The online version of an evidence-based hand exercise programme for people with rheumatoid arthritis: An effectiveness-implementation study.
Srikesavan C., Williamson E., Lamb SE.
BACKGROUND: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is an evidence-based exercise program for adults with hand function difficulties due to rheumatoid arthritis. A self-guided online version of the program has been developed for direct access by patients. PURPOSE: To evaluate the delivery of the online program in routine therapy care and its impact on clinical outcomes, before making it widely available. STUDY DESIGN: An effectiveness-implementation study. METHODS: Volunteer patients were identified from National Health Service (NHS) hand therapy departments in the United Kingdom. Patients were given access to the 4-week program, delivered via text, videos, polls, and social discussion forums. Self-reported pain and hand function were collected at baseline, discharge, and telephone follow-up at 4 months. Delivery of baseline and discharge sessions, acceptability, and patient engagement and experience were also explored. RESULTS: A total of 78 patients were enrolled from 18 therapy departments in 15 NHS trusts in England, Scotland, and Wales. Sixty-five patients took part, of whom 46 (71%) registered with the online SARAH program. The majority of baseline and discharge sessions were delivered face-to-face. Pain improved at discharge and was stable at follow-up. Hand function significantly improved with medium effect sizes of Cohen's d of 0.6 and 0.52 respectively. The majority of patients rated themselves as improved and were continuing the SARAH exercises at discharge and 4 months. No related adverse effects were reported. Patient engagement was high during the first week of the program but gradually declined. Most patients were satisfied and found the program useful. CONCLUSIONS: The online SARAH program delivered in routine therapy care was acceptable and beneficial to patients. Improvements in clinical outcomes were similar to the SARAH clinical trial and our previous implementation work.