Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions.

Abstract

OBJECTIVE\nTo systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality.\n\n\nMETHODS\nSeveral electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥ 10 participants. Quality appraisal was done by two independent raters using the Physiotherapy Evidence Database (PEDro) Scale.\n\n\nRESULTS\nSixteen good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20 - 267 participants (median = 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected.\n\n\nCONCLUSION\nExisting evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to SSc s rarity and involving participants in rehabilitation studies that require active participation over time due to high disease burden. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.