THE ONLINE VERSION OF AN EVIDENCE-BASED HAND EXERCISE PROGRAMME FOR PEOPLE WITH RHEUMATOID ARTHRITIS: A PROOF-OF-CONCEPT STUDY

Srikesavan C1, Williamson E2, Thompson J1, Adams J3, Cranston T1, Lamb SE11University of Oxford, Nuffield Department of Orthopedics, and Musculoskeletal Sciences, Oxford, United Kingdom, 2University of Oxford, Nuffield Department of Orthopedics, and Musculoskeletal Sciences, Headington, Oxford, United Kingdom, 3University of Southampton, Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, Southampton, United KingdomBackground: The Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, 12-week exercise programme. It is clinically and cost-effective and recommended by national guidelines for people with rheumatoid arthritis (RA). An online version of the SARAH programme (mySARAH) has been developed to allow direct access for people with RA. mySARAH consists of six online sessions completed over 12 weeks. It includes education about managing arthritis, teaches the SARAH exercises and how to progress them, along with ways to stay motivated (goal setting, exercise planning, online exercise diary). mySARAH is delivered through text, exercise videos, interviews, illustrations, with links to further information.Purpose: To assess the feasibility, acceptability, and safety of the online version of the SARAH programme.Methods: We are currently recruiting adults with RA who report problems with hand function and who have access to the internet. We plan to enroll up to 12 participants.Participants are observed during four of the six mySARAH sessions to assess their ability to complete the programme. We film the participants performing the SARAH exercises. to allow evaluation of exercise completion. Participants undertake two sessions independently at home. Between online sessions, participants are asked to carry out the exercises dailyAt baseline and 12 weeks, hand function is measured using the Michigan hand outcomes questionnaire hand function subscale and grip strength using Jamar dynamometer. Hand joint pain is measured using a 0-10 numerical scale at each session. The exercise videos are evaluated to see if the exercises are performed correctly, if assistance was required or if the participant was unable to perform the exercises correctly. At 12 weeks, patient satisfaction, ease of use, intention to continue to exercise, and perceived benefit are also collected. Approximately one month later, we will conduct a telephone interview to explore participants' experiences and collect information on hand function and perceived benefit.Results: So far, six participants have been enrolled in the study and are at different stages of the sessions of the 12-week timeline. Follow-up data is not yet available. The median (interquartile range) age of participants is 64.5 (60-71.25) years, duration since diagnosis is 7 (1.25-17.25) years, and time spent on internet daily is 60 (60-60) minutes. The median overall hand function is 61.25 (52.5-62.5), grip strength of the right hand is 12.2 (11.6-19) Kgs and the left hand is 13.75 (8.6-18) Kgs, and hand joint pain is 3 (3-3.75). All participants found the exercise videos easy to follow and correctly demonstrated all the exercises. This study is ongoing. Updated results will be presented at WCPT 2019.Conclusion(s): Initial evaluation in a small number of patients of the online version of the SARAH programme indicates that patients are able to carry out the exercises correctly and safely.Implications: If this proof of concept study finds that the mySARAH programme is feasible, acceptable to patients and safe, then broader evaluation will be carried out to test the clinical and cost- effectiveness of delivering the SARAH programme using mySARAH compared to traditional appointments with a therapist.Keywords: Proof-of-concept, Hand function, Online interventionFunding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC. Topic: Musculoskeletal: upper limb; Rheumatology; Disability & rehabilitationEthics approval required: YesInstitution: University of OxfordEthics committee: South Central - Berkshire B Research Ethics CommitteeEthics number: REC reference: 18/SC/0070; IRAS project ID: 237807All authors, affiliations and abstracts have been published as submitted.