Hand Exercise Research Articles

Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials

Objectives. Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies.Methods. A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term.Results. Mean costs (QALYs) were £58.46 (s.d. 0.662) for leaflet and advice, £92.12 (s.d. 0.659) for joint protection, £64.51 (s.d. 0.681) for hand exercises and £112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of £318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches.Conclusion. This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option.

Towards evidence-based hand exercises in rheumatoid arthritis

Disease-modifying biological agents and other drug regimens have substantially improved control of disease activity and joint damage in people with rheumatoid arthritis of the hand. However, commensurate changes in function and quality of life are not always noted. Tailored hand exercises might provide additional improvements, but evidence is lacking. We estimated the eff ectiveness and cost-eff ectiveness of tailored hand exercises in addition to usual care during 12 months.

Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial

Disease-modifying biological agents and other drug regimens have substantially improved control of disease activity and joint damage in people with rheumatoid arthritis of the hand. However, commensurate changes in function and quality of life are not always noted. Tailored hand exercises might provide additional improvements, but evidence is lacking. We estimated the effectiveness and cost-effectiveness of tailored hand exercises in addition to usual care during 12 months. In this pragmatic, multicentre, parallel-group trial, at 17 National Health Service sites across the UK we randomly assigned 490 adults with rheumatoid arthritis who had pain and dysfunction of the hands and had been on a stable drug regimen for at least 3 months, to either usual care or usual care plus a tailored strengthening and stretching hand exercise programme. Participants were randomly assigned with stratification by centre. Allocation was computer generated and unmasked to participants and therapists delivering treatment after randomisation. Outcome assessors and all investigators were masked to allocation. Physiotherapists or occupational therapists gave the treatments. The primary outcome was the Michigan Hand Outcomes Questionnaire overall hand function score at 12 months. The analysis was by intention to treat. We calculated cost per quality-adjusted life-year. This trial is registered as ISRCTN 89936343. Between Oct 5, 2009, and May 10, 2011, we screened 1606 people, of whom 490 were randomly assigned to usual care (n=244) or tailored exercises (n=246). 438 of 490 participants (89%) provided 12 month follow-up data. Improvements in overall hand function were 3·6 points (95% CI 1·5-5·7) in the usual care group and 7·9 points (6·0-9·9) in the exercise group (mean difference between groups 4·3, 95% CI 1·5-7·1; p=0·0028). Pain, drug regimens, and health-care resource use were stable for 12 months, with no difference between the groups. No serious adverse events associated with the treatment were recorded. The cost of tailored hand exercise was £156 per person; cost per quality-adjusted life-year was £9549 with the EQ-5D (£17,941 with imputation for missing data). We have shown that a tailored hand exercise programme is a worthwhile, low-cost intervention to provide as an adjunct to various drug regimens. Maximisation of the benefits of biological and DMARD regimens in terms of function, disability, and health-related quality of life should be an important treatment aim. UK National Institute of Health Research Health Technology Assessment Programme (NIHR HTA), project number 07/32/05.

Lag–lead based assessment and adaptation of exercise speed for stroke survivors

The SCRIPT project aims at delivering machine-mediated hand and wrist exercises to people with stroke in their homes. In this context, adapting the exercise to the individual needs potentially enhances recovery.We designed a system composed of a passive-actuated wearable device, a personal computer and an arm support. The system enables users to exercise their hand and wrist movements by playing interactive games which were developed as part of the project. Movements and their required speed are tailored on the individual’s capabilities. During the exercise the system assesses whether the subject is in advance (leading) or in delay (lagging) with respect to a reference trajectory. This information provides input to an adaptive mechanism which changes the required movement speed in order to make the exercise neither too easy nor too challenging.In this paper, we show results of the adaptation process in a study involving seven persons with chronic stroke who completed a six weeks training in their homes. Based on the patterns observed in difficulty and lag–lead score, we defined five session types (challenging, challenging–then supporting, supporting, under-supporting and under-challenging). We show that the mechanism of adaptation has been effective in 195 of 248 (78.6%) sessions.Based on our results, we propose the lag–lead based assessment and adaptation as an auto-tuning tool for machine based exercise, with particular focus on rehabilitation robotics. Also, the classification of sessions among different types can be applied to other studies in order to better understanding the progression of therapy in order to maximize its outcome.

A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis.

