Cochin Hand Function Scale Research Articles

Long-term follow-up after autologous adipose-derived stromal vascular fraction injection into fingers in systemic sclerosis patients

IntroductionHand involvement confers a substantial handicap in work and daily activities in patients with Systemic sclerosis (SSc). Autologous adipose-derived stromal vascular fraction is as an easily accessible source of cells with regenerative effects. We previously performed a phase I open-label clinical trial (NTC01813279) assessing the safety of subcutaneous injection of autologous adipose-derived stromal vascular fraction. Six and 12-month data have been reported. As patients were followed in our medical centre, we report their longer-term outcome beyond the end of the trial. Patients and methodTwelve females, mean age 54.5±10.3 years, initially enrolled in the clinical trial were assessed during a scheduled medical care, which took place between 22 and 30months after treatment. ResultsMultiple patient-reported outcomes showed sustained improvement, in comparison with the assessment performed just before surgery: 62.5% in the Cochin Hand Function Scale, 51.1% in the Scleroderma Health Assessment Questionnaire, 33.1% in hand pain, and 88.3% in the Raynaud Condition Score. A decrease in the number of digital ulcers number was noted. Mobility, strength and fibrosis of the hand also showed improvement. None of the 8 patients who had previously received iloprost infusion required new infusion. ConclusionDespite the limits of an open label study, the data are in favour of the long-term safety of the adipose-derived stromal vascular fraction injection. Two randomized double blind, placebo-controlled trials of this therapeutic agent are ongoing in the USA (NCT02396238) and in France (NCT02558543) and will help determine the place of this innovative therapy for SSc patients.

Using Optimal Test Assembly Methods for Shortening Patient-Reported Outcome Measures: Development and Validation of the Cochin Hand Function Scale-6: A Scleroderma Patient-Centered Intervention Network Cohort Study.

To develop and validate a short form of the Cochin Hand Function Scale (CHFS), which measures hand disability, for use in systemic sclerosis, using objective criteria and reproducible techniques. Responses on the 18-item CHFS were obtained from English-speaking patients enrolled in the Scleroderma Patient-Centered Intervention Network Cohort. CHFS unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit to CHFS items. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible form length between 1 and 17 items. The final short form selected was the form with the least number of items that maintained statistically equivalent convergent validity, compared to the full-length CHFS, with the Health Assessment Questionnaire (HAQ) disability index (DI) and the physical function domain of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29). There were 601 patients included. A 6-item short form of the CHFS (CHFS-6) was selected. The CHFS-6 had a Cronbach's alpha of 0.93. Correlations of the CHFS-6 summed score with HAQ DI (r = 0.79) and PROMIS-29 physical function (r = -0.54) were statistically equivalent to the CHFS (r = 0.81 and r = -0.56). The correlation with the full CHFS was high (r = 0.98). The OTA procedure generated a valid short form of the CHFS with minimal loss of information compared to the full-length form. The OTA method used was based on objective, prespecified criteria, but should be further studied for viability as a general procedure for shortening patient-reported outcome measures in health research.

Validation of disease activity indices using the 28 joint counts in systemic sclerosis.

To validate the Disease Activity Score 28 using ESR (DAS28-ESR) and CRP (DAS28-CRP), the Simplified Disease Activity Index and the Clinical Disease Activity Index used in RA for SSc patients. Seventy-seven SSc patients, 40 RA patients, 20 patients with primary RP (PRP) and 28 healthy volunteers were assessed. Besides the disease activity composite indices, the European Scleroderma Study Group Activity Index (EScSG-AI), the HAQ-DI, the Cochin Hand Function Scale and the Short Form Health Survey (SF36) were evaluated. The validation procedure included the assessment for truth, discrimination and feasibility. DAS28-ESR, DAS28-CRP, Simplified Disease Activity Index and Clinical Disease Activity Index showed significant correlation with EScSG-AI, HAQ-DI, Cochin Hand Function Scale and the physical component of SF36 (P < 0.001). All four indices discriminated patients with SSc from RA, PRS and healthy controls, respectively (P < 0.01). With the exception of DAS28-CRP, the other three indices also discriminated between subgroups of SSc based on value of EScSG-AI (⩽3 and >3) (P < 0.05). All four disease activity composite indices showed a good inter- and intraobserver reliability based on repeated measures of two independent investigators (P < 0.001). All four disease activity composite indices were found to be valid measures for assessing arthritis in SSc. DAS28-ESR showed the best performance regarding reliability and construct validity.

