Effectiveness of an Exercise Program and Education Through a Mobile Application for the Management of Patients With Hand Osteoarthritis and Rheumatoid Arthritis

Effectiveness of a Mobile Application of Exercise and Education for the Management of Patients With Hand Osteoarthritis and Rheumatoid Arthritis on Self-reported Functional Ability, Dexterity, Pinch and Grip Strength, Pain Intensity and Stiffness

Strengthening and stretching exercise programs, and recommendations to protect the affected joint have shown to be effective both clinically and economically in conditions such as hand osteoarthritis and hand rheumatoid arthritis. However, their application format is not up to date. In this sense, problems such as the lack of monitoring by the health professional and the lack of patients motivation may cause poor adherence to the treatment protocol, which is one of the main predictors of treatment efficiency. Therefore, an smartphone application has been developed for the rehabilitation of hand osteoarthritis and rheumatoid arthritis to enhance patients adherence and motivation. The smartphone application includes: a) exercise programs and recommendations based on the most up to date scientific evidence adapted to the pathology; and b) enhancers of patient adherence to treatment (patient diaries and behavioral change strategies).The objective is to develop a cost effective digital solution to optimize the health care offered to these pathologies based on up to date scientific evidence in order to improve the functional ability and the quality of life of these patients, and to reduce the number of consultations to primary and specialized care.

Inclusion Criteria:

1. Hand Osteoarthritis (OA) patients:

   • Subjects with hand osteoarthritis according to the American College of Rheumatology (ACR) classification criteria for clinical OA; hand pain, aching or stiffness and 3 of the following points;

     1. Hard tissue enlargement of 2 or more of 10 hand joints.
     2. Hard tissue enlargement of 2 or more interphalangeal joints.
     3. Fewer than 3 swollen Metacarpal joints.
     4. Deformity of 1 or more of 10 hand joints.

   • Pain and dysfunction in the joints of the hands and/or wrists

   • Possession of a smartphone with internet.

2. Rheumatoid Arthritis (RA) Hand patients:

   • Subjects with hand arthritis according to the American College of Rheumatology (ACR) clinical and immunological criteria for clinical RA. Patients must meet 4 of the following seven criteria:

     1. Morning stiffness in and around joints lasting at least 1 hour.
     2. Swelling in three or more joints.
     3. Swelling in hand or wrist joints,
     4. Symmetrical joint swelling.
     5. erosions or decalcification on radiographs of hand and/or wrist.
     6. Rheumatoid nodules.
     7. Abnormal serum rheumatoid factor.

   • Pain and dysfunction in the joints of the hands and/or wrists.

   • Possession of a smartphone with internet

Exclusion Criteria:

1. Hand Osteoarthritis Patients:

   • Age under 18 years
   • People with cognitive impairment
   • Surgery on any upper limb joint or fracture in the upper limb within the previous 6 months
   • People on the waiting list for upper limb surgery.
   • Persons who have received steroid injections into the joints of their hands in the two months prior to recruitment.
   • People with inflammatory rheumatic disease (arthritis, spondylitis or cancer)

2. Rheumatoid Arthritis Hand Patients

   • Age under 18 years
   • People with cognitive impairment
   • Surgery on any upper limb joint or fracture in the upper limb within the previous 6 months
   • People on the waiting list for upper limb surgery.
   • Pregnancy.