Background:

Impaired grip ability in RA is due to reduced strength in the flexor muscles as well as by dysfunctional extensor muscles leading to inability to open the hand. Furthermore the extensor muscles are important for stabilization during flexion force production and active for developing a controlled grip force. There is today scientific evidence showing that various forms of hand exercise are beneficial for improving hand function and strength in RA patients (Ronningen and Kjeken 2008; Brorsson, Hilliges et al. 2009). However, comparatively little research has evaluated and specific designed hand exercise program for the extensor muscles controlling the hand and fingers (Weiss, Moore et al. 2004; O'Brien, Jones et al. 2006).

Objectives:

The objectives for this study were to evaluate the effect of an exercise program on hand strength, hand function and perceived function of daily life activities among RA patients and to explore the possibility to improve the balance between the extensor and flexor muscle forces in the hand.

Methods:

The study group comprised of 20 patients with RA (median disease duration 20 years) that performed a hand exercise program for twelve weeks. The finger extension force was measured with a newly developed device (EX-it), finger flexion force was measured with the Grippit. Hand function was evaluated with the Grip Ability Test (GAT) and self reported questionnaire Disability Arm Shoulder and Hand (DASH).

Results:

Hand strength (both extension and flexion force) and hand function improved significantly after twelve weeks. The RA group showed improvement in the results of the DASH questionnaire (p < 0.05), but on individual level, the result was partly significant. The relation between extension and flexion force in the hand was not correlated, however, after the exercise there was a strong association between flexion and extension force (p < 0.001). The result on individual level is related to age and duration time.

Conclusion:

Twelve weeks of hand exercise significantly improved hand strength, hand function and perceived function for RA patients. Furthermore, exercise improved the relation between the finger extension and flexion force. Hand exercise is thus an effective intervention for RA patients, providing better strength and function.

References:

1. Brorsson, S., M. Hilliges, et al. (2009). A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis. J Rehabil Med 41(5): 338-42.
2. O'Brien, A.V., P. Jones, et al. (2006). Conservative hand therapy treatments in rheumatoid arthritis–a randomized controlled trial. Rheumatology (Oxford) 45(5): 577-83.
3. Ronningen, A. and I. Kjeken (2008). ffect of an intensive hand exercise programme in patients with rheumatoid arthritis. Scand J Occup Ther: 1-11.
4. Weiss, A. P., D. C. Moore, et al. (2004). Metacarpophalangeal joint mechanics after 3 different silicone arthroplasties. J Hand Surg [Am] 29(5): 796-803.