Safety, tolerability and potential efficacy of injection of autologous adipose-derived stromal vascular fraction in the fingers of patients with systemic sclerosis: an open-label phase I trial

BackgroundIn patients with systemic sclerosis (scleroderma, SSc), impaired hand function greatly contributes to disability and reduced quality of life, and is insufficiently relieved by currently available therapies. Adipose tissue-derived stromal...

Autologous adipose-derived stromal vascular fraction in patients with systemic sclerosis: 12-month follow-up.

Impaired hand function greatly contributes to disability and reduced quality of life in SSc patients. Autologous adipose-derived stromal vascular fraction (ADSVF) is recognized as an easily accessible source of regenerative cells. We reported positive 6-month safety and efficacy results from an open-label clinical trial assessing s.c. injection of autologous ADSVF into the fingers in SSc patients. The objective of this report is to describe the effects at 12 months. Twelve females, mean age 54.5 years (s.d. 10.3), were assessed 1 year after ADSVF injection. Patients were eligible if they had a Cochin Hand Function Scale score >20/90. ADSVF was obtained from lipoaspirate using an automated processing system and subsequently injected into the s.c. tissue of each finger in contact with neurovascular pedicles in a one-time procedure. Endpoints were changes in hand disability and skin fibrosis, vascular manifestations, pain and quality of life at the 12 month follow-up. During the visit, patients estimated the benefit of the procedure with a specific self-completed questionnaire. A significant decrease from baseline of 51.3% (P < 0.001) for Cochin Hand Function Scale score, 63.2% (P < 0.001) for RP severity and 46.8% (P = 0.001) for quality of life (Scleroderma Health Assessment Questionnaire) was observed. A significant improvement of finger oedema, skin sclerosis, motion and strength of the hands and of the vascular suppression score was also noted. The reduction in hand pain approached statistical significance (P = 0.052). The questionnaire revealed a benefit in daily activities, housework and social activities. ADSVF injection is a promising therapy and appears to have benefits that extend for at least 1 year.

Improvement in quality of life after surgery for glomus tumors of the fingers

Glomus tumors are benign and rare tumors that develop through a neuro-myo-arterial glomus. Complete surgical excision of the tumor remains the standard intervention. Due to the difficulty of diagnosis, management is often late, resulting in poor quality of life. This study aimed to assess improvement in quality of life after surgery in patients with glomus tumors. We performed a retrospective study from 1992 to 2011 to analyze 23 glomus tumors of the upper limbs in 22 patients. Pain was systematically the predominant symptom. Quality of life and disability were assessed preoperatively and postoperatively using two questionnaires in 11 patients: the Medical Outcome Study Short Form (SF-36 French version) and the Cochin Hand Functional Disability Scale. An evaluation of the visual analog scale (VAS) completed the study. The average age of patients was 48years with a sex ratio of 0.28. The location of the tumor was in the fingers in 20 (87%) cases. The average delay between onset of symptoms and surgery was 8.5years. Patients consulted an average of 2.8 practitioners. The average preoperative VAS was 8.7, whereas it was 0.8 postoperatively. Eleven patients were evaluated using the assessment scales, a mean of 11 years after surgery. Pain disappeared in 10 patients (91% of cases). A limitation of physical effort before surgery was found in five (45%) patients, while one patient (9%) had such limitation for a long period after surgery (P=0.006). The improvement in fine motion was also significant (P=0.03). Surgery had a positive impact on the emotional life of three patients (27%). Discomfort arose in the social life of four (36%) patients before surgery vs. one (9%) after surgery. Glomus tumors are rarely diagnosed during the first visit, leading to misdiagnosis and deterioration in quality of life, a cause of chronic pain, and limitations in activity. The significant improvement in quality of life provided by surgery necessitates earlier diagnosis of this tumor.

Ischemic digital ulcers affect hand disability and pain in systemic sclerosis.

