Journal Club Article December 2017

December, 2017:  “Will squeezing a rubber ball help my arthritis?”

Østerås N et al: Exercise for Hand Osteoarthritis: A Cochrane Systematic Review. J Rheumatol 2017 Oct 15. pii: jrheum.170424. doi: 10.3899/jrheum.170424. [Epub ahead of print

The beneficial effects of exercise on pain and function for individuals with hip and knee osteoarthritis are well documented. Is the same true for hands?

Investigators from Norway recently reported the results of a Cochrane systematic review of five randomized controlled studies that included a total of 381 participants and that assessed the effect of exercise on pain, function, and digital stiffness stemming from hand osteoarthritis.

The sample sizes of the included studies varied from 19 to 130 participants, most of whom were women with their mean age most frequently between 60 and 65 years. The exercises varied widely in terms of type, inclusion/exclusion of shoulder and elbow exercises, frequency (three times daily to three times weekly), and degree of supervision (from home-based to fully supervised). Self-reported adherence to home exercise programs in four studies ranged from 78% to 94%.

Results: Exercise produced statistically significant beneficial effects on hand pain, hand function, and digital stiffness. The effects, however were small. On ten-point scales, exercise reduced pain .5 points and stiffness .7 points. On a 36-point scale, exercise improved function 2.2 points. Adverse effects were infrequent and minor.

Two studies provided six-month follow-up data on a total of 220 participants, and one study (130 subjects) reported 12-month follow-up data. Pooled results at these intervals showed an uncertain effect on pain, function, and stiffness.

Discussion: The authors note that even though exercise produced positive results over controls, the effects were small and “may not be clinically meaningful.” They noted that base-line scores for pain, function, and stiffness were generally mild to moderate, which left a limited range for improvement.

The investigators compared exercise to previously reported results for splinting or non-steriodal anti-inflammatory medications, and the results for all three treatments were similar.

They also note that that their systematic review did not reveal the optimal exercise dosage for people with hand osteoarthritis, and self-reported adherence compounds the issue. They suggest that the dosages actually used in these pooled studies may have been insufficient to produce an optimal effect.

Comment: So when a patient asks, “Will squeezing a rubber ball help my osteoarthritis?” what should we say? According to this study, not much. The subjects included in the review generally had mild to moderate symptoms, and the effects of exercise for them were small and not sustained. One could argue either way that patients with more severe symptoms might benefit more or less from exercise. Likewise, would an exercise program maintained indefinitely produce more benefits or would the sustained exercise hasten disease advancement?

Most patients like to be proactive and do what they can to minimize or relieve symptoms. Some even grasp at entirely unproven and commercially-driven “fountains of youth” such as copper bracelets and magnets.

For patients with multiple joints bothersome from osteoarthritis, I often recommend a paraffin bath for home use and elasticized digital sleeves. Based on information provided in the review article, I am likely to say, “Don’t make a fetish out of exercises, they are probably not worth your time and effort. Use your hands for activities that you enjoy, which might include tossing a rubber ball to your dog.”

I recently came across these silicone digital sleeves and have given them to several patients with achy pip joints. The sleeves offer gentle compression and motion restriction. They seem to fit fingers of all sizes, their length can be easily trimmed, and they do not get soggy. I have no vested interest in them. Let me know if you have used these or similar sleeves and I will post your responses next month.