A. Suero-Pineda1, P. Rodríguez Sánchez-Laulhé2, A.M. Heredia Rizo1, Á. Biscarri Carbonero3, F. Barrero García3, V. Rodríguez Papalardo3, A. García López3, L.G. Luque Romero3
1University of Seville, Physiotherapy Department, Seville, Spain, 2FISEVI, Sevilla, Spain, 3Andalusian Public Health System, Sevilla, Spain

Background: Home exercise programs and recommendations have been shown to be efficient and effective for hand osteoarthritis. However, their application format is not updated. The current paper sheet and oral instructions format are not easy to follow for patients at home making these home exercises programs and recommendations inefficient. Among other problems, the lack of monitoring by the physiotherapist or the low motivation generates in the patient poor adherence to treatment, which is the main predictor of treatment efficiency. Due to the current need of tele-rehabilitation solutions and the high incidence of this pathology in the primary centres of public health system, a smartphone application was developed to provide patients with adaptable home exercise programs and recommendations based on the latest scientific evidence; and enhancers of the patient's adherence to treatment.

Purpose: To evaluate the clinical effectiveness of the digital solution proposed in comparison with the conventional method in subjects with osteoarthritis of the hand.

Methods: A randomized, controlled, multicentre, prospective, longitudinal and double-blinded study is presented. Two primary care centres of Andalusian Public Health System selected 65 patients with osteoarthritis of the hand. This prospective clinical trial compared those who received access to the digital home exercise and recommendations program based on a smartphone app (experimental group) with those enrolled in the conventional home exercise and recommendations program guided by paper sheet and oral instructions (control group). At baseline and at 3 months, manual dexterity through Nine Hole Peg Test (NHPT), grip strength, pain (numeric rating scale), and functionality through QuickDASH and AUSCAN were evaluated. A phone follow-up was developed at 6 months based on QuickDASH and AUSCAN scales. During the study time, one physiotherapist realized telephone calls to follow up weekly during the process. Physiotherapists could follow adherence and development of experimental group through a dashboard. They used this information in the follow ups to solve doubts and improve patient´s adherence and development.

Results: Experimental group showed statistically significant improvement at three months in QuickDASH (experimental group (EG) mean of difference (MD) of -12.83 points, control group (CG) MD: -3.27 points, p=0.02) and in the AUSCAN (EG MD of -7.50 points, CG MD: -1.76 points, p=0.02).
Although the mean estimates of effect on the rest of the outcomes also all favoured the experimental group, none reached statistical significance: QuickDASH at 6 months (EG MD: -11.55 points, CG MD: -3.84 points), AUSCAN at 6 months (EC MD: -8.61 points, CG MD: -3.38 points), grip strength at 3 months (EG MD: +1.79 lb, CG MD: -0.25 lb), pain at 3 months (EG MD -0.52 points, CG MD: -0.17 points) and dexterity at 3 months (EG MD: -1.42 seconds, CG MD: -1.22 seconds).

Conclusion(s): These results suggest that the digital solution proposed is clinically more effective than the conventional method employed.

Implications: This results implies an enhancement of patient care through an innovative tele-rehabilitation tool developed by physiotherapists supervision.  

Funding, acknowledgements: This study was supported by the Innovation Projects Grant #AP-0149-2017 of the Health Council of Andalusian Government. Spain

Keywords: Tele-rehabilitation, Hand osteoarthritis, Therapeutic exercises

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? Yes
Institution: Virgen Macarena and Virgen del Rocio University Hospitals, Seville. Spain
Committee: Virgen Macarena and Virgen del Rocio University Hospitals Ethics Committee
Ethics number: PI_RH_2018 - 201811719151

All authors, affiliations and abstracts have been published as submitted.

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