Journal Article Review, January 2019

Does fluidotherapy improve hand function in patients with rheumatoid arthritis?

Gunduz E et al: Is dry heat treatment (fluidotherapy) effective in improving hand function in patients with rheumatoid arthritis? A randomized controlled trial. Clin Rehabil. 2018 Nov 18:2692

If you read these journal article reviews with any regularity (or attend DD Current Science), you know that I like randomized controlled trials to guide our clinical decision making. We need more Level I and Level II studies rather than relying on intuition or expert opinion. So I was glad to see this recent, excellent Level II study.¬† Continue reading…

Turkish investigators randomized 93 patients with rheumatoid arthritis into two groups. Both groups participated in a joint protection and exercise program. This consisted of information and education regarding rheumatoid arthritis, methods of coping with pain and stress, relaxation and joint protection techniques, and gentle strengthening and stretching exercises for joint motion. Group I also received fluidotherapy 15 minutes daily, five days a week for three weeks. The control patients (Group II) were seen weekly for the first month, then monthly  for monitoring.

Outcome measures were the Health Assessment Questionnaire, the Durouz Hand Index, the Disease Activity Score-28, and measures of pain, stiffness, and grip strength. These data were collected at base line and then again at three and twelve weeks.

The two groups were well matched regarding multiple characteristics, including age, disease severity and duration, frequency of exercise and analgesic administration, hand dominance, presence of deformity.

For baseline characteristics, Group I had a significantly poorer Health Assessment Questionnaire, otherwise there were no significant differences between the groups at the outset.

Forty patients in each group completed the study. At three weeks, the groups were both improved yet significantly identical for all measures. At week 12, the Duruoz Hand Index scores were significantly better for Group II (control).

COMMENT: This was a carefully designed and executed study. The authors conclude that dry heat was not effective in improving hand function. They cite a 1992 article that found a similar result for the use of wax baths for patients with rheumatoid arthritis. For me, the bottom line is that patient education regarding coping and relaxing and protecting, gently strengthening, and stretching joints is helpful. Two different heat modalities provide no added benefit yet have both temporal and monetary costs.