From the Division of Rheumatology, Department of Physical Medicine and Rehabilitation.
Division of Rheumatology, Department of Internal Medicine.
J Clin Rheumatol. 2022 Mar 1;28(2):e422-e429. doi: 10.1097/RHU.0000000000001752.
For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc.
This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire-Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status.
Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m2. The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength.
The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.
对于系统性硬化症（SSc）患者，手部受累是一种被低估的临床表现。因此，本研究旨在探讨手部运动方案的疗效，并证明其对 SSc 患者手部功能、生活质量、焦虑和抑郁的影响。
本研究设计为单盲、随机对照比较研究。将 62 名女性 SSc 患者随机分为运动组（n = 32）和对照组（n = 30）。在一些患者失访后，每组分析了 25 名患者。在运动组中，为期 8 周的干预包括等长手部运动和自我管理的伸展运动，每天重复 10 次/2 组。所有患者在基线时和 4 周和 8 周后使用 Hand Mobility in Scleroderma（HAMIS）测试、Duruoz 手部指数（DHI）、握力、36 项简短表格、健康评估问卷残疾指数（HAQ-DI）、贝克焦虑量表（BAI）和贝克抑郁量表（BDI）进行评估。使用 Friedman 检验分析组内随时间的比较。使用 Wilcoxon 符号秩检验进行事后分析。使用多元线性回归分析来定义运动对临床状况的影响。
在 50 名总患者中，中位年龄和中位体重指数分别为 55.5 岁和 25.9 kg/m2。中位疾病持续时间为 10.0 年。34 名患者（68.0%）为弥漫性皮肤系统性硬化症（dcSSc），而 16 名患者（32.0%）为局限性皮肤系统性硬化症（lcSSc）。手部握力以及 HAMIS、DHI、HAQ-DI 和 BDI 的主要结局均随时间显著改善（p < 0.001，p < 0.001，p < 0.001，p < 0.001，p = 0.005）。组间比较显示，运动组 DHI、手部握力、HAQ-DI、BAI 和 BDI 显著改善（p = 0.02，p = 0.013，p < 0.001，p = 0.015，p = 0.036）。多元线性回归分析发现，运动是影响 HAMIS、DHI、HAQ-DI 和握力改善的最有效因素。
为期 8 周的等长手部运动和自我管理伸展运动干预可显著改善 SSc 患者的手部握力、整体健康、生活质量和心理状态。
