Effectiveness of longstanding exercise therapy compared with usual care for people with rheumatoid arthritis and severe functional limitations: a randomised controlled trial

Max M H Teuwen; Salima F E van Weely; Thea P M Vliet Vlieland; Maria A T van Wissen; Wilfred F Peter; Alfons A den Broeder; Dirkjan van Schaardenburg; Wilbert B van den Hout; Cornelia H M Van den Ende; Maaike G J Gademan

doi:10.1136/ard-2023-224912

Effectiveness of longstanding exercise therapy compared with usual care for people with rheumatoid arthritis and severe functional limitations: a randomised controlled trial

Ann Rheum Dis. 2024 Mar 12;83(4):437-445. doi: 10.1136/ard-2023-224912.

Affiliations

¹ Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands m.m.h.teuwen@lumc.nl.
² Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
³ Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
⁴ Center for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands.
⁵ Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
⁷ Rheumatology, Radboudumc, Nijmegen, The Netherlands.
⁸ Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 38171602
DOI: 10.1136/ard-2023-224912

Abstract

Objectives: To compare the effectiveness of longstanding (>52 weeks), supervised exercise therapy with usual care in adults with rheumatoid arthritis (RA) and severe functional limitations.

Methods: Participants were randomised 1:1 to the intervention (individualised goal-setting, active exercises, education and self-management regarding physical activity) or usual care. Primary endpoint was the change in the Patient-Specific Complaints activity ranked 1 (PSC1, 0-10) at 52 weeks. Secondary endpoints included the PSC activities ranked 2 and 3 (PSC2, PSC3), Health Assessment Questionnaire-Disability Index (HAQ-DI), Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL), 6-minute walk test (6MWT), Patient Reported Outcome Measurement Information System Physical Function-10 (PROMIS PF-10) and the Short Form-36 Physical and Mental Component Summary Scales (SF-36 PCS and MCS). (Serious) Adverse events (AEs) were recorded. Measurements were done by blinded assessors. Analyses at 52 weeks were based on the intention-to-treat principle.

Results: In total, 217 people (90% female, age 58.8 (SD 12.9) years) were randomised (n=104 intervention, n=98 usual care available for analyses). At 52 weeks, the improvement of the PSC1 was significantly larger in the intervention group (mean difference (95% CI) -1.7 (-2.4, -1.0)). Except for the SF-36 MCS, all secondary outcomes showed significantly greater improvements favouring the intervention (PSC2 -1.8 (-2.4, -1.1), PSC3 -1.7 (-2.4, -1.0), PROMIS PF-10 +3.09 (1.80, 4.38), HAQ-DI -0.17 (-0.29, -0.06), RAQoL -2.03 (-3.39, -0.69), SF-36 PCS +3.83 (1.49, 6.17) and 6MWT +56 (38, 75) m). One mild, transient AE occurred in the intervention group.

Conclusion: Longstanding, supervised exercise therapy was more effective than usual care in people with RA and severe functional limitations.

Trial registration number: Netherlands Trial Register (NL8235), included in the International Clinical Trial Registry Platform (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).

Keywords: Patient Reported Outcome Measures; Physical Therapy Modalities; Rheumatoid Arthritis.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Arthritis, Rheumatoid* / drug therapy
Exercise
Exercise Therapy
Female
Humans
Male
Middle Aged
Quality of Life*
Surveys and Questionnaires