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  5. Lunina N.V., Ibragimova K.O. Restoration of hand function in women with rheumatoid arthritis through physical rehabilitation

Lunina N.V., Ibragimova K.O. Restoration of hand function in women with rheumatoid arthritis through physical rehabilitation

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Publication date: 15.06.2024
DOI: 10.24412/2782-6570-2024_03_02_4
UDC 376.2

RESTORATION OF HAND FUNCTION IN WOMEN WITH RHEUMATOID ARTHRITIS THROUGH PHYSICAL REHABILITATION

N.V. Lunina1,2, K.O. Ibragimova1

1Russian University of Sport “GTSOLIFK”, Moscow, Russia
2FSBI “North-Caucasian Federal Research-Clinical Center of the Federal Medical and Biological Agency”, Essentuki, Russia

Abstract. The article presents the effects of restoring hand function in women with rheumatoid arthritis through physical rehabilitation. The duration of the physical rehabilitation course was 8 weeks. The following methods were used: morning hygiene exercises, therapeutic gymnastics, independent exercises, therapeutic massage, hydrokinesitherapy, mechanotherapy, occupational therapy, physiotherapy, balneotherapy, Nordic walking. Restoration of hand function in women with rheumatoid arthritis was determined by a significant (p≤0.05) improvement in following indices: according to goniometry, an increase in flexion in the wrist joint of the more affected hand by 20.5%, extension – by 24.1%; in the less affected hand – flexion by 13.4% and extension by 15.8%. According to hand dynamometry, muscle strength increased in the more affected hand by 33.7%, in the less affected hand – by 24%. Indices of hand function (according to the Jebsen-Taylor test) improved by 28% in the more affected hand, and by 32.2% in the less affected hand. Assessment of functional capacity in daily life (according to the Health Assessment Questionnaire) improved by 36.4%. Pain syndrome decreased by 60.2% (on the Visual Analogue Scale). The results obtained during the study reflect the effectiveness of restoring the hand function in women with rheumatoid arthritis through medical rehabilitation.

Keywords: recovery, function, hand, women, rheumatoid arthritis, means of physical rehabilitation.

Introduction. Rheumatoid arthritis (RA) is one of the most common and severe chronic autoimmune disease. According to World Health Organization, prevalence of such pathology in the population amounts from 0.5 to 2% [1]. This disease is common in people of all ages, but most cases occur at the age of 40 to 55 years, when people are in their working years [2]. RA is more common in women, with a ratio of 3:1 in relation to men. High prevalence, affecting people of working age, leading to early disability and reduced life expectancy due to comorbid diseases, typical signs of RA and various complications make this issue socially significant and urgent.

At the current stage, a wide spectrum of therapeutic measures are used for this category of patients, which, when combined, improve the health state of patients with RA. At the same time, great attention is given to the use of various means and forms of exercise therapy, as physical activity reduces the severity of symptoms, improving the quality of life of patients, and prevents further progression of the disease [3].

Aim of the study: to investigate the effectiveness of a complex of physical rehabilitation means to restore the hand function in women with RA.

Methods and organization. The study took place in the Edelweiss Center of Doctor Bubnovskij (Moscow). It included women (n=7) aged 45 to 50 years with rheumatoid lesions of the hand joints during the period of low activity of the disease: 1 = (2.6 ≤ DAS-28 ≤ 3.2) (DAS – Disease Activity Score).

Hand function was assessed by following methods:
1) goniometry was used to define movement amplitude (flexion and extension) in the wrist joint (in °);
2) hand dynamometry assessed the strength of the hand muscles (in kg);
3) the Jebsen-Taylor hand function test [5] was used to assess the motor abilities and dexterity of the hands (in points);
4) the Health Assessment Questionnaire [4] was used to determine the functional capacity in daily life (in points);
5) pain level (in points) was assessed using the Visual Analogue Sale.

The results obtained were processed statistically using the Statistica 13 analysis package. We calculated the following: the arithmetic mean (X), standard deviation (σ). Significance of differences in the studied parameters were examined using the Wilcoxon’s signed rank test (if p<0,05).

The physical rehabilitation (PR) course aimed at restoring hand function of women with RA took 8 weeks. Following tasks were accomplished in the recovery period:
1) reducing pain syndrome in the affected joints of the hand;
2) increasing blood supply in the affected joints of the hand;
3) increasing the movement amplitude in the affected joints of the hand;
4) strengthening the muscles of the shoulder girdle, free upper limb, back;
5) increasing tolerance to physical activity.

The following means and forms of PR were used to solve the indicated problems: morning hygiene gymnastics (daily, at home), therapeutic gymnastics (3 times a week, including calisthenics, respiratory and special exercises), independent exercises (daily, including all of the abovementioned exercises), therapeutic massage (segmental, course of 15 procedures of 20 min each, 5 times a week), hydrokinesitherapy (2 times a week for 40 min, including calisthenics and special exercises for hands with objects and in free swimming), mechanotherapy (on the Gloreha simulator, 2 times a week for 20-30 min), occupational therapy (sessions for developing fine motor skills were conducted on a specialized table (fig. 1), 2 times a week for 25-30 min, then on specialized simulators. Drawing, modeling, writing, cutting out were also recommended), physiotherapy (ozokerite wax applications in the form of gloves, 12 procedures, 2 times a week for 10-15 min), balneotherapy (hydrogen sulfide baths, 9 procedures, 3 times a week for 15 min), it was recommended to include Nordic walking in 6th week of recovery (once a week for 50-60 min).

