Effectiveness of longstanding exercise therapy compared with usual care for people with rheumatoid arthritis and severe functional limitations: a randomised controlled trial

Teuwen, M.M.H.; Weely, S.F.E. van; Vlieland, T.P.M.V.; Wissen, M.A.T. van; Peter, W.F.; Broeder, A.A. den; ... ; Gademan, M.G.J. (2024)

Article / Letter to editor

Objectives To compare the effectiveness of longstanding (>52 weeks), supervised exercise therapy with usual care in adults with rheumatoid arthritis (RA) and severe functional limitations.

Methods Participants were randomised 1:1 to the intervention (individualised goal-setting, active exercises, education and self-management regarding physical activity) or usual care. Primary endpoint was the change in the Patient-Specific Complaints activity ranked 1 (PSC1, 0–10) at 52 weeks. Secondary endpoints included the PSC activities ranked 2 and 3 (PSC2, PSC3), Health Assessment Questionnaire-Disability Index (HAQ-DI), Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL), 6-minute walk test (6MWT), Patient Reported Outcome Measurement Information System Physical Function-10 (PROMIS PF-10) and the Short Form-36 Physical and Mental Component Summary Scales (SF-36 PCS and MCS). (Serious) Adverse events (AEs) were recorded. Measurements were done by blinded assessors. Analyses at 52 weeks were based on the intention-to-treat principle.

Results In total, 217 people (90% female, age 58.8 (SD 12.9) years) were randomised (n=104 intervention, n=98 usual care available for analyses). At 52 weeks, the improvement of the PSC1 was significantly larger in the intervention group (mean difference (95% CI) −1.7 (−2.4, –1.0)). Except for the SF-36 MCS, all secondary outcomes showed significantly greater improvements favouring the intervention (PSC2 −1.8 (−2.4, –1.1), PSC3 −1.7 (−2.4, −1.0), PROMIS PF-10 +3.09 (1.80, 4.38), HAQ-DI −0.17 (−0.29, –0.06), RAQoL −2.03 (−3.39, –0.69), SF-36 PCS +3.83 (1.49, 6.17) and 6MWT +56 (38, 75) m). One mild, transient AE occurred in the intervention group.

Conclusion Longstanding, supervised exercise therapy was more effective than usual care in people with RA and severe functional limitations.

• Rheumatoid Arthritis
• Physical Therapy Modalities
• Patient Reported Outcome Measures

• All authors: Teuwen, M.M.H.; Weely, S.F.E. van; Vlieland, T.P.M.V.; Wissen, M.A.T. van; Peter, W.F.; Broeder, A.A. den; Schaardenburg, D. van; Hout, W.B. van den; Ende, C.H.M. van den; Gademan, M.G.J.
• Date: 2024-04-30
• Journal: Annals of the Rheumatic Diseases
• Volume: 83
• Issue: 4
• Pages: 437 - 445
• DOI: doi:10.1136/ard-2023-224912