Ischemic digital ulcers (DU) are frequent and severe complications of systemic sclerosis (SSc). The purpose of our study was to assess the effect of DU on hand disability and pain in patients with SSc. The Evaluation of the Impact of Recurrent Ischemic DU on Hand Disability in Patients with SSc (ECLIPSE) is a prospective, multicenter, noninterventional study with a 2-year followup. Patients with SSc who experienced at least 1 DU in the previous year and received bosentan therapy were included between October 2009 and March 2011. This cohort is described at the time of inclusion. There were 190 patients (132 females) from 53 centers. Mean age ± SD was 43 ± 15 years at SSc diagnosis and 53 ± 15 years at inclusion. In 105 patients (56.2%), DU were the first non-Raynaud symptoms of SSc. The mean time interval between the occurrence of Raynaud phenomenon and the first DU episode was 6.6 ± 9.1 years. The mean numbers of active DU and fingers affected per patient for both hands were 2.3 ± 1.8 and 2.2 ± 1.6, respectively. Presence of active DU at inclusion was significantly associated with pain and impaired hand function: Visual Analog Scale for pain (0 to 10) was 6.2 ± 2.6 versus 2.5 ± 2.4 (p < 0.0001) and Cochin Hand Function Scale for hand disability (0 to 90) was 38 ± 20 versus 25 ± 19 (p < 0.0001), respectively. DU represent a major sign of SSc, often affecting multiple fingers and both hands. They are significantly associated with pain and hand disability.

SAT0323 Improvement of Digital Ulcerative Disease in Patients with Systemic Sclerosis is Associated with Better Functional Prognosis

BackgroundIschemic digital ulcers (DU) represent a major complication of systemic sclerosis (SSc) leading to hand disability.ObjectivesWe investigated the impact of controlling the ulcerative disease on hand disability and quality of...

URAM scale for functional assessment in Dupuytren's disease: A comparative study of its properties

ObjectiveTo test the convergent validity and ease of use of the Unité Rhumatologique des Affections de la Main (URAM) scale for patients with Dupuytren's disease. MethodsPatients were prospectively included. We compared the convergent validity of the URAM scale, the Cochin Hand Function Scale (CHFS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, in terms of their correlation with the Tubiana score and self-assessed disability on a visual analog scale (VAS). Pearson's correlation was used for the convergent validity study. The response time for questionnaire completion was the outcome for ease of implementation. ResultsWe included 53 patients with Dupuytren's disease in the convergent validity study and 30 other patients with the disease in the time-response assessment. The URAM scale showed strong convergence with the Tubiana scale (r=0.64) and self-assessed disability on a VAS (r=0.69). Convergence with the Tubiana and self-assessed disability was higher for the URAM scale than the CHFS or DASH questionnaire. The mean [SD] response time was shorter for the URAM scale than the CHFS or DASH questionnaire (42 [20] vs 71 [35] and 103 [59] s, respectively, P<0.0001). ConclusionsThe results reinforce the psychometric merits of the URAM scale. Furthermore, the response time for assessing disability was shorter with the URAM scale than the CHFS or DASH questionnaire. This evidence supports the high recommendation for the use of the URAM scale in clinical practice and clinical studies to assess disability in Dupuytren's disease.

Sexual Function in Italian Women with Systemic Sclerosis Is Affected by Disease-related and Psychological Concerns

In patients with systemic sclerosis (SSc), sexual function is somewhat impaired. Our aim was to evaluate sexual function in women with SSc in comparison to controls, and to investigate the association with sociodemographic and disease characteristics, and physical and psychological variables. Forty-six women with SSc and 46 healthy women were assessed for sociodemographic characteristics and gynecological development and administered the Female Sexual Function Index (FSFI), Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale, Coping Orientation to Problems Experienced-New Italian Version, and Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were also assessed for disease duration and subset, Female Sexual Function in SSc, Hand Mobility in Scleroderma test (HAMIS), Cochin Hand Functional Disability Scale, Mouth Handicap in Systemic Sclerosis Scale (MHISS), Disability Sexual and Body Esteem Scale (PDSBE); and fist closure, hand opening, and mouth opening. In patients with SSc, only FSFI desire subscale score was significantly lower (p = 0.035) versus controls. Total FSFI score, similar to controls, was related with Medical Outcomes Study Short Form-36 mental component, HAQ (p = 0.022), MHISS (p = 0.038), and HAMIS (p = 0.037). In SSc, the main factors independently associated with sexual functioning were vaginal dryness [regression coefficient (B) = -0.72; p < 0.001], PDSBE (B = 0.42; p = 0.001), and HADS depression scale (B = -0.23; p = 0.035). Together, these variables explained 70% of the variance in the FSFI total score. In SSc, sexual function, although not different from controls, is influenced by specific disease-related and psychological concerns. Thus it should be included in patient evaluations and assessed in daily clinical practice.

