Okyar Burak, Öztürk Gülşah Yaşa, Kocyigit Burhan Fatih
Department of Rheumatology, Adana City Training and Research Hospital, Adana, Türkiye.
Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Adana City Training and Research Hospital, University of Health Sciences, Adana, Türkiye.
Rheumatol Int. 2025 Aug 12;45(9):195. doi: 10.1007/s00296-025-05957-6.
Hand involvement is one of the most disabling features of systemic sclerosis (SSc). Although occupational therapy is frequently employed in rheumatic conditions, its particular effects in SSc have not been studied in detail yet. This study aimed to evaluate the impact of a structured three-week occupational therapy program on hand function in SSc. This randomized controlled trial involved adult patients with SSc. Participants were randomly allocated to an intervention group that received a three-week occupational therapy program or a control group that received standard rheumatic care. Evaluations were performed at baseline (T1), immediately after the intervention (week 3, T2), and at follow-up (week 12, T3). Outcome measures included hand grip strength (HGS), fingertip pinch strength, tactile sensory threshold (as assessed by the Semmes-Weinstein monofilament test), pain threshold (dolorimetry), and hand functionality, as evaluated by the Duruöz Hand Index (DHI). Microvascular assessment was conducted utilizing nailfold videocapillaroscopy and the Capillaroscopic Skin Ulcer Risk Index. A total of 42 patients (22 in the intervention group, 20 in the control group) completed the study. There were no significant differences in baseline characteristics (p > 0.05). Significant improvements were observed in the intervention group regarding HGS, pinch strength, tactile sensation, and DHI scores (p < 0.05). No statistically significant changes were detected in pain threshold in either the intervention or control groups (p > 0.05). There were no significant differences in other outcome measures within the control group (p > 0.05). The structured occupational therapy program resulted in notable improvements in hand strength, tactile sensitivity, and functional hand use in SSc patients, with benefits sustained for up to 12 weeks. These findings suggest the incorporation of occupational therapy into routine multidisciplinary care for SSc.
手部受累是系统性硬化症（SSc）最致残的特征之一。尽管职业治疗在风湿性疾病中经常使用，但其在SSc中的具体效果尚未得到详细研究。本研究旨在评估为期三周的结构化职业治疗方案对SSc患者手部功能的影响。这项随机对照试验纳入了成年SSc患者。参与者被随机分配到接受为期三周职业治疗方案的干预组或接受标准风湿护理的对照组。在基线（T1）、干预后立即（第3周，T2）和随访时（第12周，T3）进行评估。结果指标包括握力（HGS）、指尖捏力、触觉感觉阈值（通过Semmes-Weinstein单丝试验评估）、疼痛阈值（痛觉测量法）以及通过Duruöz手部指数（DHI）评估的手部功能。利用甲襞视频毛细血管显微镜检查和毛细血管显微镜皮肤溃疡风险指数进行微血管评估。共有42名患者（干预组22名，对照组20名）完成了研究。基线特征无显著差异（p>0.05）。干预组在HGS、捏力、触觉感觉和DHI评分方面有显著改善（p<0.05）。干预组和对照组的疼痛阈值均未检测到统计学上的显著变化（p>0.05）。对照组的其他结果指标无显著差异（p>0.05）。结构化职业治疗方案使SSc患者的手部力量、触觉敏感性和手部功能使用有显著改善，且这种益处可持续长达12周。这些发现表明应将职业治疗纳入SSc的常规多学科护理中。
