SARAH Exercise Program in Patients With Rheumatoid Arthritis

Investigating the Effects of SARAH Exercise Program on Proprioception and Hand Functions in Patients With Rheumatoid Arthritis

The aim of this study is to investigate the effectiveness of the SARAH home exercise program to be applied for 12 weeks on wrist proprioception and hand functions in adult patients with rheumatoid arthritis.

Finger/hand/wrist joints can be affected in the early period in patients with RA, and as the disease progresses, it can significantly limit the patient's functionality. Damage to articular and periarticular structures seen in inflammatory arthritis may affect the sense of proprioception by destroying mechanoreceptors located in these areas. Hand functions may worsen as a result of the worsening of the sense of proprioception, which can be defined as being aware of body parts. SARAH (Strengthening and Stretching for Rheumatoid Arthritis of the Hand) home exercise program, which is a widely preferred approach in the case of hand involvement in patients with RA, includes exercises to increase hand-wrist strength and mobility. Although the effectiveness of this program on pain, muscle strength, and range of motion has been demonstrated in large patient groups, its effect on proprioception and hand functions, which may be caused by inflammatory arthritis, has not been studied. Therefore, this study aims to investigate the effectiveness of the SARAH home exercise program on wrist proprioception and hand functions in adult patients with rheumatoid arthritis.

The SARAH exercise program will be delivered by sending messages and video instructions via a freeware and cross-platform messaging service (WhatsApp Messenger) on a weekly basis.

Patients in the control group will not receive any exercise intervention. They will only maintain their routine medical treatment.

Participants will be asked to practice home exercises every day of the week for 12 weeks. The SARAH exercise program consists of 7 mobility and 4 strengthening exercises. Progress will be made by increasing the repetitions and duration of the exercises every week.

Wrist joint position sense will be evaluated with joint position sense goniometry. Joint position sense is measured by the ability to actively repeat a predetermined target angle. During the measurement, the wrist of the participant will passively be brought to the target angle and be kept in this position for three seconds. The participant will be asked to keep this position in his/her memory, then the wrist will passively be brought to the starting position. Then, the participant will be requested to bring her/his hand actively to these predetermined position. Wrist movements will be determined as three repetitive measurements for flexion, extension, radial deviation, and ulnar deviation directions.

Duruoz Hand Index and The Measures of Activity Performance of the Hand (MAP-Hand) Questionnaire will be used for subjective assessment of hand functions.

Numeric rating scale (NRS) will be used for pain assessment. NRS is scored between 0-10 and, higher scores indicate higher level of pain.

Morning stiffness related to the hand/wrist of the patients will be questioned in terms of duration and severity.

Health Assesments Questionnaire-Disability Index (HAQ-DI), which is a self-report tool and has 20 items, will be used to evaluate the general functioning.

Inclusion Criteria: RA diagnosis according to 2010 ACR/EULAR RA criteria Being between the ages of 18-65 Being able to follow Turkish instructions Volunteering to participate in the study Exclusion Criteria: Being in an acute disease exacerbation period Ongoing physiotherapy/occupational/exercise treatment regarding hands within the last 6 months History of steroid injection, surgery, or trauma to the upper extremity in the last 6 months

Data will be shared for only academic purposes (for conducting a meta-analysis or a systematic review)

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