A tailored hand exercise program for rheumatoid arthritis patients proved to be a cost-effective intervention for restoring and maintaining hand function in a randomized trial.
Sarah E. Lamb, D.Phil., of the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences at the University of Oxford (England), and her colleagues from the SARAH (Strengthening and Stretching for Rheumatoid Arthritis of the Hand) trial randomly assigned 490 adults with rheumatoid arthritis who reported hand pain or dysfunction to usual care or a tailored program of strengthening and stretching hand exercises at a hospital and in the home.
The exercise group’s improvement was more than double that of the usual care group. Hand function at 12 months improved by 3.6 points in the usual care group (95% confidence interval, 1.5-5.7) and 7.9 points in the exercise group (95% CI, 6.0-9.9) as measured by the Michigan Hand Outcomes Questionnaire (Lancet 2014 Oct. 10.[doi:10.1016/S0140-6736 (14)60998-3]).
The cost of the exercise program was $250 USD per patient and cost per quality-adjusted life-year was $15,316 USD.
“A tailored hand exercise program is a worthwhile, low-cost intervention as an adjunct to a range of drug regimens,” the researchers concluded.
Dr. Christina H. Opava
In an accompanying editorial, Christina H. Opava, Ph.D., of the Karolinska Institute in Stockholm, and Mathilda Björk, Ph.D., of Linköping University and Jönköping University, both in Sweden, wrote that successful interventions that were also cost effective were important, particularly because RA drugs are so expensive (Lancet 2014 Oct. 10 [doi:10.1016/S0140-6736(14)61285-X]).
“The use of hand exercise also has the potential to be integrated into e-health, via a web-based solution or interactive monitoring, which could further increase cost effectiveness and adherence,” they wrote.
However the positive results of the study might be jeopardized by bias introduced by selecting patients who were motivated to travel to hospital and follow a daily exercise program at home, they said.
Before the exercise program was implemented into clinical practice, it was also important to train therapists to ensure appropriate delivery of the intervention. This was especially important as the program included the use of extensive behavioral change support techniques that are not yet self-evident parts of physical therapy and occupational therapy practice, Dr. Opava and Dr. Björk said.
The trial was funded by the U.K. National Institute for Health Research Health Technology Assessment program. None of the study or editorial authors had anything to disclose.