Fig. 1. Specialized table for the development of fine motor skills

Results and discussion. Restoration of hand function is reflected in the reliable improvement of the studied indices (fig. 2, table). The goniometry indices, being a criterion of successful restoration of movement volume in the wrist joints, reflected the improvement of movement amplitude in more and less affected hand joints. Before the rehabilitation measures, flexion in the more affected hand was 55.6±5.5°, extension – 49.4±3.4°; in the less affected hand, flexion was 65.6±4.4°, extension – 56.9±3.2°. At the end of the study, the volume of movement in the wrist joint increased significantly (p≤0.05): flexion – by 20.5%, extension – by 24.1% in the more affected hand; flexion increased by 13.4%, extension – by 15.8% in the less affected hand (fig. 2).

Fig. 2. Comparison of the goniometry data of the wrist joint, °

Table

Changes in hand function during the recovery course in women with rheumatoid arthritis, X±σ

Index

Before the course

After the course

Hand dynamometry (kg)

Strength of the more affected hand, kg

10.4±1.9

13.9±2.3*

Strength of less affected hand, kg

15±2.1

18.6±1.9*

Motor capabilities and hand dexterity (the Jebsen-Taylor hand function test, points)

Function of the more affected hand, points

100±15.2

72±8,9*

Function of the less affected hand, points

88±13.9

59.7±6.2*

Functional capacity in daily life (HAQ, points)

Functional capacity in daily life, points

1.1±0.3

0.7±0.3*

Pain index (VAS, points)

Pain index, points

5.1±1.5

2.0±1.2*

Note: HAQ – Health Assessment Questionnaire; VAS – Visual Analogue Scale; * – reliable changes in the index at p≤0.05

According to the hand dynamometry data, an increase in muscle strength of the more affected and less affected hand by 33.7% and 24%, respectively, was observed (table). According to the Jebsen-Taylor test evaluating the motor capabilities and dexterity of the hands, acceleration of the performance of the tasks offered in the test is noted, and the hand function indices of the more affected hand improved significantly (p≤0.05) by 28%, and by 32.2% of those of the less affected hand, which amounted to 72±8.9 points and 59.7±6.2 points respectively. HAQ was used to determine the features of functioning in daily life in the study population with RA. Before application of physical rehabilitation means in women 45-50 years old with RA moderate impairments of life activity were revealed, estimated in 1,1±0,3 points, after application the changes amounted to 36,4%, while functional impairments were leveled to minimal, estimated in 0,7±0,3 points. The level of pain assessed by VAS significantly decreased from moderate (5.1±1.5 points) to mild pain (2±1.2 points) (table).

Conclusion. Significant improvement of goniometry, hand dynamometry; improvement of motor capabilities and dexterity of hands, functional abilities in everyday life and reduction of pain level reflect the effectiveness of restoration of hand function in women with RA using the developed complex of physical rehabilitation means.

Conflict of interest. The authors declare no conflict of interest.

REFERENCES

  1. Clinical recommendations. Rheumatoid arthritis. Available at: https://cr.minzdrav.gov.ru/schema/250_2 (accessed 29.11.23) (in Russ.)
  2. Folomeeva O.M., Nasonov E.L., Andrianova I.A., Galushko E.A., Goryachev D.V., Dubinina T.V., Zhornyak A.P., Krichevskaya O.A., Erdes Sh.F. Rheumatoid arthritis in rheumatological care of Russia: the severity of the disease in a Russian patient population: a cross-sectional epidemiological study (raiser). Scientific-practical. Rheumatolo­gy, 2017, vol. 48, no. 1, pp. 50-60. (in Russ.)
  3. Abdrakhmanova A.I., Ustinova S.M., Amirov N.B. Exercises in the management of rheumatoid arthritis. Bulletin of contemporary clinical medicine, 2019, vol. 12, no. 5, pp. 67–72. (in Russ.)
  4. Jebsen R., Taylor N., Trieschmann R., Trotter M., Howard L. An objective and standardized test of hand function. Arch Phys Med Rehabil, 1969, no. 50, pp. 311–319.
  5. Amirdzhanova, V.N. Scales of pain and HAQ in the assessment of a patient with rheumatoid arthritis. Rheumatology Science and Practice, 2006, no. 2, pp. 60-65. (in Russ.).

INFORMATION ABOUT THE AUTHORS:
Natal’ya V. Lunina – Candidate of Biological Sciences, Associate Professor, Associate Professor of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after I.M. Sarkizov-Serazini, Russian University of Sport “GTSOLIFK”, Moscow; Senior Researcher of the Center for Biomedical Technologies, FSBI “North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency”, Essentuki, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..
Karina O. Ibragimova – Bachelor of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after I.M. Sarkizov-Serazini, Russian University of Sport “GTSOLIFK”, Moscow.

For citation: Lunina N.V., Ibragimova K.O. Restoration of hand function in women with rheumatoid arthritis through physical rehabilitation. Russian Journal of Sports Science: Medicine, Physiology, Training, 2024, vol. 3, no. 2. DOI: 10.24412/2782-6570-2024_03_02_4

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