Rheumatology Advance Access originally published online on February 11, 2009
Rheumatology 2009 48(4):410-415; doi:10.1093/rheumatology/ken511
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A dynamic exercise programme to improve patients’ disability in rheumatoid arthritis: a prospective randomized controlled trial
1Clinic of Rheumatology, Hôpital Sud, Echirolles, 2Michallon Pharmacy, Hôpital A. Michallon and 3Medical Evaluation Unit, Hôpital A. Michallon, Grenoble, France.
Correspondence to: Athan Baillet, Department of Rheumatology, Hôpital sud, Grenoble Teaching Hospital, Avenue de Kimberley, BP 338, 38434 Echirolles Cedex, France. E-mail: abaillet{at}chu-grenoble.fr
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Abstract |
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Objective. To evaluate the functional, clinical, radiological and quality of life outcomes of a 4-week dynamic exercise programme (DEP) in RA.
Methods. Patients matched on the principal medico-social parameters were randomly assigned to either the DEP or the conventional joint rehabilitation group. Primary end point for judging effectiveness was functional status assessed by HAQ. Secondary outcomes included Nottingham Health Profile (NHP), Arthritis Impact Measurement Scale 2—Short Form (AIMS2-SF) and radiological worsening measured by Simple Narrowing Erosion Score (SENS). Clinical evaluation consisted of disease activity score (DAS 28), cycling aerobic fitness and dexterity. Dexterity was measured using Sequential Occupational Dexterity Assessment (SODA) and Duruoz Hand Index (DHI). Data were collected at baseline 1, 6 and 12 months.
Results. Fifty patients were enrolled. HAQ improved throughout the length of the trial in the DEP group. This improvement was greater in DEP than in the standard joint rehabilitation group at 1 month (–0.2 vs no variation from baseline, P = 0.04), but not at 6 months (–0.2 vs –0.1 in control group, P = 0.25) or 12 months (–0.1 vs no variation in control group, P = 0.51). DEP improved NHP (–23 vs + 7% in control group, P = 0.01) and aerobic fitness (+0.3 vs + 0.1 km per 5 min in control group, P = 0.02) at 1 month but the progress was not statistically significant thereafter. DEP also improved DHI, SODA, DAS 28 and AIMS2-SF, although not significantly.
Conclusion. DEP was effective on functional status assessed by HAQ, quality of life and aerobic fitness at 1 month.
KEY WORDS: RA, Rehabilitation, Exercise therapy, Dynamic exercise programme
Submitted 3 May 2008;
revised version accepted 19 December 2008.
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