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Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people

Linda Kwakkenbos1,2, Marie-Eve Carrier3, Joep Welling4

  • 1Clinical Psychology, Radboud University, Nijmegen, The Netherlands.

Trials
|December 12, 2022
PubMed
Summary

Offering an online hand exercise program to systemic sclerosis patients did not improve hand function. Low engagement with the SPIN-HAND program limited its effectiveness, suggesting group formats or therapist support may enhance outcomes.

Keywords:
Cohort multiple RCTOccupational therapyPhysical therapyRandomized controlled trialScleroderma, SystemicSystemic sclerosisTele-rehabilitation

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Area of Science:

  • Rheumatology
  • Rehabilitation Medicine
  • Clinical Trials

Background:

  • Systemic sclerosis (SSc) is a rare autoimmune disease frequently causing hand dysfunction.
  • The Scleroderma Patient-centered Intervention Network (SPIN)-HAND trial investigated an online self-guided hand exercise program.
  • Participants had SSc with at least mild hand function limitations.

Purpose of the Study:

  • To compare the effects of offering access to the SPIN-HAND program versus usual care on hand function in SSc patients.
  • To evaluate secondary outcomes including functional health and hand function at 6 months.
  • To assess the impact of an online intervention on patients with systemic sclerosis.

Main Methods:

  • A pragmatic, cohort multiple randomized controlled trial embedded within the SPIN Cohort.
  • Participants with Cochin Hand Function Scale (CHFS) scores ≥3 were randomized (3:2) to receive an offer of the SPIN-HAND program or usual care.
  • The primary outcome was the difference in CHFS scores at 3 months; secondary outcomes included CHFS scores at 6 months and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.

Main Results:

  • 466 participants were randomized; 61% of those offered the program accessed it, with 45% logging in at least 3 times.
  • Intent-to-treat analysis showed no statistically significant difference in CHFS scores at 3 months (1.2 points lower, 95% CI -2.8 to 0.3) or 6 months (0.1 points lower, 95% CI -1.8 to 1.6) between groups.
  • No significant differences were observed in other functional health outcomes.

Conclusions:

  • The offer to use the SPIN-HAND Program did not lead to significant improvements in hand function for SSc patients.
  • Low uptake and usage of the online program hindered the assessment of its potential benefits.
  • Future research could explore group-based delivery or integration with physical/occupational therapy to enhance patient engagement.