In order to preserve functional ability of patients with rheumatoid arthritis (RA) one needs to continuously apply exercises which will preserve range of joint motion. There is not enough data in the literature about their real value in the preservation of joint movement of RA patients. The aim of this work was to examine the effects of home exercising on the joint movement duration one year, as well as to determine optimal treatment periods of RA patients in hospital conditions. WORK METHODS: Examination was conducted on 31 RA patients treated at the Clinic for physical medicine and rehabilitation. During their treatment patients were educated about their illness and they were trained to exercise, independently, at their homes every day for 30 minutes in order to improve the range of motion. Their functional disability was assessed by Health Assessment Questionnaire (HAQ) that was conducted three times; at the end of first rehabilitation period, and then after a year at the beginning and the end of new rehabilitation period at the Clinic.
Most examined patients (55%) did not have any education, and poor economic condition of life had 69% of the patients. All examined patients have been exercising at home, alone, although most of them, as a result of exposed deformities had a need for assisted exercising. Among them 56.1% of the patients exercised every day and 43.9% exercised occasionally (2-3 times a week). Mean HAQ value was 1.25 after the end of first rehabilitation period. Achieved results were preserved during the following 8 months, but after that period HAQ increased to 1.90 (by 96.7% of the patients). After new rehabilitation treatment, which lasted for four weeks, HAQ returned to its earlier level (1.26). During the examined period there was no significant difference between the HAQ among patients that exercised on a daily basis and the ones that exercised occasionally (p > 0.05).
Low level of education and poor socio-economic conditions influenced the decreased effect of education. Only 7% of the patients visit the rheumatologist for control every 1-2 months. According to Ward study, less than 7 visits to rheumatologist per year is connected with the progression of functional disability. Patients with University degree had the least decrease in HAQ after a year. After new rehabilitation HAQ has been improved by all patients, and it has been returned to earlier value in 80.35% of the patients.
Home exercises are not sufficient in order to preserve functional ability of RA patients. Examination determined that rehabilitation needs to be conducted in the specialized institutions at least once a year, optimally twice a year. It contributes to reduction of progression of functional disability.