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The Effect of Paraffin and Exercise on Hand Function in Persons with Scleroderma: A Series of Single Case Studies
Theresa Mancuso, MOT, OTR/L Janet L. Poole, PhD, OTR/L, FAOTA
Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico
ABSTRACT: The purpose of this study was to investigate whether the use ofparaffin and active hand exercises would improve activity and participation in persons with scleroderma. In this series of three single case studies, participants used paraffin and performed active hand exercises daily for eight weeks. To assess hand function, measures of body function/structure and activity/participation were taken at baseline, at one month and at two months after intervention. Allparticipants experienced clinically significant improvements in both body function/structure measurements of hand function and in their ability to participate in activities. Significant improvements were found more frequently on body function/structure measures than activity/participation measures. This preliminary study lends support in favor of using paraffin and hand exercises as a treatment toimprove hand function related to participation in daily activities in persons with scleroderma. Further research with a larger sample and increased variable control is needed. J HAND THER. 2009;22:71e78.

Scleroderma (systemic sclerosis) is a rheumatic, autoimmune disease characterized by thickening of the skin and other soft tissues. Although the exact pathogenesis of scleroderma is unknown,the disabling impact on individuals with the disease has been documented in several studies.1e4 Fibrotic changes in finger joints, combined with contractures caused by thickened skin, can result in a claw-like deformity of the fingers.5 The International Classification of Functioning, Disability, and Health (ICF) offers a framework from which to view the impact of scleroderma and to categorizeoutcomes from therapeutic interventions. The ICF delineates between body functions and structures, and activities and participation.6 Body functions and structures include structures and functions of the physical body such as the nervous or musculoskeletal systems. Activities and participation encompass an individual’s ability to participate in

Correspondence and reprint requests to Janet L. Poole,PhD, OTR/ L, Occupational Therapy Graduate Program, MSC09 5240, 1 University of New Mexico, Albuquerque, NM 87131-0001; e-mail: . 0894-1130/$ e see front matter Ó 2009 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. doi:10.1016/j.jht.2008.06.009

meaningful and functional tasks. These include but are not limited to self-care, mobility, domestic duties, and employment. Pooleand Steen explored the relationship between body function and structure impairments in the hand and limitations in activity and participation in persons with systemic sclerosis.3 This study suggested that thicker skin, joint pain, tendon rubs, and contractures in the hands significantly correlated with higher disability scores on the Health Assessment Questionnaire (HAQ), indicating more limitationsin activity and participation. Clements et al. explored body function and structure impairment in persons with scleroderma and found that 53% of participants demonstrated a Health Assessment Questionnaire Disability Index (HAQ-DI) score indicating moderate-to-severe limitations in activity and participation.1 Reduced hand spread (odds ratio [OR] 4.5, 95% CI: 1.80e11.24), joint tenderness (OR2.93, 95% CI: 1.16e7.40), and impaired fist closure (OR 4.24, 95% CI: 1.68e10.70) were significantly correlated to limitations in activities involving the hands. At the activity and participation levels of the ICF, individuals with scleroderma may present with qualitative differences in prehension patterns, especially with respect to fingers used, surfaces of the fingers in contact with a given...
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