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Title: Exercise-based upper limb rehabilitation in rheumatoid arthritis
Author: Manning, Victoria
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2013
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Background: Rheumatoid arthritis (RA) is a chronic, systemic, disabling disease which reduces independence, quality of life, and longevity. Upper limb impairment causes considerable disability, contributes to work incapacity, and has substantial monetary and non-monetary, personal and societal consequences. Objectives: The studies in this thesis focus on the development and evaluation of a novel exercise programme for the rehabilitation of global upper limb disability in people with RA. It explores participants’ experiences and the factors influencing their uptake and maintenance of the programme. It evaluates the physical activity (PA) levels of adults with rheumatic diseases against PA guidelines, and assesses the proportion of respondents who report ever receiving PA advice from a healthcare professional (HCP). Methods: Following development of a global upper limb home exercise programme, supplemented by four supervised group education, self-management, and exercise sessions (the EXTRA programme), 108 people with RA of less than 5 years duration were randomly allocated to receive either the EXTRA programme or usual care. Self-reported disability, upper limb functional performance, strength, self-efficacy, quality of life (QOL), and disease activity were assessed at baseline, 12, and 36 weeks. Participants were interviewed to evaluate their experiences of the EXTRA programme. Physical activity participation, recommendation, and preferences were surveyed among 508 adults with a range of rheumatic diseases. Results: Following the EXTRA programme, there were significant improvements to upper limb disability, function, strength, and self-efficacy, but not QOL, and no adverse effects on disease activity or pain. Participants perceived the EXTRA programme to be effective and acceptable. Sixty-one percent of respondents met PA guidelines, although 27% were inactive. Forty-three percent of respondents reported receiving PA advice from a HCP. Walking was the most preferred PA (65%). Conclusions: The EXTRA programme improves upper limb disability, function, strength, and self-efficacy, with no adverse effects on disease activity or pain, in people with RA. Many people with rheumatic diseases are inactive and more than half have never discussed PA with a HCP. Recommending exercise and regular PA should be integral to rheumatic disease management.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available