Current clinical practice suggests that recovering the hand functionality lost or reduced by injuries, interventions, and chronic diseases requires, beyond pharmacological treatments, a kinesiotherapic intervention. This form of rehabilitation consists of physical exercises adapted to the specific pathology. Its effectiveness is strongly dependent on the patient's adhesion to such a program. In this paper, we present a novel device with remote monitoring capabilities expressly conceived for the needs of rheumatic patients. It comprises several sensorized tools and can be used either in an outpatient clinic for hand functional evaluation, connected to a PC, or afforded to the patient for home kinesiotherapic sessions. In the latter case, the device guides the patient in the rehabilitation session, transmitting the relevant statistics about his performance to a TCP/IP server exploiting a GSM/GPRS connection for deferred analysis. An approved clinical trial has been set up in Italy, involving 10 patients with rheumatoid arthritis and 10 with systemic sclerosis, enrolled for 12 weeks in a home rehabilitation program with the proposed device. Their evaluation has been performed not only with traditional methods, but also with the proposed device. Subjective (hand algofunctional Dreiser's index) and objective (ROM, strength, and dexterity) parameters showed a sustained improvement throughout the follow-up. The obtained results proved that the device is an effective and safe tool for assessing hand disability and monitoring kinesiotherapy exercise, portending the potential exploitability of such a methodology in the clinical practice.
Design and clinical evaluation of an effective and safe remote-monitoring tool for assessing and treating hand disabilities in patients affected by rheumatic diseases. The point-of-care sensor and patient feedback system provides an innovative approach to home-based kinesiotherapic exercises.