Hand exercises are often part of the treatment of hand rheumatoid arthritis; however, it is still unclear whether and what type of exercises is effective in the treatment of this condition. Therefore, a systematic review into the effectiveness of hand exercises in the treatment of hand rheumatoid arthritis has been performed. Studies were identified in the literature databases by predefined search criteria. The eight included studies are peer-reviewed studies published between 2000 and 2014. Hand exercises differed between studies, but always included resistance and/or active range of motion exercises. Grip strength in various grip types (power grip, key pinch, precision pinch and tripod pinch) was found to improve by hand exercise therapy without having adverse effects on pain or disease activity. Adaptations in the range of motion in response to hand exercise therapy were less pronounced. There appears to be some transfer from the improvements on the body functioning level to the level of daily functioning, with the largest improvements found on grip ability. With regard to the intervention content, there was some evidence in favour of a longer therapy duration and a higher therapy intensity. No conclusions could be drawn on the effectiveness of the different types of exercises. Collectively, the studies indicate that hand exercises may have positive effects on strength and some aspects of daily functioning without aggravating disease activity or pain, although caution should be taken for subjects in the exacerbation period.

FRI0594-HPR Two Different Sets of Handexercises Improved Grip Strength after Eight Weeks in Patients with Arthritis

BackgroundHand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand...

AB1178-HPR Hand Exercise Intervention in Patients with Polymyositis and Dermatomyositis: A Pilot Study

ObjectivesTo develop a 12-week hand exercise intervention for patients with polymyositis (PM) and dermatomyositis (DM) and evaluate adherence, patients opinion of program design and overall feasibility and the effect on...

Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial

BackgroundHand exercises are recommended for patients with hand osteoarthritis (HOA), though evidence for their effect is conflicting.ObjectiveTo evaluate, in a randomised controlled trial, the effect of HOA information plus home-based...

Hand Exercise Intervention in Patients with Polymyositis and Dermatomyositis: A Pilot Study

The aim of the present study was to develop a 12-week hand exercise intervention for patients with polymyositis (PM) and dermatomyositis (DM) and evaluate adherence, patients' opinions of the programme design and overall feasibility, and the effect on hand function and activity limitation after the intervention. A pilot hand exercise intervention was conducted on a convenience sample of 15 patients with reduced handgrip strength and established, inactive PM and DM. Acceptable adherence was set at 75%. The programme was evaluated based on patients' opinions regarding exertion, the movements involved and overall feasibility. Hand- and pinch-grip strength, grip ability, dexterity and activity limitation were assessed. Eleven of 15 patients completed the intervention, with acceptable adherence of 78-100%. Measures of handgrip strength, dexterity and activity limitation were reduced at baseline compared with normative data from the literature. Throughout the intervention, rates of perceived exertion were scored between 'moderate' and 'fairly strong'. Finger abduction and adduction were excluded from the hand exercise programme because they were not feasible to perform. Repetitions of the exercise increased gradually to a maximum of 30 per movement. Patients regarded this as too time-consuming and suggested ten repetitions daily or 10-20 repetitions 2-4 times per week. There were some individual, clinically meaningful improvements in hand function and activity limitation. A comparison between baseline and after the intervention showed that the three-jaw (tripod) pinch-grip strength (left hand) had increased (p < 0.007; z = -2.7). A hand exercise programme was found to be feasible to perform by patients with established PM or DM. The effect was limited, with few individual improvements in hand function and activity limitation, indicating a need to increase the resistance in the movements and to limit the duration of each exercise session.

The effect of two different hand exercises on grip strength, forearm circumference, and vascular maturation in patients who underwent arteriovenous fistula surgery.

ObjectiveTo compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery.MethodsWe recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb.ResultsAll of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups.ConclusionThe results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball.

CSM 2014 Orthopaedic Section Poster Presentations (OPO1106–OPO1165, OPO2218–OPO2298, OPO3106–OPO3183)

CSM 2014 Orthopaedic Section Poster Presentations (OPO1106–OPO1165, OPO2218–OPO2298, OPO3106–OPO3183)

Effect of the Laughter Therapy Combined with Cognitive Reinforcement Program for the Elderly with Mild Cognitive Impairment

