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.
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).
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
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
This work was not funded.