Look at that, a protocol for hand exercises that can be reviewed and commented on. For stroke we have jackshit, there is really nothing science-based about stroke rehab, it all seems to be 'Winging it'. You had better be comfortable with complete ambiguity because you are going to get nothing concrete except maybe they'll warn you that only 10% get to complete recovery. And they have no clue as to which 10% will make it. Of course apologists will remind us of their standard excuse, 'All strokes are different, all stroke recoveries are different'. I call bullshit on that and you will need to challenge whomever tells you that. There are 11 million stroke survivors a year, a massive number that could handle thousands of clinical trials every year. We can find answers, we just have to put in place people who will look for answers rather than sitting on their asses waiting for someone else to solve the problem.
Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial
Dr Sarah E Lamb DPhil a b 
, , on behalf of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Trial (SARAH) Trial Team†
, , on behalf of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Trial (SARAH) Trial Team†Summary
Background
Disease-modifying
biological agents and other drug regimens have substantially improved
control of disease activity and joint damage in people with rheumatoid
arthritis of the hand. However, commensurate changes in function and
quality of life are not always noted. Tailored hand exercises might
provide additional improvements, but evidence is lacking. We estimated
the effectiveness and cost-effectiveness of tailored hand exercises in
addition to usual care during 12 months.
Methods
In
this pragmatic, multicentre, parallel-group trial, at 17 National
Health Service sites across the UK we randomly assigned 490 adults with
rheumatoid arthritis who had pain and dysfunction of the hands and had
been on a stable drug regimen for at least 3 months, to either usual
care or usual care plus a tailored strengthening and stretching hand
exercise programme. Participants were randomly assigned with
stratification by centre. Allocation was computer generated and unmasked
to participants and therapists delivering treatment after
randomisation. Outcome assessors and all investigators were masked to
allocation. Physiotherapists or occupational therapists gave the
treatments. The primary outcome was the Michigan Hand Outcomes
Questionnaire overall hand function score at 12 months. The analysis was
by intention to treat. We calculated cost per quality-adjusted
life-year. This trial is registered as ISRCTN 89936343.
Findings
Between
Oct 5, 2009, and May 10, 2011, we screened 1606 people, of whom 490
were randomly assigned to usual care (n=244) or tailored exercises
(n=246). 438 of 490 participants (89%) provided 12 month follow-up data.
Improvements in overall hand function were 3·6 points (95% CI 1·5—5·7)
in the usual care group and 7·9 points (6·0—9·9) in the exercise group
(mean difference between groups 4·3, 95% CI 1·5—7·1; p=0·0028). Pain,
drug regimens, and health-care resource use were stable for 12 months,
with no difference between the groups. No serious adverse events
associated with the treatment were recorded. The cost of tailored hand
exercise was £156 per person; cost per quality-adjusted life-year was
£9549 with the EQ-5D (£17 941 with imputation for missing data).
Interpretation
We
have shown that a tailored hand exercise programme is a worthwhile,
low-cost intervention to provide as an adjunct to various drug regimens.
Maximisation of the benefits of biological and DMARD regimens in terms
of function, disability, and health-related quality of life should be an
important treatment aim.
Funding
UK National Institute of Health Research Health Technology Assessment Programme (NIHR HTA), project number 07/32/05.
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