Purpose: The purpose of this study was to investigate the effect of laughter therapy and cognitive reinforcement program on self-efficacy, depression and cognitive functions of the elderly with mild cognitive impairments (MCI). Methods: The study design was a non-equivalent control group pre and posttest design. Thirty-six subjects over the age of 65 with a diagnosis of mild cognitive impairment were assigned either to a treatment or a comparison group. Data were collected from February 7 to March 27, 2012 in the dementia supporting center. An eight week treatment program that included laughter therapy coupled with a cognitive reinforcing program including hand exercise, laughter dance routine, laughter technic and cognitive training for attention, memory, orientation and execution skill. Results: MoCA-K (t=-6.86, p<.001) and Stroop test CW correct (t=-2.54, p=.008), self-efficacy (t=-3.62, p=.001) in the treatment group were significantly higher than those of the comparison group. Reported depression (t=2.29, p=.014), Stroop test CW error (U=53.50, p<.001) in the treatment group was significantly less than the comparison group. Conclusion: In this study, the treatment was effective in improving self-efficacy, cognitive function and reducing depression in the elderly with MCI.

Massage therapy plus topical analgesic is more effective than massage alone for hand arthritis pain

20 adults were randomly assigned to a massage therapy or a massage therapy plus a topical analgesic application group. Both groups received a weekly massage from a therapist and were taught self-massage (same procedure) to be done by each participant once daily over a four-week period. The massage plus topical analgesic group as compared to the massage group had greater improvement in hand function as measured by a digital hand exerciser following the first session and across the four-week period. That group also had a greater increase in perceived grip strength and a greater decrease in hand pain, depressed mood and sleep disturbances over the four-week period. Massage therapy has been effective for several pain syndromes including migraine headaches (Lawle and Cameron, 2006)), lower back pain (Hsieh et al., 2004), fibromyalgia (Kalichman, 2010), neck and shoulder pain (Kong et al., 2013), carpal tunnel syndrome (Elliott and Burkett, 2013), and pain related to upper limb arthritis (Field et al., 2013). The purpose of the current study was to determine whether applying a topical analgesic following massage might be more effective than massage alone in treating pain associated with hand arthritis.

Effects of a soft prefabricated thumb orthosis in carpometacarpal osteoarthritis

Aims: To explore the feasibility and assess the effect of a prefabricated soft thumb-base orthosis on pain, hand strength, and activity performance in persons with osteoarthritis of the CMC joint. Methods: In this randomized controlled trial, 29 patients received hand exercises only (control group) and 30 patients received hand exercises and an orthosis (orthosis group). The primary outcome was pain, while secondary outcomes included grip and pinch strength, and self-reported symptoms and activity performance. Outcome assessments, and measures of grip strength and pain with and without orthosis in the orthosis group, were made after two months. Results: 55 participants (mean age 70.5 years) completed all assessments. There were no significant differences between the groups in primary or secondary outcomes after two months. However, in the orthosis group, pain was significantly less when wearing the orthosis than when not wearing it. Participants reported that the orthosis felt uncomfortable during activities involving water and one-third wanted more support of the CMC joint. Conclusions: A soft prefabricated orthosis seems to have an immediate pain-relieving effect during use, but no effects in terms of less hand pain, or improved strength or activity performance when not worn.

Comprehensive rehabilitation of patients with early rheumatoid arthritis: results of 6-month program

