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Dr Esther Williamson reflects on her time developing the SARAH programme for people affected by Rheumatoid arthritis of the hand, the subject of a recent NIHR evidence Alert.

A picture of someone with rheumatoid arthritis rubbing their wrist

*** Read the NIHR Alert about this research here ***

The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme is a tailored and progressive hand exercise programme for people affected by rheumatoid arthritis.

I was part of the study team that worked on the development of the SARAH programme and then tested it in a large clinical trial the University of Warwick.  The trial showed that the SARAH programme improves hand function in people with RA without increasing pain or discomfort.

I have been delighted to lead the team, along with Professor Sallie Lamb (Chief Investigator of the SARAH Trial), who have been carrying out this implementation work.

Often, clinical trials are conducted and the findings are published in a journal with little chance of an effective treatment finding its way into clinical practice. The funding provided by the Oxford CLARHC made sure that this wasn’t going to be the case for the SARAH programme. We have had a wonderful opportunity to make sure that patients were able to benefit from the SARAH programme.

One of the best things about this work has been the support we have received from the clinical community and from patients. Individual hand therapists as well as the professional groups, The British Association of Hand Therapists and the British Society of Rheumatology, have been very engaged with the trial and the implementation work.

The National Rheumatoid Arthritis Society, which is the patient support group for people with RA, has been a key collaborator on developing the resources developed for people with RA. These collaborations with patients and the clinical community were the key to the success of the SARAH implementation project.

Often, clinical trials are conducted and the findings are published in a journal with little chance of an effective treatment finding its way into clinical practice. The funding provided by the Oxford CLARHC made sure that this wasn’t going to be the case for the SARAH programme.  - Dr Esther Williamson

In order to give as many therapists as possible the skills and knowledge needed to deliver the SARAH programme to their patients, we developed an online training programme. This has been very well received. This is largely due to my colleague, Dr Cynthia Srikesavan, who as well as being an experienced physiotherapist is very tech savvy. Cynthia has worked with the SARAH implementation programmers (Tim Cranston and Lucy Eldridge), clinicians and patients to develop iSARAH, the online course.

Our team had already developed one online training course for clinicians and we had experienced quite a few technical challenges. I was expecting this to be the case for iSARAH. However, the training programme developed by Cynthia, Tim and Lucy has run incredibly well with very few technical hitches which is a credit to them all.

The SARAH implementation study relied on busy clinicians to find time to do the training and to collect patient data for the service evaluation. Nearly 600 NHS therapists completed the training which was more than we had anticipated as our target for the study had been 250.Therapists from 15 NHS Trusts went on to take part in the service evaluation and despite the always present time pressures within the NHS managed to enrol 118 patients in the service evaluation.

Collecting data from busy clinicians can be challenging but the SARAH implementation study team worked with clinicians so we ended up with 97 complete data sets. It was a lot of work but the data shows us that the SARAH programme benefits patients when delivered as part of routine clinical care, and that, is the point of the work we do.

The iSARAH training is still available at but it will be moving to FutureLearn later this year.

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