A prospective study of systemic sclerosis-related digital ulcers: prevalence, location, and functional impact

Objectives: Although digital ulcers (DUs) are common in patients with systemic sclerosis (SSc), prevalence estimates vary, and functional impact and pathophysiology have been relatively little studied. We investigated the point prevalence of all DUs (both digital-tip and extensor) in a cohort of patients with SSc, testing the hypothesis that both digital-tip and extensor ulcers are associated with functional impairment.Method: Over a 12-month period, patients attending an SSc clinic for annual review were assessed by specialist nurses: active DUs were documented and the Hand Mobility in Scleroderma (HAMIS) test performed. Patients also completed the Scleroderma Health Assessment Questionnaire (SHAQ), the Scleroderma Functional Index (SFI), and the Cochin Hand Function Scale (CHFS).Results: A total of 25 active DUs (nine digital-tip and 16 extensor surface) were found in 15 of the 148 patients recruited, giving a prevalence for each ulcer type of 6% and an overall point prevalence of 10%. HAMIS scores were higher (indicating greater impairment) in those with active DUs than in those without: left hand difference 8.8 points [95% confidence interval (CI) 3.2–14.5], p = 0.002; difference significant for extensor as well as digital-tip ulcers. Active DUs were associated with higher visual analogue scale (VAS) scores for pain (p = 0.04), DUs (p < 0.001), and ‘overall’ assessment (p = 0.03).Conclusions: Extensor surface ulcers have the same prevalence as digital-tip ulcers in patients with SSc, and are equally disabling. Clinical trials should therefore include both categories of DUs.

AB0786 Hand function and disability in patients with systemic sclerosis and digital ulcers

BackgroundDigital ulcers (DU) affect hand function in patients with systemic sclerosis (SSc) causing pain and transient or permanent disability. In clinical practice, it is not clear which are the best...

THU0237 Impact of recurrent ischemic digital ulcers on hand disability in systemic sclerosis –

BackgroundIschemic digital ulcers (DU) are a common complication of systemic sclerosis (SSc).ObjectivesTo evaluate the impact of recurrent DU on hand disability in a prospective, longitudinal, observational study of 24 months.MethodsPatients...

Psychometric properties of the Swedish version of the Scleroderma Health Assessment Questionnaire and the Cochin Hand Function Scale in patients with systemic sclerosis

Objectives: To translate the visual analogue scales (VAS) in the Scleroderma Health Assessment Questionnaire (SSc HAQ) and the Cochin Hand Function Scale (CHFS) and to examine the reliability and validity of the Swedish versions of the instruments.Method: The reproducibility, internal consistency, acceptability, and validity of the instruments were evaluated. Eighty-three consecutive patients participated in the evaluation of the SSc HAQ and 56 in the CHFS. Sixty-six per cent fulfilled the criteria for limited systemic sclerosis (lcSSc) and 29% for diffuse systemic sclerosis (dcSSc). The patients were assessed regarding disease parameters, hand involvement, and quality of life, the latter using the 36-item short form health survey (SF-36).Results: The reproducibility in the HAQ Disability Index (HAQ-DI), the VAS of pulmonary, digital ulcer, and overall disease severity, and in the CHFS was good (intra-class correlation coefficients, ICCs ≥ 0.75). The internal consistency was high in the HAQ-DI and the CHFS but lower in the VAS. The HAQ-DI showed higher correlations coefficients with physical-related scores in the SF-36 (rs = –0.600) than with mental-related dimensions (rs = –0.235). All VAS showed significant correlation with the item for general health (p < 0.05). The CHFS showed high correlation to hand-related items in the HAQ (rs = 0.858) and moderate correlation to the physical summary score in SF-36 (rs = –0.521). The instruments could not discriminate between lcSSc and dcSSc, although significant correlations between the CHFS and hand involvement (p < 0.05) indicate the ability of the CHFS to discriminate between mild and severe hand involvement.Conclusions: The Swedish version of the SSc HAQ and the CHFS meet the requirements of reproducibility and concurrent validity. More studies are needed to examine the capacity of these instruments to discriminate between disease severities.