Objective: to evaluate the efficiency of a comprehensive rehabilitation program (CRP) in patients with early rheumatoid arthritis (RA) for 6 months. Subjects and methods. Sixty patients with early RA were examined. During medical therapy, 6-month CRP was implemented in 34 patients in the study group. The 2-week in-hospital stage involved ten sessions of 15-min local air cryotherapy (-60 °C) of the hands, knee or ankle joints; ten classes of 45-min therapeutic exercises (TE) under the supervision of a trainer; ten sessions of 45-min ergotherapy (training people how to therapeutically position their joints, to apply their protective methods, to lift and move things, to use assistive devices, and to do hand exercises); orthotics (working wrist orthoses, knee ones, or individual orthopedic insoles); and four 90-min educational program classes. The outpatient and domiciliary stages included 45-min TE thrice weekly; creation of a correct functional stereotype; and orthotics. Twenty-six patients received medical therapy only (a control group). The authors estimated tender joint count (TJC), swollen joint count (SJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), joint pain on 100-mm visual analog scale (VAS), DAS28, HAQ, RAPID3, hand grip strength, average maximum knee extension and ankle flexion by the EN-TreeM movement analysis, and compliance with drug and non-drug treatments. Results. The study group showed a stably high compliance with therapy with disease-modifying antirheumatic drugs, less need for symptomatic agents, higher adherence to the methods of creating a correct functional stereotype, orthotics, and regular TE. Twenty-two patients completed 6-month CRP; 12 patents did not complete the treatment because of non-compliance with nondrug methods, primarily TE. Upon completion of the in-hospital stage of CRP, the study group exhibited significant positive changes in pain and functional status and no significant impact on global inflammatory activity indicators (SJC, ESR, CRP, and DAS28). After 6 months of CRP, there were reductions in TJC by 6.0+1.8 or 72.3% (p <0.01), SJC 4.0+1.2 or 74.1% (p <0.01), ESR by 58.2% (p < 0.01), CRP by 67.2% (p < 0.01), VAS pain by 70.4% (p < 0.01), DAS28 by 1.38+0.21 scores or 31.9% (p < 0.05), HAQ by 0.97+0.56 scores or 75.8% (p < 0.01), and RAPID3 by 5.98+0.92 scores or 60.1% (p < 0.01). The grip strength of a more and less affected hand increased by 44.9% (p < 0.05) and 31.3% (p < 0.05), respectively. The average maximum extension of a weaker and stronger knee joint increased by 88.7% (p < 0.01), and 67.7% (p < 0.01), respectively. The average maximum flexion of a more and less affected ankle joint rose by 81.6% (p < 0.01) and 70.2% (p < 0.01), respectively. Following 6 months, the changes in the control group were less significant, which determined significant differences between the groups in most indicators. Conclusion. Six-month CRP enhances compliance with drug and non-drug treatments, assists in controlling disease activity, and improves functional abilities, motor activity, and quality of life in patients with early RA. The main reason for CRP interruption is inadequate patient adherence to non-drug treatments.

Self-management approaches for osteoarthritis in the hand: a 2×2 factorial randomised trial

BackgroundOsteoarthritis is the leading cause of disability in older adults. Evidence of effectiveness for self-management of hand osteoarthritis is lacking.MethodsIn this randomised, factorial trial, we evaluated the effectiveness of joint...

Magnetotherapy in hand osteoarthritis: A pilot trial

To evaluate the effectiveness of magnetotherapy in the treatment of hand osteoarthritis (HO). In this randomized controlled single-blind follow-up study, patients with HO were randomly assigned into 2 groups (G1 and G2). The subjects in G1 (n=25) received 25Hz, 450 pulse/s, 5-80G, magnetotherapy of totally 10 days and 20 min/day combined with active range of motion/strengthening exercises for the hand. G2 (n=25) received sham-magnetotherapy for 20 min/day for the same duration combined with the same hand exercises. Outcome measures were pain and joint stiffness evaluation, handgrip and pinchgrip strength (HPS), Duruöz and Auscan Hand Osteoarthritis Indexes (DAOI) and Short Form-36 Health Questionnaire (SF-36) administered at baseline, immediately after treatment and at the follow up. When the groups were compared with each other, improvement observed in SF-36 Pain (p<0.001), SF-36 Social Function (p=0.030), SF-36 Vitality (p=0.002), SF-36 General Health (p=0.001), Pain at rest (p<0.001), Pain at motion (p<0.001), Joint stiffness (p<0.001), DAOI (p<0.001) were in favor of G1. Changes in pain, function and quality of life scores showed significant advantage in favor of the applied electromagnetic intervention in patients with HO.

Feasibility of evidence-based hand exercises in a home-based program for patients with Alzheimer's disease and depression

Ever-growing attention is being focused on the preservation of cognitive ability and on slowing the decline in people with Alzheimer's dementia (AD) utilizing an integrative treatment model (combination of medications and non-pharmacological interventions). The interventions related to increasing regional cerebral blood flow (CBF) for people with AD are in the earliest stages of development. An increased regional CRF in healthy individuals, during hand movements, has been described (Roland, P.E., 1982, Kawashima, R., 1996). To facilitate the CBF in demented, depressed seniors we have developed a set of hand - tennis ball exercises ™ for home-based programs (Bragin V., 2007). In this presentation it will be a description of the latest set of hand exercises (2010–2012) for patients with dementia and physical disabilities, applicable to office and home-based interventions. The set of hand exercises consists of hand and finger movements performed with one or both hands. After completion of the initial assessment of hand movements, all patients receive in-office training and a workbook for home-based programs plus a DVD that demonstrates the exercises. The patients are asked to pay close attention and memorize the series of hand and finger movements. Later on the dual-task portion of the program is introduced, which incorporates breathing or counting during hand exercises. We use video recording and simple computer registration of motor speed and reaction time to monitor the progress of training and finger mobility. The patients tolerate these exercises very well and over time they memorize the movements using their procedural memory capacities. These exercises help the patients regain hand and finger mobility, coordinate hand movements, and increase attention, procedural memory, and brain speed. These movements also have immediate positive effect on emotions. Patients and their caregivers report an absence of intrusive thoughts during exercises and lessened feelings of depression and anxiety. Hand exercises as a component of a home-based integrative program could positively improve hand movements for seniors living with AD. This program appears feasible for outpatient memory clinics, rehabilitation facilities, and nursing homes. The effectiveness of this model in various settings requires and deserves further research.

