Empowering 1.3 million UK citizens with rheumatoid arthritis

For the roughly 700,000 people in the UK living with rheumatoid arthritis (RA), daily life is often a series of painful compromises. RA is not just joint pain, it's an autoimmune disease that profoundly affects the hands and wrists, turning the simple act of gripping a cup of tea or buttoning a shirt into a test of endurance. RA's reach extends beyond physical discomfort, often needing frequent medical appointments, an ongoing need for medication, and in severe cases, surgery. People living with RA also face increased incidences of depression and anxiety. In 2021 alone, musculoskeletal conditions like RA were estimated to have led to 23.3 million lost working days and the financial toll on the NHS of RA and osteoarthritis combined is predicted to cost approximately £120 billion over the coming decade. Against this backdrop, the necessity for affordable and effective interventions to improve the quality of life for people with RA is urgent and undeniable.

The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) exercise  programme

Recognising this important and unmet gap, researchers – supported by the NIHR Oxford and Thames Valley Applied Research Collaboration (ARC) – developed the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme. Funding of key staff continued seamlessly from the CLAHRC, the predecessor of the ARC scheme, maintaining the momentum of this work to bring benefits to patients. The SARAH programme is a set of 11 exercises tailored to improve people with RA’s hand function – the ability to use hands for day-to-day tasks – coupled with strategies to guide patients on self-monitoring, planning and goal setting was rigorously tested in a clinical trial across 17 NHS sites. SARAH improved hand function without causing additional pain compared to usual NHS care, and significantly, was recognised by NICE as a clinically and cost-effective choice for the NHS and recommended for widespread use.

An online training platform to offer inexpensive, swift, and broad access to SARAH training

The original in-person training model for therapists was resource-heavy and impractical on a national scale. The solution came through research and implementation supported by NIHR CLAHRC Oxford and PenARC with awards from a number of funders.  They designed an online training platform to offer inexpensive, swift, and broad access to SARAH training for health professionals (called iSARAH). The evaluation of iSARAH showed that 99% of therapists trained had confidence in delivering the SARAH programme, and 85% planned to use it in their practice. But the bigger win was that 85% of patients treated by iSARAH-trained therapists reported an improvement in hand function, enduring well beyond the therapy sessions. Since 2021 this online training has educated many therapists  across the globe, and patient materials are now available in 13 languages. The training is now available via the free to access University of Exeter platform (Learn Exeter). 

The NIHR ARC OxTV and PenARC collaboration continues to support researchers as they develop a patient-facing digital tool –  directly empowering those who need it to access the benefits of SARAH. Co-developed with patients and the National Rheumatoid Arthritis Society, early feedback indicates that patients see it as a useful resource, reporting improvements in hand function following use , and providing positive feedback to further improve this digital tool with the potential to take SARAH straight to patients.

NIHR Applied Research Collaborations

NIHR Applied Research Collaborations support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems.