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Personalized Physical Therapy Versus Usual Care for Patients With Systemic Sclerosis: A Randomized Controlled Trial
François Rannou1, Isabelle Boutron2, Luc Mouthon3
1AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153, Paris, France.
Arthritis Care & Research
|October 4, 2016
Summary
A personalized physical therapy program for systemic sclerosis (SSc) patients showed short-term disability improvements but no significant long-term benefits at 12 months. This approach did reduce microstomia and pain in the short term.
Area of Science:
- Rheumatology
- Rehabilitation Medicine
- Clinical Trials
Background:
- Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by widespread fibrotic damage, leading to significant disability.
- Assessing the efficacy of targeted interventions like physical therapy is crucial for managing SSc-related functional limitations.
Purpose of the Study:
- To evaluate the long-term effectiveness of a structured physical therapy program compared to usual care in improving disability among patients with systemic sclerosis (SSc).
Main Methods:
- A 12-month, parallel-group randomized controlled trial using a modified Zelen design was conducted across four tertiary care hospitals.
- Participants with SSc and significant disability (HAQ DI ≥0.5) or joint/mouth limitations received either a 1-month supervised physical therapy program followed by home sessions or usual care.
- The primary outcome measure was the Health Assessment Questionnaire disability index (HAQ DI) score at 12 months.
Main Results:
- No statistically significant difference in disability (HAQ DI) was observed between the physical therapy group and usual care at 12 months (difference -0.01, P=0.86).
- The physical therapy group demonstrated statistically significant improvements in disability at 1 month (difference -0.14, P=0.01), hand mobility, and pain.
- Reduced microstomia was observed in the physical therapy group at 1, 6, and 12 months (P=0.01 at 12 months). No increased adverse effects were noted.
Conclusions:
- A personalized physical therapy program does not provide statistically significant long-term disability reduction in SSc patients at 12 months compared to usual care.
- However, the program offers short-term benefits, including improved disability, hand function, pain reduction, and decreased microstomia.
- Further research may explore optimizing the duration and components of physical therapy for sustained benefits in SSc management.
