Complex rehabilitation and the clinical condition of working rheumatoid arthritis patients: does cryotherapy always overtop traditional rehabilitation?

Abstract

Aim: Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. Materials and methods: Sixty-four employed women aged 24–65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients’ overall well-being: a scale from 0 to 100 (Global Health Index); and patients’ own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. Results: All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p < 0.001, p = 0.001, p = 0.007 and p < 0.001, respectively), as well as at the 3-month follow-up (p < 0.001, p < 0.001, p = 0.009 and p < 0.001, respectively). Rehabilitation using cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η² = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η² = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients’ own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent traditional approach showed decreased disease activity following the initial 3-week period; however, this improvement did not sustain to the end of follow-up, 3 months later. Conclusions: Complex rehabilitation in RA has a positive effect on patients’ clinical condition. The rehabilitation programme that includes cryotherapy overtops traditional rehabilitation, particularly as regards improvement in locomotor function, disease activity and sustaining willingness to continue working and exerts long-lasting effect.

Implications for Rehabilitation

• Rehabilitation using cryotherapy is more effective in improving locomotor function, decreasing disease activity and sustaining willingness to continue working compared to traditional rehabilitation.

• Rehabilitation using cryotherapy significantly reduces the intensity of pain experienced by patients with RA, and this positive effect is maintained at 3 months post-rehabilitation.

• Complex rehabilitation, particularly treatment using cryotherapy, improves patients’ subjective assessment of their overall well-being and perception of their disease.

• Complex rehabilitation in rheumatoid arthritis has a positive effect on patients’ clinical condition.

• Complex rehabilitation
• cryotherapy
• rheumatoid arthritis

Declaration of interest

This publication has been prepared under the long-term programme “Improving Safety and Working Conditions”. Research and development for this project was financed in 2011–2013 by the Ministry of Science and Higher Education/National Centre for Research and Development. The project is entitled “Evaluation of the Effectiveness of Rehabilitation Techniques in Chronic Diseases of the Musculoskeletal System with Respect to Achieving a Return to Work”. The project has been conducted in cooperation with the Rehabilitation Department of the Institute of Rheumatology in Warsaw and the Central Institute for Labour Protection in Warsaw.