Physiotherapy interventions in Systemic Sclerosis (SSc)
Systemic Sclerosis (SSc) is a rare and complex systemic autoimmune disease of unknown cause, that affects the skin and multiple organs due to fibrosis. SSc is a clinically heterogeneous disease, since patients can experience a broad range of symptoms, such as fatigue, pain, impaired hand function, loss of joint mobility, dry mouth, and sleeping difficulties. These symptoms are commonly associated with a considerable impact on the ability to carry out everyday activities, and the majority of patients reports impairments in their physical as well as mental health–related quality of life.
Comprehensive care in chronic diseases, including SSc, involves a combination of both pharmacologic and nonpharmacologic interventions. Because there is no cure, nonpharmacologic treatment, including psychological, educational, and rehabilitation interventions, may be provided as an adjunct to medical treatment in SSc.
The body of knowledge regarding nonpharmacologic care in systemic sclerosis (SSc) is limited and fragmented. A wide variety exists in treatment targets, the content of nonpharmacologic interventions, and outcomes measures.
This review compared 23 studies, assessing effectiveness of physical therapy, psychological therapy, occupational therapy, nursing, nutrition therapy, podiatry, and oral/ dental hygiene therapy, but excluding medication, surgery, or combined interventions with injections.
Most frequently reported interventions were aimed to improve hand function, function of mouth and face, edema in hands and legs, and pain.
A wide variety of interventions was described, reflecting the broad range of symptoms and myriad perspectives of health care providers: education, oral therapy, comprehensive rehabilitation program for physical and/or psychological functioning, self-management, comprehensive rehabilitation for the hands and/or face, aerobic training, stretching, paraffin treatment, carbon dioxide baths, manual lymph drainage, ultrasound, extracorporeal shock wave therapy, biofeedback, deep oscillation, transcutaneous electrical nerve stimulation and home total parenteral nutrition et cetera.
Conclusions:
- a multifaceted oral health intervention is effective in improving mouth hygiene;
- however, orofacial exercises are not effective in improving maximal mouth opening;
- a 12-week multidisciplinary team-care program is effective in improving limitations in activities, maximal mouth opening, and hand grip strength;
- manual lymph drainage is effective in improving hand function, limitations in activities, and quality of life.
Symptoms that are commonly experienced by patients with SSc and have a major impact on carrying out everyday activities, like fatigue, pain, limitations in hand function, and decreased mobility need priority in future research.
What are your experiences and thoughts on treating this complex cluster of symptoms?
> From: Willems et al., Arthritis Care Res 67 (2017) 1426-1439. All rights reserved to the American College of Rheumatology. Click here for the online summary.
