Purpose
Inflammatory Arthritis [IA] has adverse effects on strength, function, fatigue and well-being. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness. In 2015, our Rheumatology Physiotherapy Team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for people with IA. This research aimed to evaluate its effectiveness within a National Health Service [NHS] setting.
Approach
A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Outpatient Physiotherapy were offered a supervised PRTP (1 hour x 10 weeks): 7 exercises at 70-80% 1-repetition maximum (3 x 8-12 repetitions). Outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, 30s sit-to-stand [STS ]and Self-Efficacy (SARAH Trial) [SE]. Grip Strength and FACIT-Fatigue [FACIT-F] were added as additional outcomes in October 2018 in response to changes that people anecdotally reported. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD).
Outcomes
Results: 201 patients commenced the programme between May 2015 and April 2019. Diagnoses included Rheumatoid Arthritis (n=149), Psoriatic Arthritis (n=42), Juvenile Idiopathic Arthritis (n=5), Enteropathic IA (n=2), Oligoarthritis (n=1), Reactive Arthritis (n=1) and Undifferentiated IA (n=1). Age (mean ± SD) = 56.8±14.8 years; number of sessions attended = 7.7±3.4. There were no differences between those recorded as not completing the PTRP (n=54; 72% women; age 55.0±14.6 years; HAQ 0.99±0.70) versus the others (n=147; 78% women; age 57.5±14.8; HAQ 0.86±0.65). Therefore, a pragmatic decision was made to analyse all available data for each outcome. SMDs were calculated pre-post intervention. All outcomes improved from pre- to post-treatment, with small (≥0.2) to moderate (≥0.5) SMD values. Specific results were as follows [mean ± SD pre-treatment; mean ± SD post-treatment; mean difference (95% CI); p-value; SMD (95% CI)]: HAQ, max 3 (n=121): 0.83±0.65; 0.70±0.67; -0.13 (-0.07, -0.19); p<0.001; -0.20 (-0.46, 0.07). EQ5D VAS, max 100 (n=119): 70.0±16.3; 76.7±15.2; 6.7 (9.4, 3.9); p<0.001; 0.42 (0.17, 0.68). SE, max 70 (n=117): 52.3±10.4; 58.6±8.0; 6.3 (8.3, 4.4); p<0.001; 0.68 (0.41, 0.94). FACIT-F, max 52 (n=58): 30.9±11.5; 35.5±12.0; 4.6 (7.2, 2.1); p=0.001; 0.39 (0.02, 0.76). STS, repetitions in 30s (n=118): 13.2±4.9; 16.2±5.3; 3.0 (3.6, 2.5), p<0.001; 0.59 (0.33, 0.85). Grip Strength, kg force (n=62): 20.3±9.4; 23.6±10.6; 3.3 (4.8, 1.7); p<0.001; 0.33 (-0.03, 0.68).
Conclusion(s): All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls. Fatigue significantly impacts function in people with IA, often limiting confidence and willingness to participate in exercise activities.
Cost and savings
No additional information available
Implications
Effective evidence-based PRTPs for people with IAs can be delivered in an NHS service. Improvements in function, well-being, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring people’s perspectives of the PRTP and adherence to long-term exercise is needed.
Top three learning points
No further data available
Funding acknowledgements
This work was not funded.