A 12 WEEK MULTIDISCIPLINARY REHABILITATIVE TREATMENT PROGRAM IMPROVES FUNCTIONAL ABILITY IN PATIENTS WITH SYSTEMIC SCLEROSIS: A RANDOMISED CONTROLLED TRIAL

Background: In other rheumatic conditions the effectiveness of multidisciplinary care has been established, research in systemic sclerosis (SSc) however is scarce [1]. Objectives: To compare a multidisciplinary treatment program with usual outpatient care in patients with systemic sclerosis (SSc). Methods: 53 patients with SSc were randomly assigned to a 12 week multidisciplinary day patient programme (individual treatment by a rheumatologist, additional medical specialists if needed, clinical nurse specialist, physical therapist, occupational therapist and social worker; group education; a supervised dynamic exercise therapy aiming at improving aerobic capacity twice a week) or usual care. Outcome measures included the HAMIS (Hand Mobility in Systemic Sclerosis), grip strength, mouth opening, 6-minute walk test (6MWT), aerobic capacity (VO2max), CIS-20 (Checklist Individual Strength), SSc-HAQ (Health Assessment Questionnaire) and SF-36 Physical and Mental Component Summary Scales (PCSS and MCSS) (0, 12 and 24 weeks). Statistical analysis was done by analysis of covariance with correction for baseline values. Results: 28 patients were assigned to the intervention group (mean age 54.6 years, 15/28 diffuse SSc, 13/28 ILD) and 25 to the control group (mean age 52.2 years, 15/25 diffuse SSc, 12/25 ILD). Twenty-five (89%) of the patients in the intervention group completed the treatment program. At 12 weeks there was a significantly greater improvement in grip strength (2.2 versus -1.8 kg; p=0.001), maximal mouth opening (1.4 versus -0.9 mm; p=0.000), six minute walk test (42.8 versus 3.9 meter; p=0.015) and HAQ (-0.18 versus 0.13; p=0.003) in the intervention group than in the control group, at 24 weeks there was a significantly greater improvement of the HAMIS (-1.3 versus 0.7; p=0.038). The differences for the other outcome measures did not reach significance. At 24 weeks the differences in improvement of mouth opening sustained. Conclusion: In patients with SSc a 12 week multidisciplinary day patient treatment program was more effective than regular outpatient care with respect to hand function, mouth opening and functional ability, whereas aerobic capacity did not improve. Further studies on determinants of outcome in rehabilitation interventions is needed to identify the patients that benefit most from different strategies. References: 1. Poole JL. Musculoskeletal rehabilitation in the person with scleroderma. Curr Opin Rheumatol. 2010 Mar;22(2):205-12. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 653Session: Epidemiology, Health Services and Outcome research (Poster Presentations )