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Title: Understanding prescribed dose in hand strengthening exercise for rheumatoid arthritis: A secondary analysis of the SARAH trial
Authors: Boniface, G
Sanchez-Santos, ME
Norris, M
O'Connell, NE
Williamson, E
Lamb, SE
Issue Date: 16-May-2022
Publisher: Wiley
Citation: Boniface, G. et al.. (2022) 'Understanding prescribed dose in hand strengthening exercise for rheumatoid arthritis: A secondary analysis of the SARAH trial', Musculoskeletal Care, 20 (4), pp.899 - 907 (9). doi: 10.1002/msc.1646.
Abstract: Copyright © 2022 The Authors. Objective 1) To identify therapist or participant characteristics associated with prescribed dose of hand strengthening exercise in adults with rheumatoid arthritis and 2) To determine the impact of dose prescribed on outcome (hand function and grip strength). Methods Overall dose was calculated using area under the curve (AUC). Analysis 1 assessed the association between therapist professional background, therapist grade, baseline participant physical and psychological characteristics and prescribed dose. Analyses 2 and 3 estimated the relationship between prescribed dose and overall hand function and grip strength. Generalised estimating equation linear regression analysis was used. Results Analysis 1: Being treated by an occupational therapist (β = −297.0, 95% CI −398.6, −195.4), metacarpophalangeal joint deformity (β = −24.1, 95% CI −42.3, −5.9), a higher number of swollen wrist/hand joints (β = −11.4, 95% CI −21.6, −1.2) and the participant feeling downhearted and low all of the time (β = −293.6, 95% CI −436.1, −151.1) were associated with being prescribed a lower dose. Being treated by a grade 6 therapist (β = 159.1, 95% CI 65.7, 252.5), higher baseline grip strength (β = 0.15, 95% CI 0.02, 0.28) and greater participant confidence to exercise without fear of making symptoms worse (β = 18.9, 95% CI 1.5, 36.3) were associated with being prescribed a higher dose. Analyses 2 and 3: Higher dose was associated with greater overall hand function (β = 0.005, 95% CI 0.001, 0.010) and full-hand grip strength (β = 0.014, 95% CI 0.000, 0.025) at 4-month. Conclusion Higher dose was associated with better clinical outcomes. Prescription of hand strengthening exercise is associated with both therapist and participant characteristics.
Description: Data Availability Statement: Research data are not shared.
Ethics Statement: Ethical approval for the current project was granted by Brunel University London Research Ethics Committee (13763-LR-Jan/2019- 17,357-1). The SARAH trial (ISRCTN registration number: 89,936,343) was originally approved by the Oxford C Multi-Centre Research Ethics Committee (MREC 08/H0606/47) in addition to the research and development departments for each NHS site.
ISSN: 1478-2189
Other Identifiers: ORCID iD: Graham Boniface; Maria T. Sanchez‐Santos; Meriel Norris ; ; Neil E. O'Connell; Esther Williamson
Appears in Collections:Dept of Health Sciences Research Papers

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