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08.49 Efficacy of an intensive 24-week physiotherapy programme in scleroderma patients – preliminary data from a single-centre controlled study
  1. Maja Spiritovic1,2,
  2. Hana Smucrova1,
  3. Sabina Oreska1,
  4. Hana Storkanova1,
  5. Petr Cesak2,
  6. Adela Rathouska1,
  7. Olga Ruzickova1,
  8. Herman Mann1,
  9. Karel Pavelka1,
  10. Ladislav Senolt1,
  11. Jiri Vencovsky1,
  12. Radim Becvar1,
  13. Michal Tomcik1
  1. 1Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  2. 2Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic

Abstract

Background Involvement of skin and musculoskeletal system in systemic sclerosis (SSc) leads to loss of function, disability and reduced quality of life. Data on efficacy of non-pharmacologic care in SSc is very limited due to variety in studied interventions/outcomes.

Objectives and methods To address the limitations of existing studies, and evaluate the effect of a controlled, long-term (24-week intervention, 24-week follow-up), intensive (1 hour physiotherapy +0.5 hour occupational therapy twice weekly, and home-exercise for 0.5 hour 5x weekly), tailored physiotherapy program on function/impairment of hands/face, and quality of life/disability in cohorts with a substantial number of SSc patients. All patients fulfilled ACR/EULAR 2013 criteria, had skin involvement of hands/mouth, and were consecutively recruited between 2014–2016. At months 0,3,6,12 all patients were assessed by a physician (physical history, mRSS, EUSTAR SSc activity score, Medsger severity score), and a physiotherapist blinded to intervention [validated measurements (dFTP-delta finger to palm, inter-incisor/inter-lip distance, grip strength using Baseline dynamometer ); tests (HAMIS-Hand Mobility In Scleroderma)], patients filled out PRO questionnaires (CHFS-Cochin Hand Function Scale, MHISS-Mouth Handicap In SSc Scale, HAQ, SHAQ, SF-36) and provided blood for routine laboratory analysis and biobanking. Normality of data was tested and inter-group analysis performed with 2-way ANOVA and intra-group analysis by Friedmann’s test with Dunn’s post hoc test.

Results 25 SSc patients (22 female/3 male, 14 lcSSc/11dcSSc, median of age 54.0 and disease duration 7.0 years, mRSS 12) were recruited into the intervention group (IG) and 29 patients into CG (25 female/4 male, 16 lcSSc/13 dcSSc, median of age 49.0 and disease duration 5.0 years, mRSS 11). Compared to observed statistically significant deterioration in CG over the period of m0-m6, we found statistically significant improvement in dFTP, grip strength, HAMIS, inter-incisor and inter-lip distance. Only numerical improvement in IG compared to numerical deterioration in CG, which have not reached statistical significance, were observed in patient reported outcomes (CHFS, MHISS, HAQ, SHAQ, SF-36).

Conclusions Our physiotherapy program not only prevented the natural course of progressive deterioration of function of hands/mouth (observed in CG), but led to a significant improvement in monitored parameters, which was clinically meaningful in a substantial proportion of patients.

Acknowledgement Supported by AZV-16–33574A.

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