Effectiveness and Impact on Quality of Life of a Hand Rehabilitation Program in Longstanding Systemic Sclerosis: A Prospective, Non-Randomized, Controlled Pilot Study.

Background/

Objectives

Reduced hand function significantly contributes to disability in patients with systemic sclerosis (SSc). We aimed to evaluate the effects on hand function and quality of life of a multicomponent hand rehabilitation program in patients with longstanding SSc.

Methods

This prospective, controlled, interventional pilot study enrolled adults with SSc, disease duration >5 years and ≥1 upper limb joint contracture. The intervention consisted of 10 sessions over 5 weeks, including paraffin wax therapy and individualized hand rehabilitation. The allocation to the intervention or control group was based on the patients' availability to participate in the program. Hand mobility/function and health-related quality of life were assessed through validated outcome measures at baseline and after 5 weeks.

Results

Sixteen patients were included (intervention N = 10; control N = 6), with a median disease duration of 19.5 (15.3-24.3) years. Within the intervention group, significant improvements were observed in right-hand Hand Mobility in Scleroderma (HAMIS) score (p = 0.033) and in the Short Form (SF)-36 domains of "Energy/fatigue" (p = 0.008), "Emotional well-being" (p = 0.009), "Pain" (p = 0.020), and "General health" (p = 0.050). Compared with controls, significant benefit was observed in the SF-36 "Energy/fatigue" (p = 0.002; d = 1.97) and "General health" (p = 0.011; d = 1.50) domains. Between-group differences in hand function measures did not reach statistical significance, although moderate-to-large effect sizes favored rehabilitation across several outcomes.

Conclusions

In this pilot study, a multicomponent hand rehabilitation program was associated with improvements in quality of life in patients with longstanding SSc, despite limited effects on hand mobility. These preliminary findings suggest a potential benefit of hand rehabilitation even in advanced disease.