Original Articles
20 February 2025
Vol. 40 No. 4 (2018)
https://doi.org/10.4081/gimle.557

Rehabilitation in systemic sclerosis: proposed personalised rehabilitation programme

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
31
Views
14
Downloads

Authors

Elvira Brignoli
elvira.brignoli@icsmaugeri.it
Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy.
Paolo Frassanito
Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy.
Elisabetta Vercesi
Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy.
Chiara Ferretti
Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy.
Guido Felicetti
Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy.
Roberto F.E. Maestri
Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy.
Maja Barak
Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo; University of Pavia, Pavia, Italy.

Background: Systemic sclerosis is a multisystem autoimmune disease that causes chronic widespread obliterative vasculopathy of the small arteries associated with various degrees of tissue fibrosis. The prognosis of the disease depends largely on the visceral involvement; however musculoskeletal involvement is an important factor to functional disability. Suffering from a chronic auto-immune disease, such as Systemic Sclerosis, compromises the quality of life and the work ability. The rehabilitative treatment may be a viable option for improving the quality of life, but there are few studies to support this hypothesis in adequate population. (Rehabilitation is still an under- studied field of research).
Aim: Proposed personalised rehabilitation programme, with a multilocalized, multidisciplinary approach specifically designed for patients with Systemic Sclerosis.
Population: Forty-three patients affected by systemic sclerosis. Methods: Patients underwent a rehabilitation programme of 3 weeks. Three cycles of rehabilitation in 3 consecutive years were administered. The priority outcome measure was the Health Assessment Questionnaire-Disability Index (HAQ-DI). The effectiveness of treatment cycles repeated at 1-year intervals was also compared to the first cycle.
Results: Each treatment had an acute beneficial effect, leading to an improvement in the disability score after each of the three cycles (admission vs discharge: 1.2$0.6 vs 0.8$0.6, p<0.0001, 1.3$0.6 vs 1.0$0.6, p<0.0001 and 1.4$0.7 vs 1.1$0.7, p<0.0001). The improvement in HAQ-DI scores after repeated cycles was progressively lower, but the difference in efficacy was not statistically significant (p=0.38 and p=0.17 for the comparison between the second and the first and the third and the first cycles respectively).
Conclusions: The multilocalized, multidisciplinary protocol developed by our rehabilitation team led to a significant reduction in disability perceived by patients, independently of the disease duration. The beneficial effects at the end of the first cycle were reproduced in the subsequent cycles.
Nevertheless, there was a tendency of progressive efficacy reduction in following cycles, due to increased disability caused by disease stage.
Impact of rehabilitation: We believe that our results demonstrate the utility of personalised, multilocalized, multidisciplinary rehabilitation treatment in slowing the evolution of systemic sclerosis.

Altmetrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
1) LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA JI, et al. Scleroderma (systemic sclerosis): classification, subset and pathogenesis. J Rheumatol 1988; 15: 202-5.
2) Varga J, Abraham D. Systemic sclerosis: a prototypic multisystem fibrotic disorder. J Clin Invest 2007; 117: 557-67. DOI: https://doi.org/10.1172/JCI31139
3) Entin MA, Wilkinson RD. Scleroderma hand: a reappraisal. Orthop Clin North Am 1973; 4: 1031-8. DOI: https://doi.org/10.1016/S0030-5898(20)30836-1
4) Palmer DG, Hale GM, Grennan DM, Pollock M. Bowed fingers: a helpful sign in the early diagnosis of systemic sclerosis. J Rheumatol 1981; 8: 266-72.
5) Baron M, Lee P, Keystone EC. The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis 1982; 41: 147-52. DOI: https://doi.org/10.1136/ard.41.2.147
6) Vincent C, Agard C, Barbarot S, N'guyen JM, Planchon B, Durant C, et al. Orofacial manifestations of systemic sclerosis: a study of 30 consecutive patients. Rev Stomatol Chir Maxillofac 2010; 111: 128-34. 7) Sandqvist G, Eklund M. Daily occupations— performance, satisfaction and time use, and relations with well-being in women with limited systemic sclerosis. Disabil Rehabil 2008; 30: 27-35. DOI: https://doi.org/10.1080/09638280701190083
8) Sandqvist G, Scheja A, Hesselstrand R. Pain, fatigue and hand function closely correlated to work ability and em- ployment status in systemic sclerosis. Rheumatology 2010; 49: 1739-46. DOI: https://doi.org/10.1093/rheumatology/keq145
9) Hudson M, Steele R, Lu Y, Thombs BD, Group TCSR. Work disability in systemic sclerosis. J Rheumatol 2009; 36: 1-6. DOI: https://doi.org/10.3899/jrheum.081057
10) Pope JE. Musculoskeletal involvement in scleroderma. Rheum Dis Clin North Am 2003; 29: 391-408. DOI: https://doi.org/10.1016/S0889-857X(03)00017-6
11) Del Rosso A, Boldrini M, D'Agostino D, Placidi GP, Scarpato A, Pignone A, et al. Health-related quality of life in systemic sclerosis as measured by the Short Form 36: relationship with clinical and biologic markers. Arthritis Rheum 2004; 51: 475-81. DOI: https://doi.org/10.1002/art.20389
12) Karassa FB, loannidis JPA. Mortality in systemic sclerosis. Clin Exp Rheumatol 2008; 26 (Suppl 51): 85-93.
13) Casale R, Buonocore M, Matucci-Cerinic M. Systemic Sclerosis (scleroderma): an integrated challenge in rehabilitation. Arch Phys Med Rehabil 1997; 78: 767-73. DOI: https://doi.org/10.1016/S0003-9993(97)90087-3
14) Maddali Bongi S. L'approccio riabilitativo al malato reumatico. In: Maddali Bongi S. editor. Riabilitazione reumatologica. Approccio multidisciplinare. Milano: Edizioni EDRA, 2007. p. 31-44.
15) Pizzo G, Scardina GA, Messina P. Effects of a non surgical exercise program on the decreased mouth opening in patients with systemic scleroderma. Clin Oral Investig 2003; 7: 175-8. DOI: https://doi.org/10.1007/s00784-003-0216-5
16) Maddali Bongi S, Del Rosso A, Galluccio F, Sigismondi F, Miniati I, Conforti ML, et al. Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis. Clin Rheumatol 2009; 28: 1167-73. 17) Maddali Bongi S, Landi G, Galluccio F, Del Rosso A, Miniati 1, Conforti LM, et al. The rehabilitation of facial involvement in systemic sclerosis: efficacy of the combination of connective tissue massage, Kabat's technique and kinesitherapy: a randomized controlled trial. Rheumatol Int 2011; 31: 895-901. DOI: https://doi.org/10.1007/s10067-009-1216-x
18) Maddali Bongi S, Del Rosso A, Passalacqua M, Miccio S, MatucciCerinic M. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase. Arthritis Care Res 2011; 63: 1134-41. DOI: https://doi.org/10.1002/acr.20487
19) Antonioli CM, Bua G, Frigè A, Prandini K, Radici S, Scarsi M, et al. An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility. Clin Rheumatol 2009; 28: 159-65. DOI: https://doi.org/10.1007/s10067-008-1006-x
20) Maddali Bongi S, Del Rosso A, Galluccio F, Tai G, Sigismondi F, Passalacqua M, et al. Efficacy of a tailored rehabilitation program for systemic sclerosis. Clin Exp Rheumatol 2009; 27(Suppl 54): 44-50. 21) Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 4th edn. Philadelphia: F.A. Davis Company, 2002.
22) Goats GC, Keir KA. Connective tissue massage. Br J Sports Med 1991; 25: 131-3. DOI: https://doi.org/10.1136/bjsm.25.3.131
23) Alpiner N, Oh TH, Hinderer SR, Brander VA. Rehabilitation in joint and connective tissue diseases. 1. Systemic diseases. Arch Phys Med Rehabil 1995; 76(5 Spec No): S32-40. DOI: https://doi.org/10.1016/S0003-9993(95)80597-4
24) Greenman PE. Mobilization with and without impulse technique. In: Principles of Manual Medicine (3rd edn). Philadelphia: Lippincott Williams & Wilkins; 2003. p 107-112.
25) Kabat H, McLeod M, Holt C. The practical application of proprioceptive neuromuscular facilitation. Physiotherapy 1959; 45: 87-92.
26) Poole JL, Steen VD. The use of the Health Assessment Questionnaire (HAQ) to determine physical disability in systemic sclerosis. Arthritis Care Res 1991; 4: 27-31. DOI: https://doi.org/10.1002/art.1790040106
27) La Montagna G, Cuomo G, Chiarolanza I, Ruocco L, Valentini G. La versione italiana dell'"Health Assessment Questionnaire-Disability Index" (HAQ-DI) nella sclerosi sistemica. HAQ-DI Italian version in systemic sclerosis. Reumatismo 2006; 58: 112-5. DOI: https://doi.org/10.4081/reumatismo.2006.112

How to Cite



Rehabilitation in systemic sclerosis: proposed personalised rehabilitation programme. (2025). Giornale Italiano Di Medicina Del Lavoro Ed Ergonomia, 40(4), 248-256. https://doi.org/10.4081/gimle.557
Copyright (c) 2018 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.