Date Presented 3/31/2017
This pretest–posttest RCT investigated the efficacy of exercise and thermal modalities (paraffin wax, hydrotherapy) in managing osteoarthritis and rheumatoid arthritis in hands. Little statistical data to support use of these modalities in arthritic hands exist. Significant scores indicating effectiveness of intervention methods were found.
Primary Author and Speaker: Said Nafai
Additional Authors and Speakers: Elizabeth Stevens-Nafai, Hashem Salman
PURPOSE: The two most common forms arthritis, osteoarthritis (OA), which affects 27 million Americans (Arthritis Foundation, 2016a), and rheumatoid arthritis (RA), which affects more than 1.5 million Americans (Arthritis Foundation, 2016b), are common diagnoses for occupational therapists to treat. Many Americans live with pain and decreased range of motion in the hands, which limits participation in daily activities. Treatment for symptoms in the hands includes nonpharmacological, pharmacological, and surgical interventions. Occupational therapy practitioners can provide nonpharmacological treatments that include splinting, hand exercises, and thermal modalities. Little research has been done regarding the connection between OA and RA of the hands, hand exercises, and treatment modalities utilized in occupational therapy. The research question was: Are hand exercises and/or thermal modalities effective treatment for the management of OA and RA in the hands?
DESIGN AND METHOD: This pretest–posttest randomized controlled study investigated the effectiveness of hand exercises and thermal modalities (paraffin wax and hydrotherapy) in managing OA and RA in the hands. The study was conducted over 6 wk, and there were four randomized groups. Each group had five participants; three of the four groups received 30-min treatments two times a week for 6 wk. A follow-up visit 3 mo after the end of the study was conducted to measure any changes in participants. Group 1 received strengthening and stretching exercises to both hands. Group 2 received paraffin wax treatment to both hands. Group 3 received whirlpool treatment using warm water for both hands, and Group 4 was the control group receiving no treatment. A blinded therapist measured hand strength, hand lateral pinch, hand ROM, hand edema, hand coordination, hand pain, and hand function using well-respected measurement tools. IBM SPSS Statistics Version 16.0 was used for data analysis. Analysis of variance (ANOVA) was used to analyze differences between groups.
RESULTS: The study started with a total of 20 participants, five participants in each group. However, one participant from the paraffin group was excluded due to medication changes, and another participant from the control group withdrew voluntarily. Mean age for the exercise, paraffin, hydrotherapy, and control groups were 78.6, 74.4, 80.7, and 75.7, respectively. For all outcome measures, there were no significant differences between the groups at the baseline assessment. For the hydrotherapy group, a significant difference was found in the range of motion test in Posttest 2, t(4) = –3.65, p = .02. The exercise group showed a significant difference in edema at Posttest 1, t(4) = 3.29, p = .03. The control group showed significant differences in grip strength at Posttest 1, t(3) = –4.52, p = .02, and in coordination at Posttest 2, t(3) = 7.10, p = .006.
A nonsignificant trend of improvement in most outcome measures was noticed in Posttests 1 and 2 compared with the pretest results for all groups. The exception to that was for coordination at Posttests 1 and 2 and hand pain at Posttest 2 of the hydrotherapy group; grip strength at Posttest 2, lateral pinch at Posttest 2, range of motion at Posttest 1, edema at Posttest 2, pain at Posttest 2, and hand function at Posttest 1 of the paraffin wax group; lateral pinch at Posttest 2 and hand function at Posttest 2 of the exercise group; and lateral pinch at Posttest 2, coordination at Posttest 1, and hand function at Posttests 1 and 2 for the control group. ANOVA showed no significant differences between the groups in all outcome measures.
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Arthritis Foundation. (2016a). What is osteoarthritis? Retrieved from http://www.arthritis.org/about-arthritis/types/osteoarthritis/what-is-osteoarthritis.php
Arthritis Foundation. (2016b). What is rheumatoid arthritis? Retrieved from http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php
Beasley, J. (2102). Osteoarthritis and rheumatoid arthritis: Conservative therapeutic management. Journal of Hand Therapy, 25, 163–172. https://doi.org/10.1016/j.jht.2011.11.001
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