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Arthritis Care Res (Hoboken). 2019 May 31. doi: 10.1002/acr.23998. [Epub ahead of print]

Large variability of frequency and type of physical therapy in patients of the German Network for Systemic Sclerosis.

Author information

1
Dermatology, University Hospital Cologne, Cologne.
2
Rheumatology, University Medical Center-UKSH, Luebeck, Germany.
3
Rheumatology, University Hospital Tuebingen, Tuebingen.
4
Rheumatology, Justus Liebig University Giessen, Campus Kerckhoff, Bad Nauheim.
5
Rheumatology, University Hospital Heidelberg, Heidelberg.
6
Rheumatology, Asklepios Klinik Altona, Hamburg.
7
Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitaetsmedizin Berlin, Berlin.
8
Dermatology, University Medical Center Ulm, Ulm.
9
Rheumatology, University Hospital Wuerzburg, Wuerzburg.
10
Rheumatology, Johanniter-Krankenhaus im Fläming Treuenbrietzen, Treuenbrietzen.
11
Rheumatology, Krankenhaus St. Josef, Wuppertal.
12
Dermatology, Charité Universitätsmedizin Berlin, Berlin.
13
Dermatology, University Hospital Carl Gustav Carus, Dresden.
14
Dermatology, St. Josef Hospital Bochum, Bochum.
15
Dermatology, HELIOS St. Elisabeth Klinik Oberhausen, Oberhausen.
16
Dermatology, University Hospital Muenster, Muenster.
17
Rheumatology, Immanuel Krankenhaus Berlin-Buch, Berlin.
18
Dermatology, Medical University of Graz, Graz, Austria.
19
Dermatology, HELIOS University Hospital Wuppertal, Wuppertal.
20
Rheumatology, University Hospital Erlangen, Erlangen.
21
Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany.

Abstract

OBJECTIVES:

To determine the type and frequency of physical therapy (PT) prescribed by physicians to patients of the registry of the German Network for Systemic Sclerosis.

METHODS:

The data of 4252 patients were analysed using descriptive statistics, chi-squared tests and odds ratios.

RESULTS:

Overall, 37.4% (n=1590 / 4252) of the patients received PT at the end of yearly follow-up. The most frequently used type of PT was lymphatic drainage (36.8% / n=1061), followed by exercise therapy (36.3% / n=1047) and heat therapy (23.9% / n=689). More than three quarters of treated patients (82%) received one or two different forms of PT simultaneously. The prescription of PT was associated with the extent of skin fibrosis as measured by modified Rodnan Skin Score (mRSS) (mRSS<10: 41.8% / mRSS 11-20: 55.8% / mRSS>21: 63.9%; p<0.001). Patients with musculoskeletal involvement (arthritis, muscle weakness, joint contractures, tendon friction rubs, e.g.) had a higher chance to receive PT than patients without these symptoms, with corresponding odds ratios ranging from 1.96 (95% CI 1.69-2.28; for joint contractures) to 3.83 (95% CI 2.89-5.08; for arthritis). Comparing the type of PT prescription across the initial and all follow-up visits from 2003-2017, significant alterations with a decreasing frequency of patients receiving PT could be observed (p=0,001).

CONCLUSIONS:

This is the first study reporting the use of physical therapy in SSc patients in a large cohort. Although SSc is characterized by considerable disability and restriction of motion, less than 40% of patients received PT. This article is protected by copyright. All rights reserved.

KEYWORDS:

Disclosures: The authors have no conflicts of interest; Systemic sclerosis; exercise therapy; manual lymphatic drainage; physical therapy

PMID:
31150152
DOI:
10.1002/acr.23998

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