Impact of systemic sclerosis on occupational and professional activity with attention to patients with digital ulcers

To evaluate the impact of systemic sclerosis (SSc; scleroderma) and digital ulcers (DUs) on daily living and professional activities. We prospectively evaluated 189 SSc patients for employment status and disability during meetings of the French SSc patient association (n=86, 45.5%) or during hospitalization (n=103, 54.5%). Seventy-eight (41.2%) patients had diffuse SSc. The mean±SD age was 54±13 years, and the mean±SD disease duration was 9.3±8.4 years at the time of evaluation. Sixty (31.7%) patients had at least one DU. Assessed using the Health Assessment Questionnaire (mean±SD 1.12±0.79 versus 1.39±0.84; P=0.001), the Cochin Hand Function Scale (mean±SD 20.2±18.3 versus 27.8±19.1; P<0.0001), and the Hospital Anxiety Scale (mean±SD 9.9±5 versus 8.5±4.2; P=0.04), global disability, hand disability, and anxiety, respectively, were significantly higher in patients with DUs than in others. Most patients reported a limitation in daily activities related to SSc, as assessed by a daily activity limitation scale (mean±SD 4.4±2.9) and an increased need for help in the home. Patients reported needing mean±SD 4±13.5 hours per month of paid household help related to SSc and mean±SD 1.5±10 hours per month related to DUs, with significant differences between patients with or without DUs (P=0.004). Among the 113 patients in the workforce, 67 (59.3%) were employed, 42 (37.2%) were employed full time, 36 (31.8%) received full disability pension, and 27 (23.9%) were on sick leave, with no difference between patients with or without DUs. SSc has a significant impact on activities of daily living and work disability. The need for external home help and disability are increased for those patients with DUs.

Translation, cultural adaptation and reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil

OBJECTIVE:To translate, to perform a cultural adaptation of and to test the reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil.METHODS:First, the Cochin Hand Functional Scale questionnaire was translated into Portuguese and was then back-translated into French. These translations were reviewed by a committee to establish a Brazilian version of the questionnaire to be tested. The validity and reproducibility of the Cochin Hand Functional Scale questionnaire was evaluated. Patients of both sexes, who were aged 18 to 60 years and presented with rheumatoid arthritis affecting their hands, were interviewed. The patients were initially interviewed by two observers and were later interviewed by a single rater. First, the Visual Analogue Scale for hand pain, the Arm, Shoulder and Hand Disability questionnaire and the Health Assessment Questionnaire were administered. The third administration of the Cochin Hand Functional Scale was performed fifteen days after the first administration. Ninety patients were assessed in the present study.RESULTS:Two questions were modified as a result of the assessment of cultural equivalence. The Cronbach's alpha value for this assessment was 0.93. The intraclass intraobserver and interobserver correlation coefficients were 0.76 and 0.96, respectively. The Spearman's coefficient indicated that there was a low level of correlation between the Cochin Hand Functional Scale and the Visual Analogue Scale for pain (0.46) and that there was a moderate level of correlation of the Cochin Scale with the Health Assessment Questionnaire (0.66) and with the Disability of the Arm, Shoulder and Hand questionnaire (0.63). The average administration time for the Cochin Scale was three minutes.CONCLUSION:The Brazilian version of the Cochin Hand Functional Scale was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

Methodological issues arising from a pilot RCT investigating the effectiveness of joint protection

Aims: This article describes the difficulties encountered when attempting to evaluate the addition of joint protection education to an exercise programme in the treatment of patients with osteoarthritis (OA) of the hand. This involved a pilot study for a randomized controlled trial, which was carried out in order to inform the design of future studies. Methods: Subjects were recruited from rheumatology and orthopaedic out-patient clinics in a district general hospital for a 6 month period in 2006. They were assessed at baseline and 12 weeks after intervention. There were 2 intervention groups: one receiving exercise therapy and formal joint protection education from an occupational therapist over 2 sessions, supplemented with a joint protection information booklet, and the control group which received exercise therapy and informal joint protection advice. The primary outcome measures were pain and hand function measured using the hand pain visual analogue scale and the Cochin Hand Functional Disability Scale. Six patients were recruited with OA of the hand (mean age 59.2 years and mean disease duration 8.9 years) with three randomized to the intervention group, and three to the control group. Findings: There were methodological issues arising from the study, including sample recruitment issues, time scale, limited participant numbers and ethical constraints. No statistically valid data was gained to ascertain whether exercise therapy was more effective when given in conjunction with joint protection advice than without. Conclusions: Although some results were achieved that suggested there were improvements in the measures of perceived hand pain, health status, grip strength and pinch grip, these were not statistically meaningful. The improvements were greater in the control group, which received exercise therapy without joint protection advice. Hand function was reduced in both intervention groups. The reasons for this could not be answered in this study. A larger study would need to be undertaken in order to gain statistically valid data to evaluate the effectiveness of joint protection advice for people with OA hand.

