Hand Exercises

Original Editor - Shaimaa Eldib Top Contributors - Shaimaa Eldib and Kim Jackson

Introduction

Hand Exercises are used as an intervention that aims to improve the mobility and strength of the hand and therefore,improving functional ability. Hand exercise may include:

Digit ROM Exercise Handout.jpg
  • Mobilizing exercise (Increase or maintain range of motion)
  • Strengthing exercise ( that use resistance from putty, a gel ball, or elastic band to strengthen hand and wrist muscles)[1]

There are many conditions that may affect the hand and need exercise as an intervention to help patients to perform their ADL activities independently and increase the strength of handgrip. [2]

  • Example of conditions:

Osteoarthritis is the most common joint disease and most frequently affects the hand.[3] This disease leads to pain in and around the affected joints and to swelling, stiffness, deformity, and gradual loss of function. As a result, the ability to perform daily tasks may become impaired or lost.[4] A randomized controlled trail conducted in 2015 found that hand exercises were well tolerated and significantly improved activity performance, grip strength, pain and fatigue in women with HOA[5].

Rheumatoid arthritis is the most common polyarthritis and affecting 1% of the population. Most of RA patients suffer from frequent problems for the hand and wrist like inflammation, deformity (swan neck deformity), pain, weakness, and restricted mobility, resulting in loss of function[1][6].

Hand exercise

iSARAH Hand Exercise

It is a strengthening and stretching exercise programme for the hand to help RA patients[7]. A multicentre trial had been conducted in the UK as around 490 adult patients who suffer from rheumatoid arthritis, hand pain and dysfunction and they had been on a stable drug regime for at least 3months, to either usual care or usual care plus a tailored strengthening and stretching hand exercise programme[8][9]. The study concluded that using a tailored hand exercise programme ( iSARAH) is a worthwhile, low-cost intervention to provide as an adjunct to various drug regimens. [7]

Also, a qualitative longitudinal study[10] was conducted to explore the sustained adherence for hand exercise programme(iSARAH)found that establishing a routine was an important step towards participants being able to exercise independently. Therapists provided participants with the skills to continue to exercise while dealing with changes in symptoms and schedules.[10]

The SARAH programme includes a total of 11 flexibility and strength exercises, supplemented with simple behavioural change support strategies recommended by health professionals to help patients adhere with their SARAH exercises and make hand exercising a daily habit. Any health care professional can take the course of iSARAH hand programme. Please follow this link:

https://www.clahrc-oxford.nihr.ac.uk/blog/sarah-implementing-an-evidence-based-hand-exercise-programme-into-nhs-practice

References

  1. 1.0 1.1 Williams MA, Srikesavan C, Heine PJ, Bruce J, Brosseau L, Hoxey‐Thomas N, Lamb SE. Exercise for rheumatoid arthritis of the hand. Cochrane Database of Systematic Reviews. 2018(7).
  2. Ellegaard K, von Bülow C, Røpke A, Bartholdy C, Hansen IS, Rifbjerg-Madsen S, Henriksen M, Wæhrens EE. Hand exercise for women with rheumatoid arthritis and decreased hand function: an exploratory randomized controlled trial. Arthritis research & therapy. 2019 Dec 1;21(1):158.
  3. Fife RS, Klippel J. Primer on the rheumatic diseases.
  4. Stamm TA, Machold KP, Smolen JS, Fischer S, Redlich K, Graninger W, Ebner W, Erlacher L. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2002 Feb;47(1):44-9.
  5. Hennig T, Hæhre L, Hornburg VT, Mowinckel P, Norli ES, Kjeken I. Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial. Annals of the rheumatic diseases. 2015 Aug 1;74(8):1501-8.
  6. Lamb SE, Williamson EM, Heine PJ, Adams J, Dosanjh S, Dritsaki M, Glover MJ, Lord J, McConkey C, Nichols V, Rahman A. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. The Lancet. 2015 Jan 31;385(9966):421-9.
  7. 7.0 7.1 Hall AM, Copsey B, Williams M, Srikesavan C, Lamb SE, Sarah Trial Team. Mediating effect of changes in hand impairments on hand function in patients with rheumatoid arthritis: exploring the mechanisms of an effective exercise program. Arthritis care & research. 2017 Jul;69(7):982-8.
  8. Lamb SE, Williamson EM, Heine PJ, Adams J, Dosanjh S, Dritsaki M, Glover MJ, Lord J, McConkey C, Nichols V, Rahman A. Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial. The Lancet. 2015 Jan 31;385(9966):421-9.
  9. Williams MA, Williamson EM, Heine PJ, Nichols V, Glover MJ, Dritsaki M, Adams J, Dosanjh S, Underwood M, Rahman A, McConkey C. Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation.
  10. 10.0 10.1 Nichols VP, Williamson E, Toye F, Lamb SE. A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for rheumatoid arthritis evaluated in the SARAH trial. Disability and rehabilitation. 2017 Aug 28;39(18):1856-63.