Musculoskeletal Rehabilitation in the Person with Scleroderma

Janet L. Poole

Disclosures

Curr Opin Rheumatol. 2010;22(2):205 

In This Article

Modalities

Paraffin wax bath is a heat modality (mixture of paraffin wax and mineral oil) that delivers heat through superficial conduction to relieve pain and inflammation, increase superficial blood flow, and may increase extensibility of collagen tissue.[14] Four studies provide evidence for paraffin wax in combination with hand exercises (see Table 1).[15,16,17,18•] These studies ranged in design from a series of single subjects to small randomized controlled designs and all except the study by Pils et al.[16] used paraffin in conjunction with hand exercises. The first study by Askew et al. in 1983[15] examined the effectiveness of a single treatment session consisting of paraffin wax, friction massage, and range of motion exercises in 12 persons with scleroderma. After a 20-min treatment of paraffin wax, participants in the intervention group received massage to mobilize the skin and underlying tissue followed by active range of motion exercises for the hand and wrist. Range of motion, skin compliance, and function improved significantly in the intervention group compared with the control group who did not receive any treatment.

In the study by Pils et al., all participants received paraffin treatment for 12 sessions and then were randomized to continue to receive the treatment or to discontinue treatment. At the end of 3 months, there was no significant difference between the two groups.

In the first randomized controlled trial on paraffin, Sandqvist et al.[17] compared paraffin bath and exercise with exercise only in 17 persons with scleroderma. One hand received the paraffin bath and exercise and the other hand received exercise only, which was considered the control condition. After 1 month of intervention, finger flexion and extension, thumb abduction, wrist flexion, and perceived stiffness and skin elastically improved significantly in the paraffin and exercise-treated hand compared with baseline. Improvements in finger extension, perceived stiffness, and skin elasticity were significantly greater in the hand treated with paraffin and exercise compared with the hand treated with exercise only.

In the above mentioned studies, the outcomes examined were impairment variables such as joint motion, grip, and pinch strength. The series of single case studies, by Mancuso and Poole,[18•] also assessed the effect of paraffin and exercise but examined both improvements in impairments and participation in daily activities. Three women with scleroderma used paraffin and performed active hand exercises daily for 8 weeks and were assessed at the end of 4 and 8 weeks. All participants had clinically significant improvements in grip, pinch, and joint motion. Participation in activities involving use of the hands improved but the improvements were not significant. However, there were minimally significant differences or minimal detectable change in scores from baseline to 8 weeks for the timed scores from the hand function items on the Arthritis Hand Function test for the three participants. This study is also of interest as participants had much longer disease duration than that in other studies, suggesting that with the paraffin treatment, improvements can still be observed even with long-standing disease.

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