Differences in patients with systemic sclerosis recruited from associations and tertiary care settings

ObjectiveTo compare patients with systemic sclerosis (SSc) recruited from a patient association or a tertiary care setting. MethodsWe evaluated 248 SSc patients attending 4 annual meetings of a patient association between 2004 and 2007 (177) or during hospitalization (71). health-related quality of life (HRQoL) was assessed by the SF-36, global disability by the health assessment questionnaire (HAQ), hand disability by the Cochin Hand Function Scale (CHFS), mouth disability by the Mouth Handicap in Systemic Sclerosis (MHISS) scale, global hand and wrist mobility by the Kapandji index. ResultsAs compared with hospitalized patients, those from the patient association were significantly older (mean age 58.73±12.04 vs 53.818±13.1; p=0.001) and had a longer disease duration (10.98±8.7 vs 7.13±6.723 p=0.0001). Association patients had significantly increased disability of the hand (CHFS 21.8±19.8 vs 9.8±14.1; p=0.0001) and mouth (MHISS 20.65±10.8 vs 13.25±9.3; p=0.0001) and impaired hand and wrist mobility (Kapandji score 38.05±10.26 vs 43.90±8.26, p=0.001). The 2 groups did not differ in global disability or physical and mental scores of the SF36. ConclusionPatients recruited from a patient association have more severe SSc than do hospitalized patients. This finding must be taken into account in the design of surveys and clinical trials.

Employment status and socio-economic burden in systemic sclerosis: a cross-sectional survey

To assess employment status and socio-economic burden in SSc patients. Eighty-seven SSc patients (72 females), fulfilling the ACR or the Leroy and Medsger criteria, or both, were evaluated for employment status, socio-economic burden and handicap. Statistical analysis involved Mann-Whitney U-test and Fisher's exact test and backward stepwise regression analysis. In total, 60.9% of the SSc patients were on full-time sick leave and 35.6% were receiving a disability pension. On univariate analysis, myalgia was the only clinical manifestation more frequently encountered in sick-leave patients than others (73.6 vs 47.1%; P = 0.012). Karnofsky performance status (KPS) was lower in SSc patients who were on sick leave or were receiving a disability pension than others [78.5 (10.6) vs 85.8 (9.0); P = 0.004 and 78.1 (8.7) vs 83.1 (11.2); P = 0.016, respectively]. In addition, greater global, hand and mouth handicaps and depression were observed in patients on sick leave [HAQ 0.9 (0.7) vs 0.6 (0.5); P = 0.021; Cochin Hand Function Scale 21.7 (18.9) vs 10.7 (12.1); P = 0.003; mouth handicap scale 20.2 (10.8) vs 14.6 (10.0); P = 0.014; and depression dimension of the hospital anxiety and depression scale 7.1 (3.9) vs 4.8 (3.4); P = 0.003]. On multivariate analysis, factors associated with sick leave were KPS [odds ratio (OR) 0.92; 95%CI 0.88, 0.98] and myalgias (OR 3.19; 95% CI 1.19, 8.58), and the factor associated with receiving a disability pension was decreased income (OR 8.19; 95% CI 2.67, 25.12). SSc patients commonly have to take full-time sick leave from work. Despite such patients receiving disability pensions, the socio-economic burden is considerable.

Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis

Rehabilitation may contribute to the management of systemic sclerosis (SSc) dealing with disabilities due to hand involvement. The aim of this study is to evaluate the efficacy of a rehabilitation programme based on the combination of connective tissue massage and Mc Mennell joint manipulation specifically conceived for SSc patients' hands. Forty SSc patients were enrolled: 20 (interventional group) were treated for a 9-week period (twice a week, 1 h per session) with a combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme, and 20 (control group) were assigned only to home exercise programme. Patients of both groups were assessed at baseline (T0), after 9 week (T1) and at a 9 weeks follow-up (T2). They were evaluated for quality of life by SF-36 and Health Assessment Questionnaire (HAQ), hands involvement by Hand Mobility in Scleroderma (HAMIS) test, Cochin hand functional disability scale and the measurements of ROM. In the interventional group, fist closure, HAMIS test and Cochin hand functional disability scale improved at the end of the treatment (p < 0.0001) as well as HAQ, Physical Synthetic Index (PSI) and Mental Synthetic Index (MSI) of SF-36 scores (HAQ and PSI, p < 0.0001; MSI, p < 0.001). In the control group, the programme of home daily exercises improved only fist closure at the end of the treatment (p < 0.0001). The combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme is effective in the rehabilitative treatment of SSc hands. This combined treatment may lead to an improvement of hand function and quality of life.