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SARAH: Strengthening & Stretching for Rheumatoid Arthritis of the Hand

What was the purpose of the study?

The SARAH trial was looking at two approaches to treatment for Rheumatoid Arthritis (RA) affecting the hands. We compared the provision of joint protection advice with joint protection advice in addition to an exercise programme for the hands and arms. All people who entered the trial received joint protection advice, with half of all people in the study also undertaking the exercise programme.

What were the treatment options?

Patients were randomised to one of the following options:

  • An advice session, covering methods to protect joints during every day function. They attended for a maximum of 3 sessions with a specially trained physiotherapist or occupational therapist who advised on how best to protect hand joints, day to day.
  • An advice session on joint protection, identical to the above, followed by a further five sessions of supervised exercise. These sessions were spread over 12 weeks and encouraged patients to strengthen and stretch their hands and wrists. A specially trained physiotherapist or occupational therapist provided treatments, and advice on how best to manage their condition. The exercise sessions lasted approximately 30 minutes and were on a one to one basis with a therapist.

As well as attending for the allocated treatment patients were asked to attend for three assessments and asked to fill in some questionnaires about their condition and how it affected them. Patients attended for an assessment of their hand and arm function before they received treatments and again at four and twelve months after joining the study. Assessments measured hand and arm strength, flexibility and dexterity.

What was the procedure being tested?

We tested the effectiveness of gently stretching the hand joints and strengthening the hand muscles on the painful and disabling effects of RA. Whilst all participants were advised on how to protect their joints in every day life we investigated whether it is possible to improve hand strength, mobility and function.

What are the alternative treatments?

The alternative to exercise is often to rest the hands although we do not know if this is the correct advice. Traditionally, the treatment of RA of the hands has either involved encouraging exercise or not encouraging it. Whilst there is some evidence that exercise is beneficial, not all people with RA of the hands are encouraged to exercise.

What were the possible disadvantages of taking part?

Occasionally people experience a short-term increase in pain after beginning an exercise programme. This is a normal response to treatment and is not usually long lasting.

Who organised and funded the research?

Professor Sallie Lamb is responsible for the research. It is being funded by the National Health Service’s Health Technology Assessment Programme.

What stage is the study at?

490 people were recruited and followed up over a 12 month period. The results have been sent to participants. The letter is available to view here (PDF Document) SARAH Trial Patient results letter

The findings will be disseminated at conferences and through journal publications in due course.


Key people
Enquiries contact
  • Dr Mark Williams Research Fellow (Clinical Trials)