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The NIHR-funded programme improves quality of life and can act as a low-cost intervention.

A tailored hand exercise programme has been found to improve function and quality of life for patients with rheumatoid arthritis, according to University of Oxford published in The Lancet.

The programme is made up of a series of strengthening and stretching exercises, which act as a low-cost intervention and can be adopted alongside regular medication.

 Rheumatoid arthritis affects more than 400,000 people in the UK, their quality of life can be significantly impacted by reduced hand and wrist function, which affects around 80% of patients.

The Strengthening And Stretching For Rheumatoid Arthritis of the Hand (SARAH) trial evaluated the effectiveness and cost-benefit of adding an individually tailored, progressive exercise programme for the hands and upper limbs in addition to usual care.

Funded by the National Institute for Health, the trial was led by Professor Sallie Lamb from Oxford University’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the University of Warwick. Professor Lamb is an NIHR CLAHRC Oxford theme lead.

Approximately 80% of the patients using the SARAH programme alongside their usual medication reported improved hand function a year after starting the programme. Significant improvements in strength and dexterity were also observed.

Mark Williams, Research Fellow at NDORMS, commented: “Current best practice mandates medication regimens, which substantially improve control of disease activity and joint damage, but don’t always impact on disability and health-related quality of life. By adding an optimised exercise programme for hands and upper limbs to usual care for patients with rheumatoid arthritis, we can address key issues of this debilitating condition to help patients in their daily lives.”

According to the Chartered Society of Physiotherapy, growing numbers of people are living with at least one long-term condition, and physiotherapy can lead to significant improvements in quality of life. Commenting on the research, CSP chief executive Professor Karen Middleton said:

“Interventions such as this will be invaluable as the NHS looks to address that rising demand within restrained budgets. This proactive approach enables people to manage their own condition and lead full and active lives while cutting costs for the NHS and social care.”

The next step is for the researchers to implement this programme into clinical practice, ensuring ease of access for patients.

Over 450 patients from 17 NHS trusts were part of the Strengthening And Stretching For Rheumatoid Arthritis of the Hand (SARAH) trial. All those who entered the trial received joint protection advice, with half of all people in the study also undertaking the daily exercise programme for the hands and arms.

The SARAH trial was funded by the National Institute of Health Research Health Technology Assessment Programme (NIHR HTA), project number 07/32/05 and was a collaboration between several higher education institutions (University of Warwick, University of Oxford, University of Southampton, Brunel University and University College London). 

Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial
Lamb SE, Williamson EM, Heine PJ et al
The Lancet 2014 doi:10.1016/S0140-6736(14)60998-3

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