Heated Gloves May Improve Hand Function in Diffuse Systemic Sclerosis

This study provides a unique physical therapist–patient perspective on unreported characteristics of dSSc and management of functional limitations imposed by the disease. Barb, eight years post progressive dSSc diagnosis, had had recurrent DUs yet experienced decreased pain and no DUs during the four-month intervention of daily, continuous use of heated gloves. The incapacitating pain associated with active acro-osteolysis was greatly reduced while the heated gloves were on. However, consistent with Park et al, Barb’s acro-osteolysis did not stop despite increased circulation to the digits.⁵ As a result, Barb’s fingers continued to shorten and impair hand function.

Interestingly, ROM improved in the right wrist, bilateral 2nd digits and left 5th digit. This increase occurred despite no formal stretching or strengthening exercises during the four-month intervention period. Additionally, two surprising outcomes of this study were the improvements in the nine-hole peg test performance and the return of sensation in six digits, especially the left digits. The left 5th digit improved from loss of protective sensation to within normal range. The 2nd digit had a four-year history of ulcers, yet sensation improved in the intervention period from loss of protective sensation to reduced protective sensation (see Table 3).

Conclusion

The promising outcomes in this case warrant further patient-centered research to establish efficacy and optimum parameters for heated glove use. More research is needed to assess the prophylactic potential of prescribing daily, continuous heat earlier in the disease process to perhaps delay the sequelae of dSSc vasculopathy.

Barb controlled for variables through consistent data collection methods, including setting, time frame (11 a.m.), rater and instrumentation. Subject characteristics were controlled; there were no changes in occupation, activities, diet, medication or stress levels. Therefore, future research based on Barb’s design may be feasible to determine benefit and generalizability to the larger scleroderma population.

Read “A Glove By Any Other Name May Give Less Heat,” (The Rheumatologist, November 2017).

Rosemarie Curley, MPT, DPT, completed her transitional doctorate from Northeastern University College of Professional Studies in July and practices physical therapy in inpatient rehabilitation in Richmond, Va. Personal experience with topical steroid withdrawal in children and diffuse systemic sclerosis fuels her desire to research and present the patient’s perspective in evidence-based practice.

Jeananne Elkins, PT, PhD, DPT, MPH, is an advanced fellow in geriatrics at the Birmingham/Atlanta VA Geriatrics Research Education and Clinical Care Center (GRECC) in Atlanta. She is a health services researcher. Her recent work is in evidence-based physical therapy interventions and in medical care–caregiver interactions to improve support of informal caregivers.

Disclosure

The authors have no financial/benefit ties with the gloves described in this article.

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