Self-directed and supervised exercise treatments for rheumatoid arthritis of the hand (SARAH)

Published Date: 27 Feb 2019

Rheumatoid arthritis (RA) is an autoimmune disease affecting about half a million people in the UK.

In this disorder, the body's immune system, which usually fends off infections, mistakenly attacks cells in the body's joints. This causes inflammation which over time damages joints, making them stiff, swollen and painful.

While RA can affect any joint, it is most common in the small joints of the hand. Here, it can be very disabling, affecting almost every function of life, from self-care to the ability to work.

Drug therapies are effective at reducing the clinical symptoms of RA, such as swelling and pain. However, they do not always result in improved function or strength of the hand, and, as a result, patient’s quality of life. The SARAH programme addresses this shortcoming.

Research has shown that SARAH is a low cost and effective addition to the treatment of RA. SARAH has been shown to improve hand function, reduce disability and improve quality of life for people with RA of the wrist and hand and is a recommended treatment by NICE.

SARAH consists of seven stretches and four strengthening exercises. Currently, patients attend five exercise sessions over 12 weeks face-to-face with a trained therapist. Therapists monitor their progress, tailoring the exercises to each patient.

At the start of this project SARAH was only available in the handful of NHS organisation that helped to develop it. Making SARAH available across the entire NHS by means of traditional training approaches, such as face-to-face workshops, would be expensive and time-consuming.

By contrast, delivering effective online training in SARAH, to both patients and NHS therapists, would have four main advantages:

  • Lower costs.
  • Training would be more accessible throughout the NHS.
  • Uptake across the NHS could be far faster.
  • Patients would be able to learn the SARAH exercises at their own speed and convenience.

All of these would work together to bring the benefits of SARAH to more patients sooner.

This project, which is ongoing, consists of both the development of the online tools, an evaluation of their implementation, uptake and whether the original SARAH benefits are seen via the online training.

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