Vis sammendrag
Hand osteoarthritis (OA) is a prevalent joint disease that may lead to pain, stiffness and problems in performing hand-related activitiesof daily living. Currently, no cure for OA is known, and non-pharmacological modalities are recommended as first-line care. A positive
effect of exercise in hip and knee OA has been documented, but the effect of exercise on hand OA remains uncertain.
To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with
hand OA. Main outcomes are hand pain and hand function.
We searched six electronic databases up until September 2015.
All randomised and controlled clinical trials comparing therapeutic exercise versus no exercise or comparing different exercise programmes.
Two review authors independently selected trials, extracted data, assessed risk of bias and assessed the quality of the body of evidence
using the GRADE approach. Outcomes consisted of both continuous (hand pain, physical function, finger joint stiffness and quality
of life) and dichotomous outcomes (proportions of adverse events and withdrawals).
We included seven studies in the review. Most studies were free from selection and reporting bias, but one study was available only
as a congress abstract. It was not possible to blind participants to treatment allocation, and although most studies reported blinded
outcome assessors, some outcomes (pain, function, stiffness and quality of life) were self-reported. The results may be vulnerable to
performance and detection bias owing to unblinded participants and self-reported outcomes. Two studies with high drop-out rates may
be vulnerable to attrition bias.We downgraded the overall quality of the body of evidence to low owing to potential detection bias (lack
of blinding of participants on self-reported outcomes) and imprecision (studies were few, the number of participants was limited and
Exercise for hand osteoarthritis (Review) 1
Copyright © 2017 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
confidence intervals were wide for the outcomes pain, function and joint stiffness). For quality of life, adverse events and withdrawals
due to adverse events, we further downgraded the overall quality of the body of evidence to very low because studies were very few and
confidence intervals were very wide.
Low-quality evidence fromfive trials (381 participants) indicated that exercise reduced hand pain (standardised mean difference (SMD)
-0.27, 95% confidence interval (CI) -0.47 to -0.07) post intervention. The absolute reduction in pain for the exercise group, compared
with the control group, was 5% (1% to 9%) on a 0 to 10 point scale. Pain was estimated to be 3.9 points on this scale (0 = no pain)
in the control group, and exercise reduced pain by 0.5 points (95% CI 0.1 to 0.9; number needed to treat for an additional beneficial
outcome (NNTB) 9).
Four studies (369 participants) indicated that exercise improved hand function (SMD -0.28, 95% CI -0.58 to 0.02) post intervention.
The absolute improvement in function noted in the exercise group, compared with the control group, was 6% (0.4% worsening to
13% improvement). Function was estimated at 14.5 points on a 0 to 36 point scale (0 = no physical disability) in the control group,
and exercise improved function by 2.2 points (95% CI -0.2 to 4.6; NNTB 9).
One study (113 participants) evaluated quality of life, and the effect of exercise on quality of life is currently uncertain (mean difference
(MD) 0.30, 95% CI -3.72 to 4.32). The absolute improvement in quality of life for the exercise group, compared with the control
group, was 0.3% (4% worsening to 4% improvement). Quality of life was 50.4 points on a 0 to 100 point scale (100 = maximum
quality of life) in the control group, and the mean score in the exercise group was 0.3 points higher (3.5 points lower to 4.
