Exercise therapy in people with rheumatoid arthritis and severe functional disability

Abstract

Rheumatoid arthritis (RA) is an inflammatory condition that frequently leads to significant disability. Exercise therapy is recommended to reduce functional limitations, with evidence supporting its effectiveness; however, evidence for the (cost-)effectiveness of exercise therapy in patients with severe functional disability, due to high disease activity, joint damage, or comorbidities, is limited. Additionally, knowledge gaps exist regarding the optimal outcome measures for the evaluation of functional ability and the monitoring of safety of exercises in exercise therapy trials. This thesis addresses these gaps by evaluating the effectiveness and cost-effectiveness of a long-term personalized, supervised exercise therapy intervention versus standard care for RA patients with severe functional disability. It also explores the usage and applicability of various outcome measures concerning the effectiveness and safety of exercise therapy. Findings show that this long-term exercise therapy intervention significantly improves physical function and quality of life compared to standard care, with economic analyses indicating that despite slightly higher costs, there are no economic reasons to refrain from the implementation of the intervention. The National Health Care Institute recommended, and the Minister approved, reimbursement. Starting January 1, 2025, the basic health insurance will cover long-term exercise therapy for RA patients over 18 with severe functional disability.