The thickening of the skin and subcutaneous tissue, fibrosis of the tendons and palmar aponeurosis result in contractures of the fingers, limiting flexion in the metacarpophalangeal joints (MCP) and extension in the proximal and distal interphalangeal joints (PIP, DIP). This leads to a clawtype deformity, with metacarpophalangeal joint (MCP) extension, proximal and distal interphalangeal joint (PIP, DIP) flexion and thumb adduction and limited wrist range of motion (ROM)[5,6,7,8,9,10,11,12]

Summary

Introduction

The aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. Systemic sclerosis (SSc, scleroderma) is a severe, chronic autoimmune connective tissue disease characterized by skin thickening, Raynaud’s phenomenon, visceral organ damage and musculoskeletal involvement[1]. Progressive pathological changes in the skin, internal organs and musculoskeletal system gradually cause dysfunction and affect quality of life[5,6]. Despite the knowledge of the significant impact of pathological changes in scleroderma on the function of the musculoskeletal system, the treatment of SSc focuses primarily on skin lesions and internal organ complications. Concurrent proper treatment of musculoskeletal system complications, especially those of the upper limbs, can lead to significant, global improvements in SSc treatment results and patient quality of life[15,16]

Objectives

Methods

Results

Discussion

Conclusion