글씨쓰기 훈련과 근력 훈련이 비우세손 기능과 근력에 미치는 영향

Abstract Purpose : We intend to make the study date for an effect of therapy by comparing the functional level both before and after conducting handwriting training and strength training as a part of treatment to improve muscle strength and function of the patient's non-dominant hand. Method : 8 subjects in writing training group conducted hand writing training 30 minutes at once and three times a week for 4 weeks in total 12 times, and 8 subjects in muscle training group conducted muscle training program of putty and Rolyan ergonomic hand exerciser for 15 minutes respectively in sum up 30 minutes at once and three times a week for 4 weeks in total 12 times. 8 subjects in control group are not applied any training for 4 weeks. Results : It was much more effective in handwriting training than muscle strength training by Grooved pegboard because this study showed the speed decrease from 67.11 to 58.26 seconds in handwriting compared with muscle strength training which showed 5.22 seconds decrease from 67.54 to 62.32(P<.05). It showed about 1.34 muscle strength improvement from 6.60 to 7.94 in handwriting training and 0.92 improvement of muscle strength from 7.04 to 7.96 in muscle strength training by 3-jaw chuck pinch, so handwriting training was more effective(P<.05). It showed 11.58 seconds decrease in handwriting training from 26.62 to 18.01 seconds and 10.93 seconds decrease from 27.43 to 16.50 seconds in muscle strength training, so it was significantly shortened both in handwriting and muscle strength training(P<.05). Conclusion : Dexterity, muscle strength, and handwriting ability of non-dominant hand could improve both the handwriting training and the muscle strength training.Key Words : jamar hydraulic hand dynamometer, pinch gauge, grooved pegboard test,

Effects of isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women with rheumatoid arthritis

The primary objective of our study was to evaluate the effect of 6-week-long isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women diagnosed as rheumatoid arthritis (RA). Our secondary objective was to assess the changes in handgrip strength and disease activity. This randomized, parallel, single-blinded 6-week intervention study enrolled 52 female patients between 40 and 70 years of age, who were diagnosed with RA according to American College of Rheumatology criteria, had disease duration of at least 1 year and had a stage 1-3 disease according to Steinbrocker's functional evaluation scale. Patients were randomized into isotonics and isometrics groups. Exercises were performed on sixth week. All patients were applied wax therapy in the first 2 weeks. Their pain was assessed with visual analog scale (VAS), their hand functions with Duruöz Hand Index (DHI), dexterity with nine hole peg test (NHPT) and quality of life with Rheumatoid Arthritis Quality of Life questionnaire (RAQoL). Dominant and non-dominant handgrip strengths (HS) were measured. Disease activity was determined by disease activity score (DAS 28). We evaluated the difference in the above parameters between baseline and 6 weeks by Wilcoxon paired t test. The study was completed with 47 patients (isotonics n = 23; isometrics n = 24). VAS, DHI, NHPT, and RAQoL scores significantly improved in both groups by the end of 6th week compared to the baseline scores of the study (for isotonics p = 0.036, p = 0.002; p = 0.0001, p = 0.003; for isometrics p = 0.021, p = 0.002, p = 0.005, p = 0.01, respectively). DAS 28 scores decreased in both exercise groups (p = 0.002; p = 0.0001, respectively), while isometrics showed a significant increase in dominant HS (p = 0.029), and isotonics showed a significant increase in non-dominant HS (p = 0.013). This study showed that isometric and isotonic hand exercises decrease pain and disease activity and improve hand functions, dexterity and quality of life as well as mildly increasing muscle strength in patients diagnosed as RA.