Thompson J1, Williamson E1, Srikesavan C1, Lamb SE1
1University of Oxford, Nuffield Department of Orthopedics, and Musculoskeletal Sciences, Oxford, United Kingdom
Background: The Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH) is a 12-week exercise programme for people with hand problems due to rheumatoid arthritis (RA); delivered in six sessions by a hand therapist. The SARAH programme is clinically and cost-effective and recommended in clinical guidelines. It is uncertain if the programme can be delivered as part of routine care in the National Health Service (NHS) in the United Kingdom and improve patient outcomes.
Purpose: To evaluate the implementation of the SARAH programme into routine NHS care.
Methods: An online programme (iSARAH) was made freely available to train NHS therapists. Therapists who complete this training are invited to deliver the SARAH programme in their departments. Patients are invited to take part in the service evaluation. Those who agreed to take part gave permission for their contact details to be shared with the study team for the administration of a follow-up questionnaire. The therapist collected data during the programme sessions. Data included the Michigan Hand Outcomes Questionnaire hand function subscale (0-100), grip strength and pain (5-point scale). Patient-perceived global recovery, satisfaction, and usefulness of the SARAH programme were collected during the final session. At 4 months' follow-up, patients were sent a postal questionnaire measuring function, pain, global recovery, and frequency of home exercise sessions. The Wilcoxon signed-rank test was used to compare pre- and post-treatment scores.
Results: We contacted 90 therapists who agreed to be contacted about the service evaluation after completing the iSARAH training. 19 therapists from 14 NHS Trusts agreed to participate.
59 patients have been enrolled. 14 patients have completed the SARAH programme with data returned to the study team by the treating therapist. We present this data here.
The majority of patients were female (86%). The median age was 64.5 (interquartile range [IQR] 54-71) years and RA duration was 5.5 (IQR: 1.0-18.75) years.
At baseline, the median pain score was 3 (IQR: 2-3) and median hand function was 47 (IQR: 42.5-57.5). The median grip strength of the left hand was 12.33 (IQR: 9.20-15.50) Kg and right hand was 16.67 (IQR: 11.67-21.67) Kg.
At the final session, the median pain score was 2 (IQR: 1-3) and median hand function was 70.0 (IQR: 60.0-75.0). The median grip strength of the left hand was 14.67 (IQR: 11.72-18.50) Kg and right hand was 17.0 (IQR: 10.91-23.25) Kg.
Significant improvements were observed in pain (p=0.017), hand function (p=0.003), and grip strength of the left hand (p=0.014). All patients were satisfied with the programme and perceived as useful. Twelve patients (85.71%) reported improvements in the arthritis of their hands.
4-month follow-up data is not yet available. The study is ongoing and updated results will be presented at the WCPT 2019.
Conclusion(s): The evidence-based SARAH programme can be successfully delivered in routine NHS care. Early improvements in pain, function, and grip strength were detected on completion of the programme and the majority of patients reported benefit. The evaluation needs to be completed.
Implications: Providing an evidence-based hand exercise programme has the potential to improve patient care.
Keywords: Service evaluation, Rheumatoid arthritis, Clinical outcomes
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Purpose: To evaluate the implementation of the SARAH programme into routine NHS care.
Methods: An online programme (iSARAH) was made freely available to train NHS therapists. Therapists who complete this training are invited to deliver the SARAH programme in their departments. Patients are invited to take part in the service evaluation. Those who agreed to take part gave permission for their contact details to be shared with the study team for the administration of a follow-up questionnaire. The therapist collected data during the programme sessions. Data included the Michigan Hand Outcomes Questionnaire hand function subscale (0-100), grip strength and pain (5-point scale). Patient-perceived global recovery, satisfaction, and usefulness of the SARAH programme were collected during the final session. At 4 months' follow-up, patients were sent a postal questionnaire measuring function, pain, global recovery, and frequency of home exercise sessions. The Wilcoxon signed-rank test was used to compare pre- and post-treatment scores.
Results: We contacted 90 therapists who agreed to be contacted about the service evaluation after completing the iSARAH training. 19 therapists from 14 NHS Trusts agreed to participate.
59 patients have been enrolled. 14 patients have completed the SARAH programme with data returned to the study team by the treating therapist. We present this data here.
The majority of patients were female (86%). The median age was 64.5 (interquartile range [IQR] 54-71) years and RA duration was 5.5 (IQR: 1.0-18.75) years.
At baseline, the median pain score was 3 (IQR: 2-3) and median hand function was 47 (IQR: 42.5-57.5). The median grip strength of the left hand was 12.33 (IQR: 9.20-15.50) Kg and right hand was 16.67 (IQR: 11.67-21.67) Kg.
At the final session, the median pain score was 2 (IQR: 1-3) and median hand function was 70.0 (IQR: 60.0-75.0). The median grip strength of the left hand was 14.67 (IQR: 11.72-18.50) Kg and right hand was 17.0 (IQR: 10.91-23.25) Kg.
Significant improvements were observed in pain (p=0.017), hand function (p=0.003), and grip strength of the left hand (p=0.014). All patients were satisfied with the programme and perceived as useful. Twelve patients (85.71%) reported improvements in the arthritis of their hands.
4-month follow-up data is not yet available. The study is ongoing and updated results will be presented at the WCPT 2019.
Conclusion(s): The evidence-based SARAH programme can be successfully delivered in routine NHS care. Early improvements in pain, function, and grip strength were detected on completion of the programme and the majority of patients reported benefit. The evaluation needs to be completed.
Implications: Providing an evidence-based hand exercise programme has the potential to improve patient care.
Keywords: Service evaluation, Rheumatoid arthritis, Clinical outcomes
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Topic: Rheumatology; Musculoskeletal: upper limb; Disability & rehabilitation
Ethics approval required: No
Institution: University of Oxford
Ethics committee: Clinical Trials and Research Governance (CTRG)
Reason not required: This was service evaluation of routine care and not a research study. Audit departments at each participating hospital provided local approval.
All authors, affiliations and abstracts have been published as submitted.
