Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 5, 2021
Date Accepted: Feb 18, 2022
(closed for review but you can still tweet)
Exercise, Educational and Self-Management Program Delivered with a Smartphone App (CareHand) in Adults with Rheumatoid Arthritis of the Hands: Randomized Controlled Trial
ABSTRACT
Background:
Rheumatoid Arthritis (RA) is a highly prevalent autoimmune disease that usually involves hand or wrist problems. Current evidence recommends a multimodal therapy for RA including exercise, self-management, and educational strategies. To date, the efficacy of this approach as delivered with a smartphone app has been scarcely investigated.
Objective:
To assess the short and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with a conventional approach, for people with RA of the hands.
Methods:
A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with hands RA (22 women, 61%), from two community health-care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, combined with self-management and monitoring tools; or to a Control group that received a written home exercise routine and recommendations on a paper sheet, as the usual protocol provided at primary care settings. Both interventions lasted for three months (4 times a week). The primary outcome was hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (Visual Analogue Scale, VAS), grip (dynamometer) and pinch strength (pinch gauge), and upper limb function (Quick DASH). All measures were collected at baseline and at a 3-month follow-up. Further, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain and Quick DASH were also collected at 1- and 6-months follow-up.
Results:
A total of 30 individuals, corresponding to 58 hands (CareHand group=26, Control group=32) were included in the analysis. Nineteen participants (53%) were under disease-modifying antirheumatic drugs treatment at baseline. The ANOVA demonstrated a significant time*group effect for the total score of the MHQ (F=9.163, P<.001, η2=0.147), and for several of its subscales: hand overall function, work performance, pain, and satisfaction (all, P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70 to 25.03) at 3 months, and 17.21 points (95% CI 4.78 to 29.63) at 6 months. Further, no time*group interaction was observed for any of the secondary measures (all P>.05).
Conclusions:
Adults with RA of the hands that used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared to usual care. The current findings suggest that the CareHand app is a promising digital tool for delivering exercise therapy and self-management recommendations in this population. Results must be interpreted with caution due to the lack of efficacy on the secondary outcomes. Clinical Trial: Clinicaltrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974
Citation
Request queued. Please wait while the file is being generated. It may take some time.