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Rheumatology Practice Management April 2015 Vol 3 No 2 - Rheumatoid Arthritis

It has not been established that exercise improves hand and wrist function in people with rheumatoid arthritis (RA). The study Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) evaluated the clinical efficacy and cost-effectiveness of exercise for patients with RA and qualitatively described the experience of the participants.

The pragmatic, multicentered, individually randomized controlled trial and the embedded qualitative study included 490 adult patients from 21 rheumatology and therapy departments in 17 National Health Service trusts in England. Patients with RA were eligible for the study if they had been on stable medication for ≥3 months to treat pain and dysfunction of the hands and/or wrists. The 2 study groups were: usual care, which provided education, general exercise advice, and functional splinting if needed (n=244); and usual care plus a personalized exercise program comprising 6 sessions of strengthening and stretching exercises with a hand therapist, daily home exercises, and adherence strategies (n=246).

Follow-up evaluations were at 4 and 12 months after randomization. The primary outcome was the Michigan Hand Outcome Questionnaire (MHQ) overall hand function subscale score recorded at 12 months. The health economics evaluation was based on the European Quality of Life-5 Dimensions and medication and healthcare use. Outcomes were obtained for 89% of participants at 12 months (222 in usual care and 216 in the exercise program). For the primary outcome, there was a statistically significant difference in favor of the exercise program. Imputed analysis produced incremental cost-effectiveness ratio estimates of £17,941 [$26,812.75] (0.59 probability of cost-effectiveness at willingness-to-pay threshold of £30,000 [$44,834.87] per quality-adjusted life-year).

The researchers concluded that the results of the trial suggest that the addition of an exercise program to usual care for patients with hand/wrist RA is clinically effective and cost-effective when compared with usual care alone. Williams MA, et al. Health Technol Assess. 2015;19(19):1-222.

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Last modified: May 27, 2015
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