Arthritis patients show long-term benefits from 3 weeks intensive exercise training directly following hospital discharge*
1Institute for Behavioral Research, University of Twente, 2Department for Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, 3Twenteborg Ziekenhuis Almelo, 4St Maartenskliniek, Nijmegen and 5Saxion Universities of Applied Sciences, Enschede, The Netherlands
Correspondence to: K. W. Drossaers-Bakker, Department for Rheumatology and Clinical Immunology, Medisch Spectrum Twente, P.O. BOX 50.000, 7500 KA Enschede, The Netherlands. E-mail: w.drossaers{at}ziekenhuis-mst.nl
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Abstract |
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Objective. To examine the efficacy of short-term intensive exercise training (IET) directly following hospital discharge.
Methods. In the Disabled Arthritis Patients Post-hospitalization Intensive Exercise Rehabilitation (DAPPER) study, patients with rheumatoid arthritis or osteoarthritis were eligible when they needed hospitalization for either a flare-up in disease, elective hip or knee arthroplasty. The intervention group received IET for 3 weeks immediately after discharge; the control group was treated with the usual care (UC). The intensive exercise was provided in a resort. Outcomes were assessed at baseline, after 3, 13, 26 and 52 weeks. Range of motion was measured using the Escola Paulista de Medicina–Range of Motion scale (EPM-ROM), disability was measured using the HAQ and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), and for health-related quality of life (HRQoL), the Research and Development 36-Item Health Survey (RAND-36) was used.
Results. The IET showed a better and faster improvement than UC on all outcome measures except for HRQoL. Up to 52 weeks after baseline, the EPM-ROM and the MACTAR remained favourable in IET compared with UC. At 3 weeks, the MACTAR improved significantly more in the IET compared with the UC: mean difference –5.5 (95% CI –8.4 to –2.2). At 26 weeks, the mean difference remained significant (–5.2; 95% CI –10.0 to –0.34). At 52 weeks, the effect was not significant; however, the mean difference in improvement between the groups can be considered clinically relevant. At 3 weeks, the IET had improved significantly more on the HAQ walking and rising subscales.
Conclusion. Intensive short-term exercise training of arthritis patients, immediately after hospital discharge results in improved regain of function. The DAPPER programme has a direct effect, which lasts up to 52 weeks.
KEY WORDS: Exercise therapy, Outcome assessment, Rheumatoid Arthritis, Osteoarthritis, Randomized controlled trial, Arthroplasty
*Results of the DAPPER (Disabled Arthritis Patients Post-hospitalization Intensive Exercise Rehabilitation) study.
Submitted 6 April 2007;
revised version accepted 6 August 2007.
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