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Kwakkenbos L, Carrier ME, Welling J, Levis B, Levis AW, Sauve M, Turner KA, Tao L, Aguila K, Carboni-Jiménez A, Cañedo-Ayala M, Harb S, van den Ende C, Hudson M, van Breda W, Nguyen C, Boutron I, Rannou F, Thombs BD, Mouthon L. Randomized controlled trial of an internet-based self-guided hand exercise program to improve hand function in people with systemic sclerosis: the Scleroderma Patient-centered Intervention Network Hand Exercise Program (SPIN-HAND) trial. Trials 2022; 23:994. [PMID: 36510233 PMCID: PMC9742661 DOI: 10.1186/s13063-022-06923-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Systemic sclerosis (scleroderma; SSc) is a rare autoimmune connective tissue disease. Functional impairment of hands is common. The Scleroderma Patient-centered Intervention Network (SPIN)-HAND trial compared effects of offering access to an online self-guided hand exercise program to usual care on hand function (primary) and functional health outcomes (secondary) in people with SSc with at least mild hand function limitations. METHODS The pragmatic, two-arm, parallel-group cohort multiple randomized controlled trial was embedded in the SPIN Cohort. Cohort participants with Cochin Hand Function Scale (CHFS) scores ≥ 3 and who indicated interest in using the SPIN-HAND Program were randomized (3:2 ratio) to an offer of program access or to usual care (targeted N = 586). The SPIN-HAND program consists of 4 modules that address (1) thumb flexibility and strength; (2) finger bending; (3) finger extension; and (4) wrist flexibility and strength. The primary outcome analysis compared CHFS scores 3 months post-randomization between participants offered versus not offered the program. Secondary outcomes were CHFS scores 6 months post-randomization and functional health outcomes (Patient-Reported Outcomes Measurement Information System profile version 2.0 domain scores) 3 and 6 months post-randomization. RESULTS In total, 466 participants were randomized to intervention offer (N = 280) or usual care (N = 186). Of 280 participants offered the intervention, 170 (61%) consented to access the program. Of these, 117 (69%) viewed at least one hand exercise instruction video and 77 (45%) logged into the program website at least 3 times. In intent-to-treat analyses, CHFS scores were 1.2 points lower (95% CI - 2.8 to 0.3) for intervention compared to usual care 3 months post-randomization and 0.1 points lower (95% CI - 1.8 to 1.6 points) 6 months post-randomization. There were no statistically significant differences in other outcomes. CONCLUSION The offer to use the SPIN-HAND Program did not improve hand function. Low offer uptake, program access, and minimal usage among those who accessed the program limited our ability to determine if using the program would improve function. To improve engagement, the program could be tested in a group format or as a resource to support care provided by a physical or occupational therapist. TRIAL REGISTRATION NCT03419208 . Registered on February 1, 2018.
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Affiliation(s)
- Linda Kwakkenbos
- grid.5590.90000000122931605Clinical Psychology, Radboud University, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marie-Eve Carrier
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Joep Welling
- grid.491384.30000 0004 9361 2881NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Brooke Levis
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada ,grid.9757.c0000 0004 0415 6205Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Alexander W. Levis
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T. H. Chan School of Public Health, Cambridge, MA USA
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, ON Canada ,Scleroderma Canada, Hamilton, ON Canada
| | - Kimberly A. Turner
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Lydia Tao
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Kylene Aguila
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Andrea Carboni-Jiménez
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Mara Cañedo-Ayala
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | - Sami Harb
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada
| | | | - Marie Hudson
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada ,grid.14709.3b0000 0004 1936 8649Department of Medicine, McGill University, Montreal, QC Canada
| | - Ward van Breda
- grid.12380.380000 0004 1754 9227Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Christelle Nguyen
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Isabelle Boutron
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François Rannou
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Brett D. Thombs
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research of the Jewish General Hospital, 3755 Cote Ste Catherine Road, Montreal, QC H3T 1E2 Canada ,grid.14709.3b0000 0004 1936 8649Department of Medicine, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Biomedical Ethics Unit, McGill University, Montreal, QC Canada
| | - Luc Mouthon
- Université Paris Descartes, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France ,grid.411784.f0000 0001 0274 3893Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Paris, France
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