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Improving Access to the SARAH Exercise Programme for Rheumatoid Arthritis Patients Through an Online Course

  • Evaluation
  • Improving Health and Social Care
  • Social Care

SARAH - Evaluating the Provision of an Online Course for Patients

The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme is an evidence-based exercise intervention designed to improve hand function in people with rheumatoid arthritis. It was previously tested in a large clinical trial and found to be clinically and cost-effective.

This study evaluated a self-guided online version of SARAH, designed to help patients access the programme with minimal therapist support. The study aimed to:

  • Assess the feasibility of delivering SARAH online within NHS therapy services.
  • Evaluate patient engagement, satisfaction, and clinical outcomes.

Participants were recruited from 18 NHS hand therapy departments across England, Scotland, and Wales. They were given access to a four-week online SARAH programme, including videos, text guidance, and discussion forums.

Impact and Implementation

The SARAH online programme is a practical, scalable solution that allows NHS therapy departments to offer effective hand therapy with fewer appointments. Instead of six face-to-face sessions, patients can now access SARAH with just two therapist consultations, reducing the burden on NHS resources.

The programme is now being promoted by the British Association of Hand Therapists (BAHT) and British Society of Rheumatology (BSR) to encourage wider use in clinical practice.

NHS staff can access SARAH training and patient resources:

Next Steps

  • Make the patient course widely available across NHS therapy services.
  • Monitor real-world impact on patient outcomes and service efficiency.
  • Develop additional digital tools to support patient engagement beyond the initial four weeks.

Project lead / contact: Esther Williamson — Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (ox.ac.uk) and Professor Sallie Lamb (University of Exeter)

Website: Online Course available at https://learn.exeter.ac.uk

ARC theme: Community Health and Social Care Improvement

Completed Project

Key Findings

  • High patient uptake: 65 patients enrolled, with 71% registering for the online programme.
  • Positive clinical outcomes: Hand function improved significantly. Pain reduced or remained stable throughout follow-up.
  • Sustained engagement: Most patients continued SARAH exercises at discharge and four months.
  • Patient satisfaction: Most found the programme useful and easy to follow. Drop-off in engagement over time suggests the need for ongoing support.
  • Challenges in digital access: Some patients struggled with logging in or internet access, while others preferred face-to-face therapy.