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Implementation of strengthening and stretching for rheumatoid arthritis of the hand

Rheumatoid arthritis is the most common polyarthritis and has a substantial effect on the quality of life of millions of people across the world. Its major effects are on the small joints of the hands and feet. Drug management has substantially improved the joint damage and deformity associated with the disease, however improvements in function are not always noted. Evidence for the role of exercise to improve hand function has been uncertain. In 2004 the NIHR Health Technology Assessment programme commissioned our research group to conduct a trial of strengthening and stretching exercises for people with rheumatoid arthritis of the hand (the SARAH trial).

Led by Professor Sallie Lamb, the group designed an intervention that combined a tailored exercise programme with strategies to help people to keep up these exercises on a daily basis. This large-scale randomised controlled trial involving 490 people demonstrated that the exercise programme was more effective than usual care over one year.

We are now working on addressing the challenges of implementing the SARAH exercise intervention into clinical practice.


Our first SARAH implementation project is an online training course iSARAH for NHS hand therapists to facilitate prescription of the SARAH programme to people with rheumatoid arthritis (RA).

iSARAH course is now available online and provided free of charge to NHS physiotherapists and occupational therapists. iSARAH includes four simple instructional modules with exercise videos and illustrations, a section on frequently asked questions, and a self-assessment at the end of the training. iSARAH will take approximately 3-4 hours to complete.  A course certificate can be downloaded on successful completion of the training.

To access the course, please visit and register with NHS email address.


Our next project in facilitating the SARAH programme into practical use is through a web-based, self-directed SARAH programme for people with RA (mySARAH). People with RA can directly register with the website and access the SARAH programme at their convenience. They will be guided through each exercise session of the 12 week SARAH programme, and will be regularly monitored for symptoms of pain and hand function over a period of one year. mySARAH will include exercise training and planned review sessions, brief online questionnaires, exercise videos,  testimonies, exercise illustrations, exercise diary, exercise planner, technical support and visual display reports of clinical progress made.

MySARAH website is currently under development.

Contact us for information about this work. The SARAH exercise intervention is available for NHS clinicians to download - take a look at our resources page.